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Claim Form

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0% found this document useful (0 votes)
33 views3 pages

Claim Form

form
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
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Page tof @ fcref@Lombard Nibhaye Vaade Claim Form for Motor Vehicle (70 BE FILLED AND SIGNED BY OWHVER OF VEHICLE) {issuance ofthis frm i not to be taken as an adizeon of aii. Pease ansier all questions fly) For Claim registration, please call on Toll Free Number 1800-2-666 TForwaton ABOUT SURED Po coven are RPS PPT IORLIT/ A] Rano POI | ve PRIS ZI Plat iets taste cla J seventies HOY Tele fal IMI ical sa JS) ul ola) ela, Tele Je Infos lol Aled MODI ie J vie: [A e][ea_Iftol fel) JL cae: I J | oe Je Res Tel No I 10 owe, FOO rots. [ IAT tetera eset tener awe ILI omer efor aout aim procs) ese pave’ IIIT ICICI JL soit coe no IO Co rescence D tke GD abceshe CD shctotone © C oketcole I >be Gecupetion Ssnice 1 Marketing Con mtorketiig — C1 Business D others Nacinendenteciwrtony = et Daa ee Oss essay teres 16 oe on ose oe Honmany ef emvetevtie Hoary doyahue as Oo: os Aromgsbnetnyar 1

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