Please fill in this form so that we can process your claim quickly and send the money to your M-pesa.PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Middle NameLast Name *Phone Number *Email Address *Policy IDWhat is your policy number?Benefits to claimBike RepairsMedical ExpensesFuneral costsDisabilityDeathWhat do you want to claim?Upload copy of your IDChoose FileNo file chosenDelete uploaded filePlease upload a copy of your national IDPersonal StatementExplain what happened in details.0 / 180Upload PhotosChoose FileNo file chosenDelete uploaded filePlease upload photos of the damages to the BikeUpload Police AbstractChoose FileNo file chosenDelete uploaded filePlease upload a police abstractUpload copy of the logbookChoose FileNo file chosenDelete uploaded filePlease upload a copy of the logbook.Upload copy of your Driving LicenseChoose FileNo file chosenDelete uploaded filePlease upload a copy of your DLUpload copy of the ticketChoose FileNo file chosenDelete uploaded filePlease upload a copy of your ticketUpload Medical ReportChoose FileNo file chosenDelete uploaded filePlease upload a discharge summary/letter or medical reports from an NHIF certified hospital with stamp and doctors sign.Upload copy of the burial permitChoose FileNo file chosenDelete uploaded filePlease upload a copy of the burial permitUpload a copy of your written statementChoose FileNo file chosenDelete uploaded filePlease upload a copy of your written statementGDPR *Yes, I agree with the privacy policy and terms and conditions.Request a Claim
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