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First Name

Last Name

Gender

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Age

years old

Phone Number

Mexican Zip Code (Zip code where the vehicle will circulate in Mexico)

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Vehicle Type

Car / SUV Pickup

What is the legal status of your vehicle in Mexico?

National (Purchased in Mexico with Mexican Plates) Legalized (Foreign vehicle with approved Mexican Plates) I’m not sure / I don’t know

Its important to be specified within the insurance company

Vehicle Make

Vehicle Model

Vehicle Model Year

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Vehicle Description

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