Motor Vehicle Information
Private Car
Commercial Vehicle
Name
Address
Contact Number
E-mail
Coverage Period Date (Annual)
Model
Make
Type
Color
Plate Number
Serial/Chassis Number
Motor Number
Fair Market Value
of Your Vehicle
Accessories
Aircon
Brand
Value
built-in
add-on
Stereo
Brand
Value
built-in
add-on
Speakers
Brand
Value
built-in
add-on
Magwheels
Brand
Value
built-in
add-on
others
Mortgaged?
Yes
No
If yes, Name of
Mortgagee Bank