DCS Helmets Accident Insurance Activation

For more details regarding this insurance policy, please click here.

Full Name (As per NID/Passport/Birth Certificate) *
পূর্ণ নাম (আপনার এনআইডি/পাসপোর্ট/জন্ম সনদ অনুসারে)

Date of Birth *

Mobile *

Email (Optional)

Dealer Name *

Purchase Date *

Helmet Model *

Activation Code *

Identification Type *

Identification Number *

Upload Identification (Front) *

Upload Identification (Back) *

Nominee Name *

Nominee Relationship With Enrolled Person *

Upload Nominee NID (Front) *

Upload Nominee NID (Back) *

By clicking submit I am agreeing to the Terms of Service and insurance policy specific conditions.