| Main Driver |
| Driver's Date of Birth* |
(yyyy-mm-dd) |
| How long have you held a valid Barbadian driver's licence? |
|
| Do you currently have a car insurance policy in your name, or are you listed on someone else’s policy as an additional driver?* |
|
| How long have you had/or been listed as additional driver on this policy? |
|
| Select the renewal month:* |
|
| What level No Claims Discount are you currently earning?* |
|
| Are you a BARP member? |
|
| Additonal Drivers |
| Will there be any one else driving the vehicle? |
|
| Will there be any additional persons under 21 years of age driving the vehicle? |
|
| Will there be any additional persons driving the vehicle who has held a licence for less than two (2) years? |
|
| Claims History |
| How many accidents or claims have you or any additional drivers on this quotation been involved in, in the last five (5) years? |
|
| Were you or any authorized drivers on this quotation found to be at fault? |
|
| What was the total payout on all accidents or claims? |
|