Quick Menu
Home
Get Stickers
Load Policy Record
View Payload
All Stickers
All Errors
Logout
Access DN Payload
Debit Number:*
Load Record
POLICY DETAILS
Policy Type:
-- SELECT POLICY TYPE --
NEW BUSINESS
RENEWAL
Policy Number:*
Purpose of Usage:*
-- SELECT--
PRIVATE
COMMERCIAL
Branch Code:*
Cover Type:*
-- SELECT --
THIRD PARTY ONLY
THIRD PARTY FIRE AND THEFT
COMPREHENSIVE
Product:*
-- SELECT --
PRIVATE_INDIVIDUAL_X1
PRIVATE_CORPORATE_X4
TAXI
HIRING_CARS
MINI_BUS
MAXI_BUS
MOTOR_CYCLE
AMBULANCE_HEARSE
OWN_GOODS_SMALL
OWN_GOODS_LARGE
ART_TANKERS
GEN_CARTAGE_SMALL
GEN_CARTAGE_LARGE
Z802_ONSITE
Z802_ONROAD
GW1_CLASS1
GW1_CLASS2
GW1_CLASS3
Extra TPPD: (Optional)
Excess Buy Back: (Optional)
-- SELECT --
APPLY
DO NOT APPLY
Customer Type:*
-- SELECT--
INDIVIDUAL
CORPORATE
NATURAL
LEGAL
Agent Code
Created Date
Start Date
End Date
INDIVIDUAL CUSTOMER DETAILS
Ghana Card Number:*
Title:*
-- SELECT --
MR
MRS
MS
MISS
DR
PROF
REV
HON
CHIEF
NANA
First Name:*
Other Names:*
Date of Birth:*
Sex:*
-- SELECT --
MALE
FEMALE
Phone Number:*
Education Level:*
-- SELECT --
NONE
PRIMARY
SECONDARY
TERTIARY
POSTGRADUATE
VOCATIONAL
Marital Status:*
-- SELECT --
SINGLE
MARRIED
DIVORCED
WIDOWED
SEPARATED
DOMESTIC_PARTNERSHIP
UNKNOWN
Digital Address:*
Residential Address:*
Occupation:*
COMPANY DETAILS
TIN Number:*
Business Name:*
Business Sector:*
Business Size:*
Registered Address:*
Year Established:*
Contact Person:*
Contact Person Phone:*
Contact Person Email:*
Business Email Address:*
Business Phone Number:*
Residential Address:*
VEHICLE DETAILS
Registration Number:*
Year of Registration:*
Manufacture Year:*
Body Type:*
-- SELECT MODEL --
SALOON
ESTATE
COUPE
WAGON
TRUCK
TANKER
WHEEL LOADER
EXCAVATOR
MINIBUS
MAX BUS
CATERPILLAR
ARTICULATOR HEAD
PICKUP DOUBLE CABIN
TRACTOR
MOTOR BIKE
FORK LIFT
SEDAN
HATCHBACK
CONVERTIBLE
CROSSOVER
SUV
MINIVAN
LUXURY_SEDAN
SPORTS_CAR
SUPERCAR
HYPERCAR
LIFTBACK
NOTCHBACK
FASTBACK
TARGA_TOP
PHAETON
PICKUP_TRUCK_LIGHT
PICKUP_TRUCK_HEAVY
BOX_TRUCK
FLATBED_TRUCK
DUMP_TRUCK
SEMI_TRUCK
PANEL_VAN
CARGO_VAN
STEP_VAN
DELIVERY_VAN_SMALL
SERVICE_TRUCK
TOW_TRUCK
FIRE_TRUCK
AMBULANCE
GARBAGE_TRUCK
TANKER_TRUCK
CONCRETE_MIXER_TRUCK
LOGGING_TRUCK
BUS_PASSENGER
SCHOOL_BUS
MOTORCOACH
ARTICULATED_BUS
PASSENGER_VAN
CONVERSION_VAN
CAMPER_VAN
RV_CLASS_A
RV_CLASS_C
MOTORHOME
LIMOUSINE
AMPHIBIOUS_VEHICLE
DUNE_BUGGY
GO_KART
ATV
UTV
SNOWMOBILE
GOLF_CART
TRACKED_VEHICLE
HEARSE
MOTORCYCLE_STANDARD
MOTORCYCLE_CRUISER
MOTORCYCLE_SPORT
MOTORCYCLE_TOURING
MOTORCYCLE_DUAL_SPORT
MOTORCYCLE_DIRT
SCOOTER
MOPED
MOTORCYCLE_CHOPPER
TRIKE
SIDECAR_MOTORCYCLE
ELECTRIC_CAR
HYBRID_CAR
CLASSIC_CAR
CUSTOM_BUILD
CONCEPT_CAR
RACE_CAR
NEV
AUTOCYCLE
Make:*
Value of Vehicle:*
Number of Seats:*
Chassis Number:*
Vehicle Color:*
Fuel Type:*
PETROL
DIESEL
ELECTRIC
HYBRID
CNG
LPG
BIOFUEL
HYDROGEN
PLUGIN_HYBRID
FLEX_FUEL
Gross Weight:*
Mileage:*
Cubic Capacity:*
Gross Premium:*
Calculation Type:*
FULL_YEAR
SHORT_RATE
REQUEST FOR STICKER