Endorsment

Home Endorsment

Endorsment Form

  • Endorsement No:Policy No:
  • Type of PolicyExpiry Date
  • I/We hereby give authority to General Insurance Company Limited, Upper Redcliffe Street, St. John’s, Antigua, to effect the following change(s) to my/our Policy, at caption,
  • FromTo
  • (Please mark the requisite box)

  • Delete VehiclesAnd Add 
  • (Note: drivers’ particulars to be noted overleaf)
  • Additional PremiumRefund
  • ALL OTHER TERMS CONDITIONS LIMITATIONS AND EXCEPTIONS REMAIN THE SAME.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Delete and Add Endorsment

  • Registration Number:Registration Number:
  • Type/Make of Vehicle:Type/Make of Vehicle:
  • ColorColor
  • CCCC
  • Seating Capacity:Seating Capacity:
  • Year of Manufacture:Year of Manufacture:
  • Chassis Number:Chassis Number:
  • Engine Number:Engine Number:
  • Sum Insured/Purchase Price:Sum Insured/Purchase Price:
  • Period of InsurancePeriod of Insurance
  • Registration Number:Registration Number:
  • Type/Make of Vehicle:Type/Make of Vehicle:
  • ColorColor
  • CCCC
  • Seating Capacity:Seating Capacity:
  • Year of Manufacture:Year of Manufacture:
  • Chassis Number:Chassis Number:
  • Engine Number:Engine Number:
  • Sum Insured/Purchase Price:Sum Insured/Purchase Price:
  • Period of InsurancePeriod of Insurance
  • Particulars of Additional Drivers

  • AgeDriving Experience
  • OccupationRelationshipExcess
  • AgeDriving Experience
  • OccupationRelationshipExcess
  • AgeDriving Experience
  • OccupationRelationshipExcess
  • OccupationRelationshipExcess
  • AgeDriving Experience
  • OccupationRelationshipExcess