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Product
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Special Comprehensive Motor Insurance Cover
Status
*
→
Customer
Agent
Agent code
→
Payment Mode
*
→
Online
OverDraft
Variant (Cover type)
*
→
Bronze
Silver
Gold
Diamond
Amount Insured
₦
Amount Payable
₦
THE PROPOSER/OWNER
Surname
*
→
Other Names
*
→
Gender
→
Male
Female
Date of birth
*
→
Address
*
→
Occupation
*
→
Phone Number
*
→
Alternate Phone Number
→
Email Address
*
→
THE VEHICLE DETAILS
Registration Number
*
→
Make
→
Model
*
→
Engine Number
*
→
Chassis Number
→
Year of Manufacture
→
Colour
*
→
Enter your Policy Number
→
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