Vehicle Addition or Replacement Form

Policy Information

Vehicle addition or replacement request

  • Name of insured:

  • ID number of insured:

  • Policy Number:

  • Is this a vehicle replacing another vehicle on the policy?

  • Details of the vehicle:

  • Who will be the regular driver?:

  • From which date do you require cover?

  • Upload: If available the invoice or offer to purchase.

  • Please complete Captcha Code

  • Please take note that this is just a request to add the vehicle to the policy and your consultant will contact you shortly to discuss all the details that we will need before the vehicle will be on cover.

  • This field is for validation purposes and should be left unchanged.