ONE MONTH THIRD PARTY INSURANCE IN KENYA from Ksh950

FREE FUEL APPLICATION FORM

Type of motor vehicle(Required)

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What is the MAKE OF CAR that will get the FREE FUEL - FULL TANK(Required)

Please input the make of car get free fuel

What is the CAR MODEL eg. Allion, Caldina(Required)

Please put your cars model e.g. X6, Xtrail, Vitz

Estimated NUMBER OF LITRES of vehicles FULL FUEL TANK(Required)

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Kindly note, the winner gets a FREE FULL TANK

Salutation(Required)

Kindly input your salutation

Full Name(Required)

Please let us know your full name.

Mobile Number(Required)

Please enter your mobile number including country code (E.g. Kenya - +2547xx123456)

National Identification Number or Passport Number(Required)

Kindly input your identification number to limit everyone to one application per person. Your ID will be required to get free fuel

Your National ID will be required TO REDEEM the free fuel

Your Email(Required)

Please let us know your email address.

Number plate(Required)

Please enter a Kenyan number plate

The Car Registration "Number Plate" will be required to redeem FREE FUEL

Which of the following TYPES OF INSURANCE do you CURRENLY HAVE(Required)

Third Party Car Insurance

Comprehensive Car Insurance

Medical Inpatient Insurance

Medical Inpatient & Outpatient Insurance

Life Insurance Policy

None of the above

Kindly input any of the above choices

The BEST CAR INSURANCE in your opinion is provided by(Required)

Choose one of the options available from options availed

Preferred Oil Marketing Company(Required)

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CLOSEST Petrol Station Location

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