Online Quote Request

SECTION 1: PERSONAL DETAILS

Your Name*

Phone Number*

Email*

Profession or Occupation*

Postal Address:*

Type of Insurance Cover*

Private Dwelling or Commercial Building?*

Private
Commercial

DETAILS OF BUILDINGS AND CONTENTS TO BE INSURED

Are you:*

a Property Owner only
an Owner Occupier
or a Tenant

Plot Number*

Physical Address*

PREMISES*

State the nature of your premises:

Self contained flat
Rooms not self contained

CONSTRUCTION:*

Of what materials is the building constructed:

CONSTRUCTION:*

Of what materials is the building constructed:

FINANCIAL INTEREST:

Name and address of Mortgagee (if any)

OTHER INSURANCES

Is the property covered by other policies? Provide details

SECURITY*

Are all windows and openings burglar-barred?

Yes
No

SECURITY*

Is any security alarm installed?

Yes
No

SECURITY*

Are the premises guarded between 18:00 hours and 06:00 hours every day?

Yes
No

Security*

State as a number of days the longest continuous period in any year when the premises are likely to be left without an inhabitant.

BUSINESS*

Is there any profession, business or trade carried out in the dwelling or in any portion of the premises?

Yes
No

Give full particulars*

a) Building*

b) Household furniture furnishing clothing and personal effects in the home or its domestic outbuildings or garages owned by any member of the Insured's family or domestic staff including motorized gardening items*

c) Films tapes cassettes cartridges or discs up to the value as unused material or if purchased prerecorded at makers latest list price.*

d) All other contents including fixtures and fittings for which Insured is liable valuables money visitors personal possessions and interior decorations*

HIGH VALUE ITEMS

Please declare all items above 5% of the total above

Description	Value

ALL RISKS DETAILS

Personal Possessions declaration

LIST OF ITEMS TO BE COVERED

Description	Serial and Model (for electronics)	Sum Insured

PARTICULARS OF VEHICLE TO BE INSURED

Make*

Registration No.*

No. Of CC/HP*

Year of Make*

Colour*

Value (MK)*

Just put the figure without currency code

Type of Vehicle*

Section to which vehicle shall be put*

A) Use as a private car excluding the carriage of passengers for hire and reward.
B) Use as taxi cab or private hired motor car of private type.
C) Use as a goods carrying vehicle excluding the carriage of passenger for hire and reward.
D) Use as a motorcycle or autocycle for private of business purposes other than the carriage of passengers for hire and reward.

Indicate the number of passengers the vehicle is authorized to carry*

Type of Cover*

Comprehesive
Third Party Fire & Theft
Third Party

Value of the Vehicle*

Terms of Service

DECLARATION

I/ We hereby apply for Insurance against risks as set out in the Libertas General Insurance Company Limited standard policy and declare that the above particulars and answers are true and complete in every respect and that no material fact has been suppressed or withheld, and I/ We undertake to exercise all ordinary and reasonable precautions for the safety of the property, and I/ We agree that this declaration and the answers given above shall be the basis of the Contract between myself/ ourselves and Libertas General Insurance Company Limited, and I/ We further agree to accept a Policy subject to the usual conditions prescribed by Libertas General Insurance Company Limited, and endorsed on its Policy, and to pay the first premium there under.

Declaration Agreement*

I agree to the terms of service

Terms of Service

DECLARATION

I/We declare that the particulars are true and I/We undertake that the vehicle shall not be driven by any person who to my/ our knowledge of belief has been refused Motor Insurance or continuance thereof. I/We agree that this proposal and declaration shall be the basis of the contract between me/ us and the company and I/We are willing to accept the policy subject to the Terms and Exceptions and Conditions prescribed by the Company.

Declaration Agreement*

I agree to the terms of service

Hidden

For Official Use Only

Total Premium (Inclusive of Stamp Duty and Vat)

Phone

This field is for validation purposes and should be left unchanged.

+265 1 832-844

+265 886 638 337

info@libertas.co.mw

Ground Floor, Unit House, Victoria Avenue, Blantyre

SECTION 1: PERSONAL DETAILS

DETAILS OF BUILDINGS AND CONTENTS TO BE INSURED

ALL RISKS DETAILS

PARTICULARS OF VEHICLE TO BE INSURED

Terms of Service

Terms of Service

For Official Use Only

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