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FILL IN FORM TO REPORT CLAIM

We require this claim notification form to be filled in full

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Kindly input a valid email address

Kindly choose your desired insurance company

A police station is required

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Please select a car Manufacturer

Please select a car model

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Minimum amount is KES500,000.00 (Kindly input amount without a comma)

Kindly choose the month your car number plate

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