Quotation

Proposer Type

Proposer First Name

Proposer Middle Name

Proposer Last Name

Mobile No.

Email Address

Which Global Insurance branch do you want to be served from?

Insurance Start Date

Insurance End Date

A. Add 500 ETB to the quoted amount if you would like the valuation to be done by our empaneled Veterinary Doctors.
B. Add 500 ETB per animal to the quoted amount if you would like each animal to be tagged by us.
C. Insurance cover takes effect after receipt of Veterinary Surgeon’s Inspection Report (as per standard policy terms)

Type of Animal

Breed

Tag Number

Name

Age In Years

Gender

Use of Animal

Number Of Animals

Proposed Value

Actual Proposed Value

Unique Identification Marks on the Animal

Remove

Total Proposed Value (Max Total Proposed Value : 999999999)