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Policy name: Third party special types (Ambulance / hearses)

Category:

First name:

Last name:

Email address:

Phone number:

Address:

Vehicle & license information

Vehicle year:

Vehicle make:

Vehicle model:

Vehicle colour:

Vehicle type:

When do you want your insurance to start:

Number plate:

Engine number:

Chassis number:

Value: ie 10000

Price of policy: N 5,000.00

Accompanying images and Valid ID (Driver's licence, International Passport or National Id Card):

Accompanying video:

I have read & agree to the site terms & conditions

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