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Insurance Proposal Form

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  • Personal Detail
  • Vehicle Detail
  • Payment Detail
  • Finish

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Note: If your payment date is after above date, policy will be effective from payment date.

Accept the Terms of Service. I hereby declare that the details furnished above are true and correct

Total Premium: NPR: 0

Debit Note: TPI2021-20220031


Please pay the premium using any payment system to finalize your policy.
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I confirm the payment of premium and accept to cancellation of policy if payment is not realized.

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