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Full Name /Jina kamili
*
Phone Number /Nambari ya simu
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Email /Barua pepe
*
ID Type/Aina ya kitambulisho
*
NIDA
Voter's ID/Kitambulisho cha mpiga kura
Driving Lisense/Leseni ya udereva
Passport/Hati ya kusafiria
ID Number/Namba ya kitambulisho
*
Vehicle Type/Aina ya chombo cha usafiri
*
Private Vehicle /Gari Binafsi
Passenger Carrying Vehicle /Gari za kubeba abiria
Special Type Vehicle /Gari za mizigo
Tri-cycle /Bajaj
Motor Cycle /Pikipiki binafsi na Bodaboda
Type of cover /Aina ya bima
*
Comprehensive
Third Party
Sum Insured/Thamani ya gari
*
Vehicle Registration Number/ Namba ya gari
*
Attach Vehicle Registration Card/Ambatanisha Kadi ya chombo chako
Separate email addresses with a comma.
Submit/Tuma