RISK NO. : Business/Profession : Cover : Vehicle Regn No : Cubic Capacity : Make and Body : Yr of Manf : Engine : Log Book No : Chassis No : Seating Capacity : Use For : Vehicle Sum Insured : Description Annual Premium Basic Premium Excess Discount Tariff Loading NCD/Fleet Discount Service Tax Stamp Duty -------------------- Total Due: ========== Authorized Drivers: Excess :