GO BACK TO HOMEPAGE
Linkage Assurance Online Motor Insurance
...Get Linkage Motor Insurance in 3 Easy Steps...
Form already completed?
Resume Here
Existing Customers:
Sign In
WELCOME
CAN WE GET TO KNOW YOU PLEASE?
YOUR PERSONAL DETAILS
Please note that you will be required to upload a valid ID later
Your Title:
Select Your Title
A Company
Mr
Mrs
Miss
Chief
Dr
Barr
Prof
Bishop
Honorable
Pastor
First Name:
Last Name:
Insured Name:
Your Gender:
Select Your Gender
Male
Female
Certificate Name:
Phone Number:
Email Address:
Date Of Birth:
Occupation:
Insured Office/Business Address:
Residential Address:
(If different from Insured Address)
Your Mode Of ID:
Select Your ID Type
Drivers License
International Passport
NIN Card
NIMC Slip
Certificate Of Registration
Voters Card
Have a Linkage Policy No?:
NO
YES
Enter Policy No:
State Of Residence:
Local Govt Area:
(Select Your State 1st)
Broker Agent/Markerter Code:
(If you have one)
PLEASE CONFIRM DETAILS BEFORE WE PROCEED
YOUR PROVIDED PERSONAL DETAILS ARE:
YOUR PERSONAL DETAILS
FISRT NAME :
LAST NAME :
INSURED NAME :
INSURED ADDRESS :
RESIDENTIAL ADDRESS :
STATE OF RESIDENCE :
LOCAL GOVT AREA :
INSURED PHONE NO :
OCCUPATION :
INSURED EMAIL ADDRESS :
INSURED DATE OF BIRTH :
CERTIFICATE NAME :
POLICY NUMBER :
SELECTED FORM OF ID :
BROKER AGENT/MARKETER CODE :
...Get Linkage Motor Insurance in 3 Easy Steps...
