New Policy Application From

Policy Holder Information

Name*

First Last

Email*

Phone*

KRA PIN Number*

Is this policy for an individual or a company?*

National ID Number*

Passport Number:

Please Use this if you do not have a National ID number.

Certificate of Incorporation Number*

Please enter this number if you are creating a policy for a company.

Company/ Organization Name*

What insurance cover would you like get today?

Location of the building or structure to be insured?

List of assets and value.

Max. file size: 3 MB.

Use this section to attach a Word/ PDF form.

Phone

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