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Please fill out all the required information completely and truthfully to be entitled to buy insurance online with V-Store - the online insurance service that offers you more than coverage.

Personal Detail

Confirm E-mail*
First name*
Last name*
I.D Card No.* Date of birth*
Age Gender*
Marital status
Home phone number
Mobile phone number* Confirm mobile  
phone number*
Fax number


House number Village No.
Building / Village Lane / Alley
Street City
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I would like to buy an insurance policy from your company under the terms the company has set for this insurance policy. I warrant that the particulars provided above are correct and complete and agree that this request to buy insurance shall be the basis of the contract between the company and me. More
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