Get a Quote | GoldStar Insurance

Identity and residency

Use the details shown on the policyholder's identification.

Title

Full legal name Sex

Identification type

Identification number Nationality Visa status (foreign nationals only) Country of residence Physical address Email address Phone number

PEP declaration

Tell us whether the policyholder is a Politically Exposed Person.

Is the individual a Politically Exposed Person (PEP)?

Yes No

Income and source of funds

Provide the current employment or income context.

Employment status

Employer or business name Tax identification number (TIN) Other employment or source-of-funds information

Company or partnership information

Use the organisation's registration and trading details.

Registered name Trade name (if different) Entity

Company origin

Organisation type

Other organisation type Nature of business TIN Physical address Email address Primary telephone Other telephone

Corporate PEP declaration

Disclose PEPs among senior management, owners, directors or shareholders.

Is a senior manager, owner, director or shareholder a Politically Exposed Person (PEP)?

Yes No

PEP 1 name PEP 1 relationship PEP 1 function / designation PEP 2 name PEP 2 relationship PEP 2 function / designation

Contact person and bank account

Provide the authorised contact and the organisation's account details.

Contact person full name Designation Telephone contact National ID number (NIN) Contact email Bank name Account number Branch name Branch code

Corporate supporting documents

Attach the documents applicable to the organisation.

Trading licence Certificate of incorporation / registration Memorandum of Association / partnership deed Beneficial Ownership Form Company Form 20 Authorisation for person acting for a foreign company

Privacy consent and signature

Review the privacy notice and confirm the declaration.

Is this KYC form for a minor?

Yes No

Signed by Date signed

Client signature

Sign here Mouse, stylus or finger

Signature stays only in this local draft.

Who needs cover?

Choose your cover.

No products found

Build your proposal request.

This cover starts with an advisor.

Tell us about the proposer and premises.

List property and sums insured.

Confirm risk history, safety and extra perils.

Set the period of insurance, then sign.

Declaration

Tell us who owns the assets and where cover is needed.

List every asset and its correct sum insured.

Describe the premises, security and insurance history.

Confirm the proposal and sign.

Declaration

Tell us who owns and operates the vehicle.

Describe the vehicle and its current value.

Explain how the vehicle operates and who will drive it.

Confirm previous cover, losses and declaration.

Declaration

Tell us about the person travelling.

Describe the journey and destination.

Review the declaration, then sign.

Declaration

Tell us about the business and its professional services.

Summarise professional income, contracts and the insured team.

Select liability limits and disclose relevant risk history.

Review the declaration, then sign.

Declaration

Confirm the policyholder's identity.

Identity and residency

PEP declaration

Income and source of funds

Company or partnership information

Corporate PEP declaration

Contact person and bank account

Corporate supporting documents

Privacy consent and signature

Privacy notice

Review your quotation request.

Quotation declaration

Quote request received.