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Vehicle Insurance

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Name: *
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Is there any claim in previous policy ? Yes No
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R.C. Book:
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Current Year Renewal Letter:
I hereby declare that furnished information above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

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