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Motor Insurance
Travel Insurance
Application for Motor insurance
Full Name
ID/PP Number
Date of Birth
Email Address
Contact Number
Address
Selected vehicle
Select Policy
Vehicle Registration Number (AA0A-1234)
Attach Copy
Please attach a clear copy of the original Registration of the motor vehicle to avoid the consequences at the time of the claim.
For Hire
Not For Hire
Cubic capacity
I agree to the Terms & Conditions of Ceylinco.
Application for Travel insurance
Travel Policy Booklet
Full Name
Passport Number
Attach Copy
Please attach a clear copy of the original Passport to avoid the consequences at the time of the claim.
Date of Birth
Email Address
Please contact us at +9693939 if you are over the age of 59 years.
Contact Number
Address
Departure Date
Return Date
One way trips are excluded and the total number of travel days must not be more than 179.
Add your Destination (Including Transits)
Select Cover Limit
NIDC Number
Purpose of Travel
Are you presently in good health?
Any claim arising from pre-existing illness/conditions will not be entertained.
Details of Sickness/Illness
Medical History
Benefits may not be payable if you do not fully disclose any material facts which could influence our assessment and acceptance of this application and, if you are in any doubt as to whether any facts or material, you should disclose them. This applies even if professional advice has not been sought. Examples are varicose veins, allergies, backache, bunions, piles, gynecological problems (including any irregularities of menstruation), any ear, nose or throat problems or any pains, swellings of lumps.
Nominee for receiving death benefits
Name
NIDC/Passport No
Age
Relationship
I hereby declare that the above answers are true and complete and that I have withheld no information whatever material to this proposal. I agree that this proposal and declaration and the truth and completeness of the answers herein shall be the basis of the contract between me and Ceylinco Insurance PLC. If the answers now given by me cease to be true and/or complete, I undertake to give immediate written notification to the company. I further agree to accept the usual form of policy issued by the Company subject to the terms and conditions therein contained.
Policy Summary
Policy Number
MLMIxx3x0xxxxx
Policy Class
Motor Insurance
Policy Product
Third Party Insurance
Cover Duration
July 31st, 2022 to July 31st, 2022
Cover Limit
MVR 100,000.00
Vehicle Details
Motorcycle, A0AA 5611, 50 - 150 cc
NID Card
A000000
Customer Name
Santosh Subramaniam
Confirm
MVR 140.00
Customer
Insurance Type
Payment Status