1

Personal Details

2

Risk Details

3

General Policy Details

Personal Details

Male Female

Contact Details

Period of Insurance

Provide the below information (Note: At least one of the country must be “Kenya”.)
Point of loading? *
Point of Off-loading? *
Security of Vehicle
Particulars of Vehicle *
Indicate whether the vehicles are (tick as appropriate)

Vehicle Details

If cover is required on specified vehicles, please complete the schedule below.

Trailer Details

If cover is required on specified vehicles, please complete the schedule below

Limit of Liability

Do you wish to purchase these?