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Client Details
 
First Name*
Last Name*
Occupation*
Email Address*
Street Address
Parish
 
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Value of Vehicle*
Year of Manufacture* eg: 2010
Vehicle Seating
Make*
Model*
Body Type eg: Hatchback
CC Rating:* eg: 2200cc
Left Hand Drive Vehicle?
Vehicle Registration No:
Engine No:
Chassis No:
Mortgagee:
 
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Estimated Value of Building*
General Location of Property*
Occupancy of Premises*
Usage of Building*
Wall Construction*
Roof Construction*
Value of Contents
Value of Satellite Dish
Value of Solar Electric (PV) System
 
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Main Driver
Driver's Date of Birth* (yyyy-mm-dd)
How long has the client held a valid Barbadian driver's licence and has been continuously driving for?
Does the client currently have a motor insurance policy in their name, or are is listed on someone else’s policy as an additional driver?*
How many years has the client had this motor insurance policy?
Select the renewal month:*
What level No Claims Discount is the client currently earning?*
Is the client a BARP member?
Additonal Drivers
Will there be any additional persons driving the vehicle?
Will there be any additional persons under 21 years of age driving the vehicle?
Will there be any additional persons driving the vehicle who has held a licence for less than two (2) years?
Claims History
How many accidents or claims has the client or any additional drivers on this quotation been involved in, in the last five (5) years?
Was the client or any authorized drivers on this quotation found to be at fault?
What was the total payout on all accidents or claims?
 
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Are you a BARP member?