NOTE: Fields marked with * are required.

Upload Supporting Documents

NB: You are required to upload scanned copy of the following documents. Size of each file must not exceed 1mb and format must be in PDF, JPEG or PNG.


I hereby declare that the above statements and particulars are true and correct, and I agree that this proposal and declaration shall be the basis of a contract of insurance between me and the company (FBN General Insurance) ; such contract to be expressed in the form of a policy (click here to read policy document). I am willing to accept a policy subject to the terms, exception and conditions prescribed by the company (FBN General Insurance) therein. I undertake that the vehicle to be insured shall only be driven by my authorized nominee and also shall not be driven by any person who to my knowledge is not legally authorized to drive, or has been refused any motor vehicle insurance/continuance thereof.

I also hereby affirm that in line with the Nigeria Data Protection Regulation, 2019 (NDPR) , I consent to the collection and processing of my personal data/information in line with the consent clause of the data protection regulation. Click here to read the Consent Clause.
check to confirm declaration above

check to confirm acceptance of policy terms, exceptions and conditions
Date 2023-11-29