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User Information
Type of Policy  
Date of Birth  
When were you first issued a Barbados drivers licence ?  
Vehicle Information
Is the vehicle a left hand drive vehicle? Yes   No
Does the vehicle have soft top? Yes   No
Is the vehicle a sports car? Yes   No
Is the vehicle a Trailer? Yes   No
Is the vehicle a
Non Standard Reconditioned? Yes   No
Are you currently earning a No Claims
Discount on this vehicle? Yes   No
If so, how much? %

If so, how much? %

What is the Engine CC of the Vehicle ? e.g. 2500
What is the value of the Vehicle ? e.g. 10000
Are there any additional drivers? Yes No

Additional drivers age

When were they first issued a Barbados drivers licence ?

DISCOUNT
Rates
Are you a credit union member ? Yes No

Are you a member of the Barbados
Association of Retired Persons? Yes No
Do you have a fleet of vehicles?
(Two or more vehicles) Yes No
QUOTE
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Contact Information
 


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Disclaimer

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