LS2 Helmets (Premium) Insurance Activation

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

Date of Birth *

Mobile *

Email (Optional)

Dealer Name *

Helmet Purchase Date *

Helmet Model * Select THUNDER VECTOR VECTOR II STORM STORM II STREAM II RAPID II ADVANT X ADVANT STROBE II INFINITY INFINITY II DRIFTER X-FORCE FAST II FF800 FF802

Activation Code *

Please check the back side of the insurance card to get the Activation Code

Nominee Name *

Nominee Relationship With Enrolled Person * Spouse Child Father Mother Sibling

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