Motor Vehicle Insurance Form

By filling in the form you are accepting the terms and conditions stipulated on this site.

Applying from Zimbabwe

If you are in Zimbabwe, fill in the form, submit online, and approach any CBZ branch of your choice or CBZ Insurance Head Office with your Registration Book and National ID.

Applying from outside Zimbabwe

If you are outside Zimbabwe, fill in the form, download the completed form, sign, scan and email to wz.oc.zbc@selasecnarusni

(Please note that cover applies to vehicles registered in Zimbabwe only)

section 1

section 2

section 3

section 4

section 5

Details of the Proposer

Title

Mrs

Miss

First Name

Middle Name

Surname

Date Of Birth

National ID Number

Email Address

Occupation

Residential Address

Postal Address

Employer

Employer's Tel No.

Telephone Numbers

Home

Area Code

Number

Business

Area Code

Number

Mobile Number

Annual Income Range

up to $10,000

$10,000 to $20,000

$20,000 to $50,000

Above $50,000

Bank

Account Number

Motor Vehicle Insurance Application Form