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LS2 Helmets (Premium) Insurance Activation
Home
LS2 Helmets (Premium) Insurance Activation
LS2 Helmets (Premium) 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
*
Address
*
Identification Type
*
Select
NID Card
Smart NID Card
Identification
Number
*
Upload
Identification
(Front)
*
Upload
Identification
(Back)
*
Nominee Information
Nominee Name
*
Nominee Relationship With Enrolled Person
*
Spouse
Child
Father
Mother
Sibling
Upload Nominee NID (Front)
*
Upload Nominee NID (Back)
*
By clicking submit I am agreeing to the
Terms of Service
and
insurance policy specific conditions
.
Submit