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Schedule No. (5)

Effective from 22/9/2016

"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: