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  • Schedule No. (5)

    "Schedule of Details of the Insured Motor Vehicle in the Insurance Policy against Third Party Liability"

    Details of Motor Vehicle

    Country of Manufacture

    Plate Number

    Make, Model and Color

    Motor Vehicle Classification

    Registration Type

    Purpose of use

    Manufacturing Year

    Tonnage

    Number of Passengers with Driver

     

     

    Engine Number:

    Chassis Number:

     

    ……………………….. Company declares that the Motor Vehicle detailed above inthis 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 …/…/…..

    Total premium:                                                 Issuance date: …/…/…..

    Insured's Details

    Company's Details

    Insured's Name

    :

     

    Company's Name

    :

     

    Address

    :

     

    Address

    :

     

    E-mail

    :

     

    E-mail

    :

     

    Postal Address

    :

     

    Postal Address

    :

     

    Phone

    :

     

    Phone

    :

     

    Identification Number

    :

     

     

     

     

    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 ID

      First

      Second

      Third

      Family 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 Mark

      Truck

      Small Truck

      Large Truck

      Other

       

      Model/Use

      Private

      Commercial

      Rental

      Driving Learning

      Other

      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