Motor Quotation
Motor Quotation
Motor Quotation
CUSTOMER DETAILS
NAME : MRS. KAJIA WANG
ADDRESS : P.O. BOX 20709 Al Ain Business Code : AXA UAE
FAX : +971 (4) 02/6315929 Date : 03/07/2010
EMAIL : [email protected] Ref No : QTE736191
Dear KAJIA WANG
Thank you for contacting AXA Insurance and giving us the opportunity to provide you with a quote for your insurance requirements.
Based upon the details given, the quotation is set out below for your convenience and is valid for 14 days from the date of this letter.
Kindly complete any customer information omitted in the shaded boxes.
DRIVERS DETAILS
Name of Main Driver KAJIA WANG Age 31
Driving License held for 7 Years Contact No +971 (50) 4948246
No Claims Discount 5 Years and above Claims in last 5 years
YOUR VEHICLE
Make PEUGEOT Use Social Domestic, Pleasure and Commuting
Model 308 1.6L CONFORT Engine No
Colour Chassis No
Reg No Seating Capacity 4+1
Year of manufacture 2009 Engine Capacity 1,600
Bank Loan Insured Value AED 49,500
ADDED VALUE OPTIONS
In addition, according to the type of policy above or the added value options you have selected, the following benefits are included in
the premium:
Reasonable Care
The insurer shall not be liable for any losses if the insured vehicle is not securely locked and the ignition
key removed whilst the insured (Driver) is not in the vehicle.
IMPORTANT NOTICE
1. NON DISCLOSURE: All facts which are likely to influence our assessments, acceptance and renewal of this insurance must be
advised to us. If you fail to notify us of all relevant facts you may find that your policy will not operate fully. Furthermore, you must not
have had any insurance cancelled, refused or any special conditions applied.
2. PURPOSE: It is warranted that the vehicle will not be used for any other purpose other than that for which it was intended, it will not
be used for the carriage of passengers or goods for hire, reward or rental.
3. ADEQUACY OF VALUE OF THE VEHICLE: Please check whether the value indicated represents the correct market value of
your vehicle. Proof may be requested.
ADDITIONAL DOCUMENTS REQUIRED
WHAT DO I DO NOW
Should you wish to accept this offer, please sign the declaration below and fax it to us on 043150101. Please note that by signing this
document you are agreeing that the details given are correct and AXA Insurance will use this Proposal Form. If the details are incorrect,
please call us on 8004845
PAYMENT AUTHORISATION
In respect of the agreed insurance contract, I hereby confirm acceptance of the policy terms, conditions and premium payable. My mode
of payment will be.
Cash Credit Card (Please complete the details in the box below)
I hereby authorise AXA Insurance (Gulf) BSC (c) to charge an amount of AED 1,797
ONE THOUSAND SEVEN HUNDRED NINETY-SEVEN UNITED ARAB DIRHAM ONLY .
from Credit Card Number The Expiry Date of the card is __/__
DECLARATION
I hereby declare that to the best of my knowledge and belief that the above statements and particulars are true and correct and that I
have not withheld any information material to this proposal. I agree that this proposal and Declaration shall form the basis of the
contract between me and the Insurer.
I also undertake that the vehicle to be insured shall not be driven by any person below 25 years of age or with less than 12 months
driving experience unless their names have been declared above.
Third party liability Yes 5 Million Yes 3.5 Million Yes 3.5 Million
*Five years maximum available agency repair period, subject to conditions and payment of an additional premium