Book traversal links for Schedule No. (5)
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 Manufacture | Plate Number | Make, Model and Color | Motor Vehicle Classification | Registration Type | Purpose of use | Manufacturing Year | Tonnage or Weight | 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 …/…/….. | |||||
Agreed upon premium: | Issuance date: …/…/….. | ||||
Insured's Details | Company's Details | ||||
Insured's Name | : | Company's Name | : | ||
Address | : | Address | : | ||
: | : | ||||
Postal Address | : | Postal Address | : | ||
Identification Number | : | ||||
Phone | : | Phone | : | ||
Name and signature of the Insured or their representative: | Signature and stamp of the Company: |