Third Party Insurance - Scratch Card

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Product Type Required

Pin Number Required

Start Date Required YYYY-MM-DD

End Date Required YYYY-MM-DD

CUSTOMER

Business Required

Insured Name Required

Email Required

Telephone Required

Contact Optional

Identity Type Required

Identity No. Required

Contact Address Required

Date of Birth Required YYYY-MM-DD

Occupation Required

Sector Required

State Required

Town Required

VEHICLE

Vehicle Type Required

Vehicle Make Required

Vehicle Model Required

Vehicle Year Required

Registration No Q123ERT Verify?

Chassis No 17 Letters

Engine No Required

Vehicle Colour Required

Engine Capacity (cc) Required

Registration Date YYYY-MM-DD

NIID Status

NAICOM ID

Date	Reg.No	Policy No	Client Name	Chassis No	Make \| Model \| Color	Start	End	Premium