Motor Insurance Quatation Form

Name of Proposer

Occupation

Age/D.O.B

PO Box

Tel #

Additional driver (Ifany)

Name

Age/D.O.B

Licence #

Accidents

Comprehensive / Third party only

How long has client a full Bahamain driver’s license?

Is the vehicle to be for private use only?   yes   no

If no, explanation as to use

Is the vehicle a standart car truck or a sports car?   standard   truck   sports

Any previous accidents or claims?   yes   no

Brief details

Prior Vehicles

No of years Insurer