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Third Party Motor Insurance

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PRIVATE

Vehicle use

Type of vehicle

Vehicle Tonnage *

What car do you drive?

When do you want your cover to start?

First Name *

Last Name *

Mobile Number *

Email Address *

I accept our Terms and conditions

Vehicle Tonnage:

Vehicle use:

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Underwriter

Title *

First Name *

Last Name *

Middle Name

Passport/ID Number *

Occupation *

KRA Pin *

Nationality *

Date of Birth *

Gender *

Male

Female

Contact Details

Physical address *

Postal Address *

Town/City *

Postal Code *

Mobile Number *

Email Address *

Personal Details

Vehicle Details

Vehicle Registration *

Car Manufacturer *

Model *

Type of body *

Year of manufacture *

Seating capacity including driver *

How many years have you had a full Kenyan driving licence? *

Engine CC *

Chasis Number *

Contact Details

Questionaire

In respect to yourself or any other person who to your knowledge will drive, has any insurer:-

Declined a proposal
Required an increased premium or imposed special conditions
Cancelled or not invited renewal of a policy

Yes

Do you or any other person who to your knowledge will drive the proposed vehicle:-

1) Suffer from defective vision or hearing or any physical, mental infirmity or disease?

Yes

2) Been convicted during the past 5 years with any offence in connection with driving of any motor vehicle?

Yes

3) Have a full Kenyan drivers licence?

Yes

Will the vehicle be used on any airstrip/airport premises or along runways or taxi ways where the public do not normally have access?

Yes

Insurance Sticker

Where would you like to collect your insurance sticker?

Collect from JamboSure offices (View park towers, Utalii street, Tel: +254 020 22 20 544/5 /+254 070992000)

Physical Delivery (Please ensure that you have provided correct contact details.)

Documents

Please attach the following documents which are needed to complete your purchase. If you can not provide them at this time, our insurance advisors will contact you to provide them within 7 days.

Note: Accepted file extensions are: bmp, jpg, png, gif, jpeg, pdf, doc, docx

National ID/Passport:

KRA PIN Certificate:

Vehicle Logbook:

Declaration

I here by declare and warrant on my behalf and on behalf of all persons proposed to be insured that the above statements are true and complete in all respects and that there is no other information which is relevant to this application for insurance that has to be disclosed. I agree that this proposal and the declaration shall be the basis of the contract between me and all persons to be insured and the Insurance Provider.

Yes

Vehicle Details

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PREVIEW YOUR DETAILS

Underwriter

Personal Details

First Name:

Middle Name:

Last Name:

Passport/ID Number:

Occupation:

Nationality:

KRA Pin Number:

Date of Birth:

Gender:

Contact Details

Address:

Mobile Number:

Email Address:

Vehicle and Other Details

Vehicle registration:

Car manufacturer:

Model:

Type of body:

Year of manufacture:

Seating capacity including driver:

Engine CC:

Chasis Number:

How many years have you had a full Kenyan driving licence?:

Where to collect sticker:

National ID/Passport:

KRA PIN Certificate:

Vehicle Logbook:

Questionaire (Declaration for whole insured party)

In respect to yourself or any other person who to your knowledge will drive, has any insurer (a) Declined a proposal or (b) Required an increased premium or imposed special conditions or (c) Cancelled or not invited renewal of a policy

Do you or any other person who to your knowledge will drive the proposed vehicle:

Suffer from defective vision or hearing or any physical, mental infirmity or disease?

Been convicted during the past 5 years with any offence in connection with driving of any motor vehicle?

Have a full Kenyan drivers licence?

Will the vehicle be used on any airstrip/airport premises or along runways or taxi ways where the public do not normally have access?

Questionaire

Third Party Motor Insurance

Underwriter

Insurance Sticker

Documents

Declaration

PREVIEW YOUR DETAILS

Underwriter

Personal Details

Contact Details

Vehicle and Other Details

Questionaire (Declaration for whole insured party)

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