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Authorized Drivers Information

Authorized Drivers Information (1)
Driver Name*
NRC/ Passport No.*
Birth Date*
Relationship to Policy Holder*
Driving License No.*
/
/
Driving License Expiry Date*
Your license has expired.
Related Documents of Authorized Driver
This field is to input driver license of authorized driver. (JPG, PNG, Word, Excel, PDF, etc.)
Driver License (Front)*
Delete
Driver License (Back)*
Delete
Add
Terms and Conditions*
Disclaimer : You are to disclose in this proposal form fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder may be void. No cover attaches until the premium has been paid.
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