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First Name
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Last Name
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Address1
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Address2
City
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State/Province
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Zip/Postal Code
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Home Phone
Mobile Phone
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Countries to Visit
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Argentina
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Reason for travel
*
tourism, business, study, etc.
Date of Departure
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Month
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Day
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Year
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Date of Return
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Month
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Day
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Year
Year
2024
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2027
2028
2029
2030
2031
2032
2033
2034
Description of Vehicle
Vehicle Type
*
-- please select type of vehicle --
Passenger Car
New Truck
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Registered in (country):
*
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Afghanistan
Aland Islands
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Andorra
Angola
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Antarctica
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Bouvet Island
Brazil
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British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Caribbean Netherlands
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
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Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong S.A.R., China
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
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Macedonia
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Malaysia
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Mali
Malta
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Mayotte
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New Zealand
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Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
North Korea
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
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South Africa
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Svalbard and Jan Mayen
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Sweden
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Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
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Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
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Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Currency Type
Select the currency used for the vehicle value
US Dollar
Canadian Dollar
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Value of vehicle at time of purchase
Please enter value in 1,000.00 format
Value now:
*
Please enter value in 1,000.00 format
Year of manufacture:
Make of vehicle:
This is the brand of the vehicle (e.g. BMW)
Vehicle Model
Enter the model of the vehicle (e.g. R 1200 GS)
Chassis No. (VIN):
Additional Notes
