MOTOR INSURANCE PROPOSAL FORM

BML INSURANCE cm Of dE ea cSwacscnerwa x

u cnia OT om

Proposal no. Policy no.

Individual Company National ID Card

     

Occupation: Nature of Business: Work Permit Passport

      

ID No.
       

Date of Birth: Male Female Reg No.

  D D M M Y Y Y Y    

Permanent Address (as in ID card): Contact Name:

       

Current Address Nationality:



House/Building name: Contact No:

     

Road: District: Email:

  
Postal Code: Atoll,Isand: Fax:
    

If another party has an interest   

Full Name: Phone no: Address:

    

Vehicle Details  

Registry no: Value of Vehicle: Date of Purchase:

      

Condition of Vehicle when Purchase: New Vehicle Second Hand Vehicle

      

Condition of Vehicle Now: Good Problems Occur

     

Please specify if Vehicle has Problems:

    

Purpose of Vehicle: Private Hiring Vehicle Commercial Others, Please Specify:

           

Depriciated Value:
             

Type of Insurance: Comprehensive Insurance

Third Party Insurance Comprehensive Insurance
including theft
      
   

Documents required with the Proposal: Vehicle’s registry copy ID. Card/license copy
         

DecIaration: I/We desire to effect with the Company an insurance, in the terms of the Policy used for this class of business and I/We warrant that the above state-
ments and particulars are correct and complete. I/We agree that this proposal shall be the basis of the contract and part of the insurance between myself/ourselves
and the Company.
                
                 

Signature: Date:     

1-2
Purchase Value Less of Depreciation    

Age of vehicle, not exceeding 6 months

      Nil

Age of vehicle, exceeding 6 months but not 1 year

          
2.5%

Age of vehicle, exceeding 1 year but not 2 years

           5%

Age of vehicle, exceeding 2 year but not 3 years

           7.5%

Age of vehicle, exceeding 3 year but not 4 years

           10%

Age of vehicle, exceeding 4 year but not 5 years

15%
          

Age of vehicle, exceeding 5 year but not 10 years

20%
          

Age of vehicle, exceeding 10 years

30%
     

Claims Lodge During the Last 3 Years        

Year Claim Number Amount (MVR)

   