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NATIONAL INSURANCE COMPANY LIMITED. (Regd. Office : 3, Middleton Street, Calcutta – 700 071). MOTOR CLAIM FORM. •. Issue of this form is not to be  Verification of original vehicle registration certificate and driving licence along with filled in claim form (signed only by the insured) is a must for arranging survey. No. Download m-Chatra app. Your insurance policy now at your nger tips! Intimation Cum Preliminary Claim Form - AutoSecure Car Insurance 2) The issue of this form is not to be taken as an admission of liability by Tata AIG. MOTOR INSURANCE CLAIM FORM. (The issuance of this form does not imply admission of liability) er Note No: Claim. First Name. Middle Name. Last Name. I/We hereby agree, affirm and declare that : 1. The statements/information given/stated by me, us in this claim form are true, corrected and complete. 2.

NATIONAL INSURANCE COMPANY LIMITED. (Regd. Office : 3, Middleton Street, Calcutta – 700 071). MOTOR CLAIM FORM. •. Issue of this form is not to be 

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Please complete this proposal form in full and ensure you sign the declaration overleaf and 5 Had a policy of motor insurance cancelled by any insurer?