Type of policy *

Select Make *

Select Model *

Is Your Vehicle Brand new? *

First Reg. Year *

Vehicle use *

Engine Capacity (CC) *

Insured Value (BHD) *

During the present policy period, was there any claim in which you were the party at fault? *
Will you be able to submit a NO CLAIM CERTIFICATE from your present insurer ? *
Customer type? *

Date of birth *

Driving License issue date

CPR/CR Expiry *

Do you have active bank loan with your Vehicle? *
Do you require GCC Coverage ? (Additional premium apply) *


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