Schedule No. (5)
IA-BOD-RES 25/2016"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 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 …/…/….. 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:
| ||