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Select Vehicle Type

Car Dual Purpose Three Wheeler Motorcycle Motor Coach

Select Insurance Type

Full Insurance Third Party

SRCC (Strike, Riot, Civil Commotion Cover)

Yes No

TR (Terrorism cover)

Yes No

Do you have a vehicle registration No?

Yes No

Do you have any Lease, Loan or Hire on vehicle?

Yes No

Make, Model and Year of Manufacture

Manufacturer Year

Estimated Market Value

Usage?

Private Hiring Rent

Choose the type of fuel

No Claim Bonus

Your Name *

Mobile No *

Additional Remarks

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