Submitted by mindq on Tue, 12/17/2019 - 17:07 First Name Last Name Email Address Contact Number Gender - None -MaleFemale Age Occupation Type of the Insurance Cover - Select -ComprehensiveThird party only Payment Type - Select -MonthlyAnnual Make - Select -AcuraAlfaromeoAston MartinAudiBentleyBuickBMWCadilacCamrhinoCheryChevroletChryslerCitroenCumminsDaewooDafDaihatsuDodgeDucatiEagleFerrariFiatFiskerFordFreighlinerGMCGenesisGeoGonowGWMHarleyHavalHinoHondaHyundai HummerInfinityIsuzuIvecoJaguarJeepJohn DeereKawasakiKlaKiaKomatsuKTMLadaLexusLamborghiniLand RoverLaylandLincolnLotusMahindraManMaseratiMasseyMaybachMazdaMcLarenMercedesMercuryMiniMitsubishiNissanOldsmobileOpelPanozPeugeotPlymouthPontiacPorsheRamRenaultRollsroyceRoverSaabSaturnScaniaSeatSkodaSmartSsangyongSubaruSuzukiTataToyotaTeslaVauxhallVenterVentureVolkswagenVolvoXinkaiYamahaOther Category - Select -ConvertibleCoupeHatchbackMinivanPickupSedanSUVVanWagon Toyota Model - Select -AurisAvansaAvensisAygoCamryCorollaCruiserDynaFortunerFT-86HiaceHiluxIQMark 2PradoPriusPrius+QuantumRAV4RunXVersoVerso-SWishYaris Acura Model - Select -CLILXIntegraLegendMDXMDX Sport HybridNSXRDXRLRLXRLX Sport HybridRSXSLXTLTLXTSXVigorZDX Aston Martin Model - Select -DB11DB9DB9 GTDBSRapideRapide SVanquishVanquish SVantageVirage Audi Model - Select -A1A3A4A5A6A7A8Q1Q3Q5Q7R8TT Buick Model - Select -CascadaCenturyEnclaveEncoreEnvisionLaCrosseLeSabreLucernePark AvenueRainierRegalRegal SportbackRegal TourXRendezvousRivieraRoadmasterSkylarkTerrazaVerano Bentley Model - Select -GTGTCMulsanneSpur BMW Model - Select -1-Series3-Series4- Series5-Series6-Series7-SeriesX1X2X3X4X5X6 Camrhino Model - Select -Camrhino Alfaromeo Model - Select -1594C8CBreraGiuliettaMito Chery Model - Select -Chery Chevrolet Model - Select -AveoCamaroCaptivaCruzeOrlandoSparkUtilityVolt Chrysler Model - Select -300cCrossfireDeltaVoyagerYpsilon Citroen Model - Select -C1C3C3 PicassoC4C5C6DS3DS4DS5Multispace Cummins Model - Select -EQB160-20 Cadillac Model - Select -ATSATS-VAllanteBroughamCT5CT6-VCTSCTS-VCateraDTSDeVilleELREldoradoEscaladeEscalade ESVEscalade EXTFleetwoodSRXSTSSevilleSixty SpecialXLRXT4XT5XT6XTS Daewoo Model - Select -Daewoo Daf - Select -Daf Daihatsu Model - Select -CopenMateraTerios Dodge Model - Select -AvengerCaliberJourneyNitro Ducati Model - Select -Ducati Eagle Model - Select -PremierSummitTalonVision Ferrari Model - Select -458599612CaliforniaEnzoF430FF Fiat Model - Select -500BravoDobloPandaPuntoQuboTipo Fisker Model - Select -Karma Freightliner - Select -Sprinter 2500 CargoSprinter 2500 CrewSprinter 2500 PassengerSprinter 3500 CargoSprinter 3500XD CargoSprinter WORKER CargoSprinter WORKER Passenger Ford Model - Select -B-MaxBantamC-MaxConnectEcosportEverestF-250F-350FiestaFocusGalaxyKaKugaMondeoRangerS-Max GMC Model - Select -1500 Club Coupe1500 Regular Cab2500 Club Coupe2500 Crew Cab2500 HD Club Coupe2500 HD Extended Cab2500 HD Regular Cab2500 Regular Cab3500 Club Coupe3500 Crew Cab3500 Extended Cab3500 Regular CabAcadiaAcadia LimitedCanyon Crew CabCanyon Extended CabEnvoyEnvoy XLJimmyRally Wagon 1500Rally Wagon 2500Rally Wagon 3500Rally Wagon G2500Safari CargoPassengerSavana 1500 CargoSavana 1500 PassengerSavana 2500 CargoSavana 2500 PassengerSavana 3500 CargoSierra (Classic) 1500 Crew CabSierra (Classic) 1500 Extended CabSierra (Classic) 1500 Regular CabSierra (Classic) 2500 Crew CabSierra (Classic) 2500 HD Crew CabSierra (Classic) 2500 HD Extended CabSierra (Classic) 2500 HD Regular CabSierra (Classic) 3500 Crew CabSierra (Classic) 3500 Extended CabSierra (Classic) 3500 Regular CabSierra 1500 Crew CabSierra 1500 Double CabSierra 1500 Extended CabSierra 1500 HD Crew CabSierra 1500 Limited Double CabSierra 1500 Regular CabSierra 2500 Crew CabSierra 2500 Extended CabSierra 2500 HD Crew CabSierra 2500 HD Extended CabSierra 2500 HD Regular CabSierra 2500 Regular CabSierra 3500 Crew CabSierra 3500 Extended CabSierra 3500 HD Crew CabSierra 3500 HD Regular CabSierra 3500 Regular CabSonoma Club CabSonoma Club Coupe CabSonoma Crew CabSonoma Extended CabSonoma Regular CabSuburban 1500Suburban 2500TerrainVandura 1500Vandura 2500Vandura 3500Vandura G1500Vandura G2500Vandura G3500YukonYukon DenaliYukon XLYukon XL 1500Yukon XL 2500 Gonow Model - Select -MultiwagonX-Space GWM Model - Select -C10C20C30C50H5H6M4Steed Harley Model - Select -Harley Honda - Select -AccordCivicCR-VCR-ZFCXInsightJazzNSXS2000 Hummer Model - Select -H2H3 Hyundai Model - Select -AccentCoupeElantraGenesisI10I20I30Santa FeSonataVeloster Infinity Model - Select -EXFXG37MMG TF Isuzu Model - Select -KB200KB240KB250KB300 Iveco Model - Select -Daily Jaguar Model - Select -X-TypeXFXJXK Jeep Model - Select -CherokeeCompassPatriotWrangler John Deere Model - Select -John Deere Kia Model - Select -CarensCeedCeratoOptimaPicantoRioSorentoSoulSportageVenga Komatsu - Select -Komatsu Lada - Select -Lada Land Rover Model - Select -DiscoveryEvoqueFreelanderRoverSport Kawasaki Model - Select -Kawasaki Lexus - Select -CTESGSISLFALXRX Layland Model - Select -LeylandbisLaylandtruck Man Model - Select -Mantruck KTM Model - Select -KTM Massey Model - Select -Massey Mazda Model - Select -2356CX-5CX-7DemioMX-5RX-8 Mercedes - Select -A-ClassB-ClassC-ClassClCLCE-ClassGL-ClassM-ClassMercbusMerctruckR-ClassS-ClassSLSLKSLRSLSSprinter Mini Model - Select -ClubmanConvertCooperHatchbackMan Nissan Model - Select -370ZBluebirdCubeGT-RHardbodyJukeLeafLegrandMicraMuranoNavaraNissan 2.4NissanbusNissantruckNotePathfinderQashqaiSafariSentraTildaX-Trail Mahindra Model - Select -BoleroGenioQuantoRevaScorpioXUV500 Opel - Select -AstraCorsaMerivaVivaro Peugeot Model - Select -107207300820840074075008RCZTepee Porshe Model - Select -BoxterCarreraCayenneGT3PanameraSpyder Renault Model - Select -ClioEspaceFluenceKangooKoleosMeganeMidlum 220ModusScenicTwingoTwizyZoe Rollsroyce Model - Select -GhostPhantom Rover - Select -Rovercar Saab Model - Select -Saab 93Saab 95 Scania - Select -Scaniabus Seat Model - Select -AlhambraAlteaExeoIbizaLeonToledo Skoda Model - Select -FabiaOctaviaRoomsterSuperbYeti Smart Model - Select -FortwoForfour Ssangyong Model - Select -ActyonKorandoRextonRodius Subaru Model - Select -ForesterImprezaJustyLegacy Suzuki Model - Select -AltoGS150HRKizashiSplashSwiftVitara Tata Model - Select -IndicaIPO918ACGLNano Vauxhall Model - Select -AmperaAngilaAntaraInsigniaVXR8Zafira Venter Model - Select -Ventertruck Venture Model - Select -Ventertruck Volkswagen Model - Select -AmarokBeetleCaddyCrosspoloEOSGolfJettaPassatPhaetonPoloSciroccoSharanTiguanTouaregTouranUp Volvo Model - Select -C70S40S60S80V50V70XC60XC90 Xinkai Model - Select -Xinkai Yamaha Model - Select -YBR Other Model - Select -Other Genesis Model - None -G70G80G90 Lamborghini Model - Select -AventadorGallardoHuracanMurcielagoMurcielago LP640 Geo Model - None -MetroPrizmStormTracker Lotus model - None -EliseEvoraEvora 400ExigeExige S Lincoln Model - None -AviatorBlackwoodContinentalCorsairLSMKCMKTMKXMKZMark LTMark VIIMark VIIINautilusNavigatorNavigator LTown CarZephyr Maserati model - None -CoupeGhibliGranSportGranTurismoLevanteQuattroporte Maybach Model - None -5762 McLaren model - None -570GT570S650S675LT720SMP4-12C Mercury - None -CapriCougarGrand MarquisMarauderMarinerMilanMontegoMontereyMountaineerMystiqueSableTopazTracerVillager Mitsubishi Model - Select -ASXChallengerChariotColtGrandisILancerOutlanderPajeroShogunTriton Oldsmobile model - Select -8898AchievaAleroAuroraBravadaCieraCustom CruiserCutlassCutlass CieraCutlass CruiserCutlass SupremeIntrigueLSSRegencySilhouetteToronado Panoz Model - Select -Esperante Plymouth model - Select -AcclaimBreezeColtColt VistaGrand VoyagerLaserNeonProwlerSundanceVoyager Pontiac Model - Select -AztekBonnevilleFirebirdG3G5G6G6 (2009.5)G8GTOGrand AmGrand PrixLeMansMontanaMontana SV6SolsticeSunfireTorrentTrans SportVibe Ram model - Select -1500 Classic Crew Cab1500 Crew Cab1500 Quad Cab1500 Regular Cab2500 Crew Cab2500 Mega Cab2500 Regular Cab3500 Crew Cab3500 Mega Cab3500 Regular CabC/VC/V TradesmanDakota Crew CabDakota Extended CabProMaster 1500 CargoProMaster 2500 CargoProMaster 3500 CargoProMaster Cargo VanProMaster CityProMaster Window Van Saturn Model - Select -AstraAuraIonL-SeriesOutlookRelayS-SeriesSKYVUE Tesla model - Select -Model 3Model SModel X Year of manufacture Year of manufacture: Year Year19901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Registration Number Insured Value (BWP) If you sum insured is above 1 Million Pula , contact us for a personalised quotaion 3600500 enquiries@bic.co.bw Is you vehicle a Grey Import - Select -YesNo Contribution type - Select -MonthlyAnnualy CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
