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  • Schedule No. (5)

    Schedule of Details of the Insured Motor Vehicle in the Insurance Policy against Loss and Damage

    Details of Motor Vehicle
    Country of ManufacturePlate NumberMake, Model and ColorMotor Vehicle ClassificationRegistration TypePurpose of useManufacturing YearTonnage or WeightNumber of Passengers with Driver
             
    Engine Number:Chassis Number:


    ……………………….. Company declares that the Motor Vehicle detailed above in this Schedule is insured with it according to the provisions of this Policy.

    Issued By:Issuance Date:


    Policy Number:

    The term of insurance begins at …………. on …/…/….., and expires at …………. on …/…/…..
    Agreed upon premium:Issuance date: …/…/…..
    Insured's DetailsCompany's Details
    Insured's Name: Company's Name: 
    Address: Address: 
    E-mail: E-mail: 
    Postal Address: Postal Address: 
    Identification Number:    
    Phone: Phone: 
    Name and signature of the Insured or their representative:Signature and stamp of the Company:
    • Motor Vehicle Insurance Application

      Applicant's Details
      Name according to IDFirstSecondThirdFamily Name
           
      Date of Birth/ /P.O. Box Postal Code 
      ID Number E-mail 
      Home Phone Office Phone Mobile 
      Address/Emirate 
      Profession Employer 
      Driving License Number Expiration Date 
      Trade Name (if any) Commercial Register Number 
      Head Office 
      Insurance Service Details
      Registration MarkTruckSmall TruckLarge TruckOther
      Model/UsePrivateCommercialRentalDriving EducationOther
      Body Number Engine Number 
      Chassis Number Engine Capacity (CC) 
      No. of Passengers Manufacturing Year 
      Current Value without Accessories Current Value, including Accessories (to be elaborated) 
      Insurance Period Insurance Type 
      Insured/Representative Signature 


      /Stamp: Insurance Authority/

      Insurance Authority - Unified Motor Vehicle Insurance Policy Against Loss and Damage