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Proposer Info:

Name of proposer

Contact number

Email

Address

Occupation

Date of Birth

Vehicle Info:

Select Vehicle Type

Year of Manufacture

Chassis Number

Plate Number

Current Market Value IQD

Required Option

Requested Info:

Please provide Driver(s) license of the owner and the vehicle registration card.
For any other driver/s of the vehicle, please attach the copy of driver(s) license.
Cars to be insured must be inspected before issuing the policy.

I/we, the undersigned, declare herewith that all the information provided, to the best of my/our knowledge, are complete and correct and that this proposal forms the basis and will be part of the policy to be issued in connection with the above risk(s), and that there are no current damages to the premises to be insured

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