Page 1 of 4 ! ! , -. /. -01. -02. 3. - 0 i Full name of the proposer: ii Full name of the registered owner: iii Postal Address: Email iv Physical address: v Telephone vi Precise Occupation.

 

MOTOR CYCLEP FPROPOA1. Full Surname First Middle 2. Pin. No. 3. Tel. No. Res. ce 4. Postal Address Code Email 5. Trade or Business 6. Period for which Insurance.

 

Allianz Insurance plc Complete Motor Trade and Complete Headlight.

 

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4th Floor, Glennie Street, Colombo – 02, Sri Lanka. Tel: 2300400 Fax: 2304404 E-mail: info allianz. lk COMMERCIAL VEHICLE INSURANCE PROPOSAL.

 

MOTOR VEHICLE PROPOSALFORM PLEASE READ THESE NOTICES CAREFULLY About Commercial and Trucksure Commercial and Trucksure specialises in transport insurance.

 

PROPOSAL FOR COMMERCIAL VEHICLE INSURANCE Please answer all questions and give detailed answ ers wherever required 1. Proposer’s Details c Business / Occupation.

 

MOTOR VEHICLE PROPOSAL FORM To obtain a Quote and a Cover Note, please fax this form to Chris Glass on 03 9813 5744. We will.

 

MOTOR VEHICLE PROPOSALFORM PLEASE READ THESE NOTICES CAREFULLY About Commercial and Trucksure Commercial and Trucksure specialises in transport insurance.

 

Motor Plan ProposalForm arising will be between yourself and R M Insurance Private Limited. Cover in Brief will comp ensate for damages.

 

MOTOR VEHICLE PROPOSAL FORM To obtain a Quote and a Cover Note, please fax this form to Chris Glass on 03 9813 5744. We will.

 

Motor Plan ProposalForm arising will be between yourself and R M Insurance Private Limited. Cover in Brief will comp ensate for damages.

 

TRUCKSURE PTYLTD ABN: 78 078 661 220 AFSL: 238151 As agent for the Insurer PO Box R1940 Royal Exchange NSW1225 Level 6, 3 Spring Street Sydney NSW2000.

 

Page 1 of 3 !!!!!!!!!! ! ! ! ,-. /, ! 0 0 -/ !1 !!! , 0 ,!2/ ! 1! ,-. /, 3!!!! ! ,-. 2 ! ! ,-!!. /0. 1. 0234!!5 6!!77777!. ,6!!777777!89 !/ : 6!77777777 : 6!!7777777777 ! / x -9 ; x 3 ; x -2;û x 9; x -; x9 ; x-1 6; x -8 ; x! -8; x ! 5; x 7 3; x 7 3; x 7 3

 

Proposer’s Full Name : Address : Business Occupation : Age : Commencement date : PARTICULARS OF THE VEHICLE Registration Marks Number Make of Vehicle Horse.

 

Proposal Form - my:asset Private Car Package Policy Please enter details of the Customer Title Pls. Tick : Mr. Ms. Mrs. Gender: Male Female Date.

 

-APV-PRO-12/09 PRIVATE MOTOR VEHICLE INSURANCE PROPOSAL COVER PROVIDED The following alternative forms of cover are available: see Question19 1. THIRD PARTY.

 

LION ASSURANCE MOTOR PRIVATE PROPOSALFORM. 1.

 

1. No. Pendaftaran2. Tahun Dibuat 3. Ruang Duduk Regn. No. Year Make Seating Capacity 4. Keupayaan Padu5. Warna Cubic Capacity Colour.

 

1. No. Pendaftaran2. Tahun Dibuat 3. Ruang Duduk Regn. No. Year Make Seating Capacity 4. Keupayaan Padu5. Warna Cubic Capacity Colour.

 

PRIVATE MOTOR PROPOSALFORM a Proposer’s full name and title Mr/Mrs/Miss/Ms b Postal address c Address where vehicle will be kept if Different.

 

Plot No. 1131, Parirenyatwa Road, Fairview, Lusaka P O Box 32825, LUSAKA, ZAMBIA. Tel: 2601 Fax: 2601 222863 E-mail: nicozam.

 

CMFM APP 1011 ABN 78 006 767 540 AFSL 236653 Level 50, 80 Collins Street, Melbourne VIC 3000 Telephone: 03 9211 3716 Fax: 03 9211 3745 Email:.

 

Head Office: Newtown Centre,30-36 Maraval Road, Newtown, Port of Spain, Trinidad Tobago,W. I. Telephone: 868 625-GGIL 4445 ƒ Fax: 868 622-9994.