MOTOR INSURANCE QUOTATION FORM
The asterisk(*), part is a requirement.
CUSH INSURANCE AGENCY | NAIROBI ATHIRIVER KITUI
MOTOR VEHICLE,TUK TUK,TRACTOR,MOTORBIKE,TRAILERS | Tick the box ⚪ appropriately. we are empowered by 20+ insurance companies as below;
Proposer
*
(individual, business, company)
ID Number
*
(individual, business, company)
KRA Pin (individual, business, company)
full names
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
Motor registration number
*
Make and Model
*
Type Of Vehicle/s
*
car
Lorry
Pickup
Tractor
Dump Truck
tuk tuk
Limo
Tanker
Bus
Van
Motor bike
Motor
purpose(coverage) Of Vehicle/s
*
Private
Commercial own goods
Commercial general cartage
Institutional
Psv Matatu
Taxii
Uber
Private hire
Touring
Driving school
Trailer
Self drive
Vehicle Purpose
Type of cover
*
Third party only
Comprehensive
Other
Number Of Vehicles
Please Select
1
2
3
4
5
6
7
8
9
10 or more...
Cover duration
*
2 weeks(psv only)
1 month(All)
3 months(psv only)
1 month installment(All)
2 months installments(All)
3 months installments(All)
6 months(psv only)
1 year(annual)(All)
Other
Policy start date
*
-
Day
-
Month
Year
vehicle 1
Policy start date
-
Day
-
Month
Year
vehicle 2
Policy start date
-
Day
-
Month
Year
vehicle 3
Policy start date
-
Day
-
Month
Year
vehicle 4
Any other Vehicle(Policy start date)
Sum insured(vehicle value before valuation)
vehicle 1,2 3,4, 5--
SELECT COMPANY OF YOUR OWN CHOICE
*
1. HERITAGE INSURANCE COMPANY.
2. KENYAN ALLIANCE INSURANCE COMPANY.
3. INTRA AFRICA INSURANCE COMPANY.
4. CIC GROUP INSURANCE COMPANY.
5. OLD MUTUAL INSURANCE COMPANY
6. DIRECTLINE INSURANCE COMPANY.
7. MADISON INSURANCE COMPANY.
8. PACIS INSURANCE COMPANY.
9. TRIDENT INSURANCE COMPANY
10. CANNON INSURANCE COMPANY
11. TAKAFUL INSURANCE COMPANY
12. BRITAM INSURANCE COMPANY
13. APA INSURANCE COMPANY
14. AAR INSURANCE COMPANY
15. KENYA ORIENT INSURANCE COMPANY
16. OCCIDENTAL INSURANCE COMPANY.
17. GA INSURANCE COMPANY
18. MONARCH INSURANCE COMPANY
19. JUBILEE INSURANCE COMPANY
20. ICEA LION INSURANCE COMPANY
21. KENIDIA INSURANCE COMPANY
22. FIDELITY SHEILD INSURANCE COMPANY
23. GEMINIA INSURANCE COMPANY
24. DEFINITE INSURANCE COMPANY
25. PIONEER INSURANCE COMPANY
26. SAHAM INSURANCE COMPANY
27. AAR INSURANCE COMPANY
Type Of Goods/Cargo(general cartage only)
Please Select
General Freight
Building Materials
Refrigerated
Other
Do you wish to include additional riders(Additional charges applies)(COMPREHENSIVE COVER ONLY)
Excess protector/waiver(recommended)
Political violence and Terrorism
Driver personal accident
Wind screen cover above free limit
Motor extension/courtesy car
Radio/music cover above free limit
Other
Goods/cargo Value
Ksh.50,000
Other
Share documents(comprehensive covers only)
Logbook or IDF
KRA pin
ID Copy
Anti theft device certificate(if fitted)
Other
Shared via WhatsApp;
0728974447
0798883447
Other
Any other details to assist us make informed decision?
ID Copy Upload
Browse Files
Drag and drop files here
Choose a file
individual, business, company
Cancel
of
KRA Pin Copy Upload
Browse Files
Drag and drop files here
Choose a file
individual, business, company
Cancel
of
Log book Copy Upload
Browse Files
Drag and drop files here
Choose a file
individual, business, company
Cancel
of
Any other Copy Upload
Browse Files
Drag and drop files here
Choose a file
individual, business, company
Cancel
of
Signature
Print Form
Save
Submit Form
Submit Form
Clear Form
Should be Empty: