Insurance Informaiton

Insured Name :

Phone Number : Address :          

Insured Period : From :               To :

Scope of Cover : Comprehensive Third Party Liability Passenger Liability Accident to driver

Note : if you select Comprehensive it already include Third Party and Passenger Liability

Motor Informaiton

Mark Model     Year Registration No Cubic Capacity

No. of seats Weight Tons       Chassis No        Engine No

Motor Value Total Premium USD