Motor Quote Form

Use the form below to get a quotation for motor vehicle insurance.

Private Car Proposal Form

Proposer's Details (Whether business or individual)

Full Name of Proposer
Full Name of Proposer

Contact Details.

Vehicle Details

Are there any Special / non-standard accessories (while on the Vehicle) that will need to be separately insured at an additional premium?
Examples are Special lights or lamps, wind/ sun/ rain shield, radio cassette, Rims, helmets, items box container, Side Mirrors, etc.).

Type of Policy Required (Please indicate from the 3 scopes)

Anti-theft Devices

Ownership Details

Are you the owner of the Vehicles(s)
Are they registered in your name?

Use Limitations

Will the Vehicle be used exclusively for social, domestic and pleasure purposes?
If not, please indicate for what OTHER purposes it will be used: