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Premium: K0 Vehicle: 1

Vehicle Type *
Registration No *
Make & Model *
Chassis No *
Engine No *
Year of Make *
Engine Capacity
Seating Capacity
Colour
Cubic Capacity
Estimated Value (K) *
Cover Type *
Comprehensive Cover
Standard Third Party Limit
Combined Third Party Limit
Limit of Liability * Premium
100,000 ZMW 100
200,000 ZMW 350
300,000 ZMW 600
500,000 ZMW 1,100
   
 
No Claim Discount (NCD)
No   Yes   No of Years

Please present original NCD certificate to us at the time of vehicle inspection.

Cover Start Date *
 
 
 
 
 
Profession Discount
No   Yes
Select Profession
 
Total Premium K0
Fleet Discount(30%) (K0)
Profession Discount(5%) (K0)
Online Discount (15%) (K0)
Sub Total K0
Tax (3%) K0
Net Premium --
Disc Collection Point
Instalments
Debit my account on:
1st Deposit
Monthly Payments --
 
Conventional Product       Takaful Product
 
* Insure 5 or more vehicles to qualify for a 30% Fleet Discount!
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