Vehicle Inspection Form

Name of Insured

ADDRESS

EMAIL

POLICY NO

SUM INSURED

MAKE & MODEL

REGISTRATION NUMBER

CHASSIS NUMBER

YEAR OF MANUFACTURE

GLAZING (INSCRIBE REG./INDEX MARK ON GLASS)
YesNo

COLOUR

SPEEDOMETER READING

ANY OTHER SPECIAL FEATURE

RECOMMEDATION

OFFICER’S NAME

INSURED/REPRESENTATIVE’S

SIGNATURE

OFFICER's SIGNATURE

DATE

Δ