NEW RENEWAL NEW Vehicle Information ModelGRAZIA 125ACTIVA 125ACTIVA 6GDIOCD 110SP125SHINEUNICORNLIVOX BLADEHORNET 2.0 Variant Registration Number* Year of Manufacture*200620072008200920102011201220132014201520162017201820192020 Month of Manufacture*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Type of Vehicle Ownership*IndividualCorporate Vehicle Requirement*No LienHypothecationHire PurchaseLeaseOther Customer Information First Name* Last Name* E-mail* Telephone* City* Postal Code* Comment RENEWAL Vehicle Information ModelGRAZIA 125ACTIVA 125ACTIVA 6GDIOCD 110SP125SHINEUNICORNLIVOX BLADEHORNET 2.0 Variant Registration Number* Year of Manufacture*200620072008200920102011201220132014201520162017201820192020 Month of Manufacture*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Type of Vehicle Ownership*IndividualCorporate Insurance Company* Insurance Policy Type*—Please choose an option—Third PartyComprehensiveNo Insurance Expiry Date* Vehicle Requirement*No LienHypothecationHire PurchaseLeaseOther Current Premium* Insured Value* Customer Information First Name* Last Name* E-mail* Telephone* City* Postal Code* Comment
