Motor Insurance Proposal Form

Please note that for the purposes of this insurance, MONEY means cash, bank notes, currency notes, cheques, money order
or postal order in the personal custody of the insured’s authorized employees.


    YesNo

    Manufacturer's Name/Model No and Year of Make, Size and Dimension, Material Used, Built into Wall / Fixed Floor, Who has possesion of keys

    YesNo

    DeclinedCancelledHad special terms imposed?