Imported Vehicle Insurance Application Form
Applicant Information
Full Name
Date of Birth
Address
Phone Number
Email
Vehicle Information
Make
Model
Year
Vehicle Identification Number (VIN)
Engine Number
Country of Import
Date of Import
Registration Number
Insurance Details
Type of Coverage
Comprehensive
Third Party
Third Party, Fire and Theft
Coverage Amount
Insurance Period
6 Months
12 Months
Additional Information
Details
I confirm that the information provided is accurate.