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Proposer

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Contact address must contain House No. and street name (i.e 7, Kufo street)
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The Vehicle

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Please provide the following details for your vehicles in a schedule in PDF in the case of more than one vehicle:

1. Registration Number
2. Make and Model
3. Type of Body
4. Year of Manufacture
5. CC or Horse Power
6. Chassis No
7. Engine No
8. Value (Naira)
9. Please list and give the value of the non-standard accessories and extra fittings of the vehicle which are included in the estimated market value shown above

Download sample template
A PDF document or photo containing a list of beneficiaries to be covered (Max file size: 2MB)

Use of Vehicle

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Declarations

I/We hereby declare that the statements, answers given by Me/Us in this proposal form are true to the best of my/our knowledge and belief.

I/We hereby understand and agree that the statements, answers and particulars provided herein above are the basis on which this insurance is being granted and that if, after the insurance is effected, it is found that any of the statements, answers or particulars are incorrect or untrue in any respect, the company shall have no liability under this insurance.

I/We have read, understood and agree with the terms and conditions mentioned on this proposal form.

AXA Mansard is joining the rest of the world in being environmentally responsible. We invite you to join us in this cause by using only the electronic copy of your policy document which will be sent to your registered email address. You can also access it from your online account at www.axamansard.com or on MyAXA Plus App (available on Play Store or IOS Store).

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Kindly ensure all payments are made directly into AXA Mansard's designated corporate account(s). All cash payments MUST be made in person, as the company shall not be held liable for cash payments made to/through other third parties apart from NAICOM licensed Insurance brokers.

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