West Coast Global InsuranceServices

www.InsureMeWC.com

West Coast Global Insurance Servicesprovides Mexico Auto Insurance for both Mexico Registered Vehicles & Tourist Auto Vehicles. Cars driving into Mexico or U.S., Canadian & Mexican Registered Autos located in Mexico All year Round. Comp & Collision & Mexico Liability Insurance Only Options Available.

West Coast Global Insurance Services

Ca.Lic. #0E50745

USA - (818) 788-5353

Mex - 01 (800) 099 0614

Request Quote - West Coast Global Insurance Servicesprovides Mexico Auto Insurance for both Mexico Registered Vehicles & Tourist Auto Vehicles. Cars driving into Mexico or U.S., Canadian & Mexican Registered Autos located in Mexico All year Round. Comp & Collision & Mexico Liability Insurance Only Options Available.

INSURED DETAILS

BENEFICIAL OWNERS DETAILS

CONTACT DETAILS

I have Whats App? : Yes No

LOCATION DETAILS

ADDITIONAL DETAILS

OWNER'S/OPERATOR'S/VESSEL'S LOSS AND CLAIM HISTORY

OWNER/PRIMARY DRIVER

Driver's License Status ?

Inactive
Active

Any Vehicle Losses or Claims?

No
Yes

Any Major Convictions?

No
Yes

Years of Driving Experience?

Have you held, over the last year any high ranking public or political position?

No
Yes

Is the Primary Applicant a Citizen of the United States or Canada and/or maintains permanent resident status in the United States or Canada?

No
Yes

UNDERWRITING QUESTIONNAIRE

Does the Primary Applicant Own or Rent a Home/Condo in Mexico for a minimum of 4 months of the year?

No
Yes

How many more drivers not including yourself would you like to add?

How many Vehicles would you like to Secure Coverage for?:

DIGITAL SIGNATURE

I acknowledge that West Coast Real Estate & Insurance, Inc., doing business as West Coast Global Insurance Services, does not guarantee any coverages and has presented this informal application/questionnaire solely for the purpose of collecting general information. I comprehend that the submission of this informal application/questionnaire does not constitute insurance coverage for either myself or the insured item for which I am seeking information.

I am aware that the coverage limits I have requested may be subject to change upon the generation of a formal quote by an insurance company. It is my responsibility to thoroughly review the coverages and policy conditions at that time. I confirm that I have read the foregoing application/questionnaire, along with any attached documents, and declare that the information provided therein is true, complete, and correct to the best of my knowledge and belief. I understand that this information serves as an inducement for the company to consider issuing an insurance policy, and no coverage is currently being offered.

I acknowledge that West Coast Real Estate & Insurance, Inc., DBA West Coast Global Insurance Services, will be in communication with me to further assist with my insurance needs. I hereby grant my consent to receive telephone calls, text (SMS & MMS) messages, and email communications. I understand that providing consent is not a condition of purchase, and standard message and data rates may apply. For more information on how your data is handled, please visit our Privacy Policy. (PRIVACY POLICY)
Checking this box serves as my digital signature.

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