Motor Insurance Order Form

Fields follow the motor certificate format: insured details, vehicle information, coverage dates and premium calculation.

1. Name and Address of the Insured

Insured Name * Mobile Number * Email Address *

2. Description of Vehicle

Vehicle Type * Full Insured Value / F.I.V * Registration Mark and Number * Engine Number Chassis Number Make / Model / CC / Reg. Year Number of Seats Ownership Type Document / Registration Copy

3-7. Coverage, Driver and Limitation

Effective Date * Expiry Date Geographical Area Persons / Classes Entitled to Drive Limitations as to Use

Premium Computation

Basic Premium Own Damage Rate % Exclusion Discount % Special Offer % VTS / AVLS Discount 10% No Claim Bonus 30% Motor Liability Premium Passenger Premium Paid Driver Premium VAT %

Calculation will save Net Premium, VAT, Gross Premium, Special Offer and Total Payable to dashboard. Branch admin can process this motor order like travel orders.