Schedule No. (5)

Effective from 22/9/2016

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 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 …/…/…..
Agreed upon 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	:
Identification Number	:
Phone	:	Phone	:
Name and signature of the Insured or their representative:		Signature and stamp of the Company: