Select your NAGICO territory* Select your NAGICO territory Anguilla Antigua Aruba Bahamas Bonaire BVI Curacao Dominica Grenada Guadeloupe La Guyane La Réunion Martinique Montserrat Nevis Saba St Barthelemy St. Eustatius St. Kitts St. Lucia St. Maarten St. Martin St. Vincent Trinidad & Tobago Turks & Caicos Islands
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Select the type of Policy - St Martin* Select the type of Policy - St Martin Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Fire & Extended Perils Marine Hull Marine Liability Public Liability
Type of policy - Guadeloupe* Type of policy - Guadeloupe Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Fire & Extended Perils Marine Hull Marine Liability Public Liability Other
Type of policy - Trinidad & Tobago* Type of policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Personal Accident Plan Other
Type of policy - Bahamas* Type of policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Personal Accident Plan Other
Type of policy - Turks & Caicos Islands* Type of policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Director’s & Officers Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - La Réunion* Type of policy - Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Fire & Extended Perils Marine Hull Marine Liability Public Liability
Type of policy - Anguilla* Type of policy Medical Life Other
Select the type of Policy* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - Antigua* Type of policy Medical Other
Select the type of Policy* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Medical Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - Aruba* Type of policy Life Other
Select the type of Policy - Aruba* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - Bonaire* Type of policy Medical Life Other
Select the type of Policy - Bonaire* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - BVI* Type of policy Medical Other
Select the type of Policy - BVI* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Director’s & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Other
Type of policy - Curacao* Type of policy Medical Life Other
Select the type of Policy - Curacao* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - Dominica* Type of policy Medical Other
Select the type of Policy - Dominica* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - Grenada* Type of policy Medical Other
Select the type of Policy - Grenada* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Marine Liability Public Liability Employers Liability Other
Type of policy - Montserrat* Type of policy Medical Life Other
Select the type of Policy - Montserrat* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money all Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - Nevis* Type of policy Medical Life Other
Select the type of Policy - Nevis* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Marine Liability Public Liability Employers Liability Workman's Compensation Other
Type of policy - Saba* Type of policy Medical Life Other
Select the type of Policy - Saba* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Personal Accident Plan Other
Type of policy - Statia* Type of policy Medical Life Other
Select the type of Policy - Statia* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Personal Accident Plan Other
Type of policy - St. Kitts* Type of policy Medical Life Other
Select the type of Policy - St.Kitts* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Marine Liability Public Liability Employers Liability Workman’s Compensation Other
Type of policy - St. Lucia* Type of policy Life Medical Other
Select the type of Policy - St. Lucia* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Other
Type of policy - St. Maarten* Type of policy Medical Life Other
Select the type of Policy - St. Maarten* Select the type of Policy Homeowners Super Plus Comprehensive Motor Third Party Motor Burglary Business Interruption Commercial All Risk Commercial Vehicle Comprehensive Machinery & Plant Contractors All Risk Directors & Officers Fidelity Guarantee Fire & Extended Perils Hurricane Xtra Marine Cargo Money All Risk Professional Indemnity Bonds Marine Hull Aircraft Hull & Liability Airport Groundhandlers Liability Marine Liability Public Liability Employers Liability Other
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Please state for whom you are requesting a quote* (Life)Requesting Quote for* Please select all that apply* Date of Birth*
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When was your last motor claim?* When was your last motor claim? Within the last 12 months 2 years ago 3 years ago 4 years ago 5 years ago > 5 years ago I have never had a motor claim
When was your last motor claim?* When was your last motor claim? Within the last 12 months 2 years ago 3 years ago 4 years ago 5 years ago > 5 years ago I have never had a motor claim
Select your Intermediary - Anguilla* Select your Intermediary C.C. Insurance Agency Fairplay Management Services N/A – NAGICO Direct
Select your Intermediary - Antigua* Select your Intermediary Bryson Insurances
Select your Intermediary - Aruba* Select your Intermediary AON Aruba N.V. Aruba Bank N.V. Aruba Happy Insurances Aruba Insurance Broker Aruba Living Today Banco di Caribe Caribbean Mercantile Bank N.V. Crystal Insurance Brokers Seguros Geerman N.V. Verdant Insurance N/A – NAGICO Direct
Select your Intermediary - Bahamas* Select your Intermediary AFS INSURANCE AGENTS & BROKERS LTD. BAHAMAS COOPERATIVE LEAGUE INSURANCE BROKERS LIMITED BAHAMAS INSURANCE BROKERS & AGENTS LTD. BMG INSURANCE AGENTS & BROKERS LTD. COLE INSURANCE AGENTS & BROKERS LTD. DEAN & ASSOCIATES PROFESSIONAL INSURANCE AGENTS AND BROKERS GLOBAL INSURANCE AGENCY LIMITED GRM INSURANCE AGENCY LTD. HERBERT NEWBOLD INSURANCE AGENTS & BROKERS LIMITED LIV INSURANCE AGENTS & BROKERS LTD. TAVARES & HIGGS INSURANCE AGENTS & BROKERS LTD. N/A -NAGICO Bahamas Branch Office
Select your Intermediary - BVI* Select your Intermediary Century Insurances
Select your Intermediary - Dominica* Select your Intermediary ADOLPHUS CHRISTIAN BERYL DAVID CGM GALLAGHER INSURANCE BROKERS DOMINICA BRANCH OFFICE UNLIMITED SERVICES PLUS HESTON CHARLES IDELINE BURTON KENNEDY ALEXANDER NANTHAN INSURANCE AGENCY LTD. NESSIE SIMON NOREEN AUSTRIE RISK CONSULTANT & INSURANCE BROKERS SUPERIOR AGENCY LTD. WELDON INSURANCE SERVICES LTD. N/A – NAGICO Direct
Select your Intermediary Grenada* Select your Intermediary N/A – NAGICO Direct Agostini Insurance Brokers (Grenada ) Limited Belmar Insurance Brokers Limited CGM Gallagher Insurance Brokers (Barbados) Limited Aban's Insurance Brokerage Service Marvin Ogilvie Zepherine Grant Life and General Insurance Broke Easy Brokerage Grensure Fire and General Insurance Agents Limited Grenada Motor and General Insurance Agency Limited
Select your Intermediary - Guadeloupe* Select your Intermediary Cooper Gay
Select your Intermediary - Martinique* Select your Intermediary Cooper Gay
Select your Intermediary - Montserrat* Select your Intermediary Judith Greer & Associates Inc. Ryan Investments Limited
Select your Intermediary - Saba* Select your Intermediary Saba Branch Office
Select your Intermediary - St. Eustatius* Select your Intermediary A.R.C. Agency N.V. Carmen L. Suares-Mars I.F. Rivers Enterprises N.V.
Select your Intermediary - St.Kitts* Select your Intermediary ACM-Advantage Capital Management CGM Gallagher Insurance Brokers CSL-Cover sure Limited DISH Limited GCI-Global Consulting Inc Star Agency Limit N/A – NAGICO Direct
Select your Intermediary - St. Lucia* Select your Intermediary N/A – NAGICO Direct Apex Insurance Agency Ltd. Combined Insurance Services Ltd. Prestige Insurance Agency Ltd. Triple-A Insurance Agency Ltd. Island Insurances Inc. Simaie Insurance Agency Ltd. CGM Gallagher Insurance Brokers RISK Insurance Consultants Regal Insurance Brokers Inc. Agostini Insurance Brokers Ltd. Sterling Insurance Brokers Ltd. IBEC
Select your Intermediary - St. Maarten* Select your Intermediary COM - Compass Insurances Enterprise Insurance Esurance Caribbean B.V Henderson Insurance Henderson International North Eastern Insurances Oriental Caribbean Insurance ORCO Bank N.V People's Insurance Agency PostSpaar Bank RAI Insurance Brokerage Akeems Insurances & Administration Sun Insurance Brokers (Best Advice Insurances) Windward Islands Bank Insurances RSW Investment & Financial Consultants NAGICO Direct
Select your Intermediary - Trinidad & Tobago* Select your Intermediary NAGICO direct Mr. Wayne Allum Mrs. Ferisha Mohammed-Khan Ms. Petal Sheena Mohammed Mrs. Lawrie Siberan-Paul Mrs. Shedaka Mohammed Mr. Akash Bisnath Mrs. Jaya Devi Maharaj Mr. Earl Steeple Mrs. Suzanne Alicia Thomas Ms. Ardyss Tamara Morris Wallum & Associates Limited Mrs. Marilin Balkissoon-Ramnarine Mrs. Ferisha Mohammed-Khan Petal Mohammed Agency Limited Mrs. Lawrie Siberan-Paul Shedaka Mohammed Insurance Services Limited Mr. Akash Bisnath Mrs. Jaya Devi Maharaj Mr. Partap Seenath Mr. Earl Steeple Mrs. Suzanne Alicia Thomas Ms. Ardyss Tamara Morris 21st Century Insurance & Reinsurance Brokers Agostini Insurance Brokers Limited Amalgamated Insurance Brokers AON Energy Caribbean Limited CIC Insurance Brokers Limited Comprehensive Insurance Brokers Limited Farah Insurance Brokers Limited Fidelity Insurance Brokers Frank Ramdeen Insurance Services Ltd Hardath General Ins. Consultants Ltd Horizon Insurance Services Limited Insurance & Allied Services Limited Insurance Brokers W.I. Ltd Bell Insurance Services Limited M & M Insurance Services Maibrol Insurance Brokers Limited Millar Insurance Brokers Limited Millennium Insurance Brokers Norman Gabriel Limited Palm Insurance Brokers Limited Pan West Indian Insurance Brokers Limited Pensurance Brokers Personalized Insurance Brokers & Reinsurance Ltd Risk Management Services Limited Risk Research Limited Samtrin Insurance Brokers Limited SDS Insurance Brokers Limited Sterling Insurance Services Limited Trinidad Insurance Consultants Limited Trinity Insurance Brokers Limited Universal Insurance Brokers Limited Global Insurance Brokers
Select your Intermediary - Turks & Caicos Islands* Select your Intermediary CSC Insurance Brokers Ltd. Excel Insurance Ltd. NW Hamilton Insurance Services Ltd.
Select your Intermediary - Nevis* Select your Intermediary N/A – NAGICO Direct Star Agency Limited Global Consulting Inc.
Select your Intermediary - St Martin* Select your Intermediary N/A – NAGICO Direct Assurances Thos Sarl Hanni Insurances Tackling Assurance Angels Assurance
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Particulars of Vehicle: Make*
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My Vehicle is* Currency* Value*
Value*
Vehicle use:* Type of Commercial Vehicle* Type of Commercial Vehicle Own Goods Rental Taxi General Cartage Minibus
Number of years you have been licensed to drive:* Driver's Age*
Driver's Gender* Reconstruction value of the property*
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Claim amount*
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