Capital Express Sales Portal - Commercial Vehicles Insurance

Insurance Purchase Form

Please ensure information provided below is/are accurate.

Account Type

Corporate

First Name

Last Name

Date of Birth

Corporate Name

Email Address

Mobile Number

State of Residence

Local Govt Area

Gender

Occupation

Address

Commercial Type

Registration Number

Please note that Registration Number validation on NIID would be done before insurance purchase can be completed.

Chassis Number

Engine Number

Vehicle Make

Vehicle Model

Year of make

Vehicle Colour

I confirm that the information provided above is/are correct and accept the Terms and Conditons