AXA Insurance (Gulf) BSC (c)

MOTOR PERFECT QUOTATION

CUSTOMER DETAILS
NAME : MRS. KAJIA WANG
ADDRESS : P.O. BOX 20709 Al Ain Business Code : AXA UAE
FAX : +971 (4) 02/6315929 Date : 03/07/2010
EMAIL : wangkajia@hotmail.com Ref No : QTE736191
Dear KAJIA WANG
Thank you for contacting AXA Insurance and giving us the opportunity to provide you with a quote for your insurance requirements.
Based upon the details given, the quotation is set out below for your convenience and is valid for 14 days from the date of this letter.
Kindly complete any customer information omitted in the shaded boxes.
DRIVERS DETAILS
Name of Main Driver KAJIA WANG Age 31
Driving License held for 7 Years Contact No +971 (50) 4948246
No Claims Discount 5 Years and above Claims in last 5 years
YOUR VEHICLE
Make PEUGEOT Use Social Domestic, Pleasure and Commuting
Model 308 1.6L CONFORT Engine No
Colour Chassis No
Reg No Seating Capacity 4+1
Year of manufacture 2009 Engine Capacity 1,600
Bank Loan Insured Value AED 49,500
ADDED VALUE OPTIONS
In addition, according to the type of policy above or the added value options you have selected, the following benefits are included in
the premium:

Agency Repairs YES

Hire Car NO
Breakdown Recovery YES
Personal Accident Cover for Driver YES
Personal Accident Cover for Passengers YES
GCC Cover NO
No Claims Discount Protection NO
Transferable Licence YES

Period of Insurance: From 03/07/2010 To 02/08/2011

PREMIUM PAYABLE: AED 1,797 EXCESS: AED 200 VOLUNTARY EXCESS: AED 0

Call AXA Insurance direct on 8004845

8am to 8pm on Saturday to Wednesday & 8am to 5pm on Thursday
And now, arranging your policy with AXA Insurance couldn't be easier! With just one phone-call, our Customer Service Team can confirm
acceptance of the policy on the terms above or discuss amendments to the quotation to suit your convenience. Just have this document
available when you call.

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AXA Insurance (Gulf) BSC (c)
Attaching to and Forming Part of Quotation. QTE736191 INSURED: KAJIA WANG
CONDITIONS

Young /Novice Driver Excess

If at the time of an acccident, the vehicle is found to have been driven by anyone:
- under 25 years of age (completed age) and/or
- with less than 12 months valid UAE licence (other than transferable licence)
then , the Insured shall bear 10% of the claim, in addition to the normal policy excess.

Racing Exclusion clause

Policy excludes liability arising out of usage of vehicle against racing, rallies and/or speed trials.

Reasonable Care
The insurer shall not be liable for any losses if the insured vehicle is not securely locked and the ignition
key removed whilst the insured (Driver) is not in the vehicle.

IMPORTANT NOTICE

1. NON DISCLOSURE: All facts which are likely to influence our assessments, acceptance and renewal of this insurance must be
advised to us. If you fail to notify us of all relevant facts you may find that your policy will not operate fully. Furthermore, you must not
have had any insurance cancelled, refused or any special conditions applied.

2. PURPOSE: It is warranted that the vehicle will not be used for any other purpose other than that for which it was intended, it will not
be used for the carriage of passengers or goods for hire, reward or rental.

3. ADEQUACY OF VALUE OF THE VEHICLE: Please check whether the value indicated represents the correct market value of
your vehicle. Proof may be requested.
ADDITIONAL DOCUMENTS REQUIRED

1. A photocopy/fax of your Driving License.

2. Proof of No Claims Bonus, if applicable.
3. Payment Authorisation Advice, if applicable. Please note that insurance cover can only commence upon receipt and acceptance of full
premium payment.

WHAT DO I DO NOW
Should you wish to accept this offer, please sign the declaration below and fax it to us on 043150101. Please note that by signing this
document you are agreeing that the details given are correct and AXA Insurance will use this Proposal Form. If the details are incorrect,
please call us on 8004845

PAYMENT AUTHORISATION
In respect of the agreed insurance contract, I hereby confirm acceptance of the policy terms, conditions and premium payable. My mode
of payment will be.

Cash Credit Card (Please complete the details in the box below)

CREDIT CARD AUTHORISATION

VISA CARD MASTER CARD AMEX

I hereby authorise AXA Insurance (Gulf) BSC (c) to charge an amount of AED 1,797
ONE THOUSAND SEVEN HUNDRED NINETY-SEVEN UNITED ARAB DIRHAM ONLY .
from Credit Card Number The Expiry Date of the card is __/__

The Card is in the name of

DECLARATION
I hereby declare that to the best of my knowledge and belief that the above statements and particulars are true and correct and that I
have not withheld any information material to this proposal. I agree that this proposal and Declaration shall form the basis of the
contract between me and the Insurer.
I also undertake that the vehicle to be insured shall not be driven by any person below 25 years of age or with less than 12 months
driving experience unless their names have been declared above.

Proposers Signature: X Date:

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 MOTOR INSURANCE
A policy that breaks with the norm to give you better protection and
exclusive advantages at the best possible price

A quick guide to your policy

Benefits Executive Perfect Third Party
Loss or damage to the insured vehicle Yes Yes Not Applicable

Third party liability Yes 5 Million Yes 3.5 Million Yes 3.5 Million

Third party property damage Yes Yes Yes

Injury to family members Unlimited Unlimited Unlimited

Fire & theft cover Yes Yes Optional

Storm, flood, riot and strike Yes Yes Yes

Personal injury cover AED 20,000 AED 20,000 Not Applicable

Emergency medical expenses AED 6,000 AED 3,500 Not Applicable

Personal belongings AED 4,000 AED 4,000 Not Applicable

No claims discount Yes Yes Yes

Oman Cover Yes Yes Yes

Off road cover Yes Yes Not Applicable

Standard agency repair period 5 years 2 years Not Applicable

Guaranteed repairs Yes Yes Not Applicable

12 months from 1st 6 months from 1st

New car replacement Not Applicable
registration registration

No excess for windscreen damage Unlimited AED 5,000 Not Applicable

Personal accident benefit - driver AED 200,000 Optional Optional

Personal accident benefit - passengers Yes Optional Optional

Maximum available agency repair period* 5 years 5 years Not Applicable

Hire car benefit Yes Optional Not Applicable

24 hour accident and breakdown recovery Yes Yes Yes

GCC cover Yes Optional Optional

Protected no claims discount Yes Optional Not Applicable

*Five years maximum available agency repair period, subject to conditions and payment of an additional premium

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