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Insured's Details

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Contact address must contain House No. and street name (i.e 7, Kufo street), Area, LGA and state
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Kindly state in full
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Third Party Details(Person or Company claiming against you)

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Contact address must contain House No. and street name (i.e 7, Kufo street), Area, LGA and state
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Kindly state in full
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Please enter Street number, name, Area, LGA and State
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Description of incident

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Witnesses to the accident/incident

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Witnesses 2

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Declaration

I/We declare the foregoing to be true and I/We hereby authorize AXA Mansard Insurance and /or their Legal representatives to deal with all matters

AXA Mansard is joining the rest of the world in being environmentally responsible. We invite you to join us in this cause by using only the electronic copy of your policy document which will be sent to your registered email address. You can also access it from your online account at www.axamansard.com or on MyAXA Plus App (available on Play Store or IOS Store).

Should you still want to receive a hard copy of your document in addition to the electronic copy, please place a request with your account officer or send an email to insure@axamansard.com. Your choice to decline making such request will serve to indicate that you do not agree to partner with us to preserve the environment.

By clicking Submit you have agreed to the terms and condition stated above.

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