| * Name | |
| * Email | |
| * Contact Phone | |
| * Make | |
| * Model | |
| * Model Type (e.g. Station Wagon) | |
| * Year of Manufacture | |
| * Registration no | |
| * Vehicle Usage | |
| * Vehicle Purchase date | |
| * Current Vehicle Mileage | |
| * Engine capacity | |
| * Motor Vehicle origin | |
| * Seating Capacity | |
| | |
| * Type of plan |
|
| | |
| * I declare that | 1. The information and answers I written on this Proposal are a truthful and complete record of all the information provided by me. |
| | |
| | 2. I have downloaded, read, understood and retained a copy of the Policy Wording (which includes the Important Notices |
| | to be bound by the terms and conditions of the policy. |
| | |
| |
|
| | |
| | |