Askari General Insurance Co. Ltd.

1st Floor, Gul Centre, Thandi Sarark, Hyderabad

Tel: (022) 2729689 Fax: (022) 2783976
:agicohyd@agico.com.pk E-Mail

Motor Vehicle Inspection Form

Agent Code:
Cover Note No: _____________________________ Policy No:_____________________________
Name of Insured: __________________________________________________________________
Address: _________________________________________________________________________
Name of Propose: __________________________________________________________________
(Please attach photocopy of Registration Book)

Telephone: _____________________________

Registration No:

Chassis No:

Engine No:

Horsepower/C.C

Type of Body

Color of Vehicle

Make of Vehicle

Year of Manufacture

Insureds Estimated Value of the Vehicle without accessories

Rs.

Insureds Estimated Value of the Vehicle with accessories

Rs.

Period of Insurance:

From/
To/

/
/

/
/

List of accessories inside the vehicle.

1)
2)
3)
General Points to be checked
Dents: _________________________________
Is your vehicle subject to any Bank Loan or Hire Purchase agreement?

Yes

No

DECLARATION
I/We desired to insure the above vehicle with Askari general insurance co. ltd. And I/we hereby declare
that the particulars given above are correct in all respect. The inspection form shall be the basis of the
contract between me/as & the insurer. Any Untrue/Incorrect statement in this form will result in the policy
being null & void from inception.
INSURED

AUTHORIZED SIGNATURE

Signature: ____________________

Signature: ____________________

Name: _______________________

Name: _______________________
For & on behalf of
Askari general insurance co. ltd

Head Office: 4th Floor, AWT Plaza, The Mall, Rawalpindi. Tel: 92-51- 9272425-7 Fax 92-51- 9272424