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id	Invoice Date	Debtor Code	Invoice No.	Effective Date	Expiry Date	Renewal	Vehicle No.	Policy No.	Principal Code	Gross Amount	Net Amount

Insured Details

Vehicle Details

Insured Details

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Details

Insured Details

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Type

Insured Name

NRIC/ ID

Date of Birth

Age

Gender

Race

Marital Status

Occupation

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Remarks

Insured Details

Type

Insured Name

Mother Company

Business Nature

Company No.

SST No.

SST Date

Person Contact

Remarks

Address & Contacts

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Risk Address & Contacts

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Fax No.

Vehicle Information

Vehicle No.

Vehicle Model

Engine No.

Vehicle Body

Chassis No.

Year Make

KG/(CC)

Color

Log. Book

Use of Vehicle

Finance

Seat

Excess

Roadtax

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Policy (New)

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Invoice No.

Invoice Date

Permit *

Company Code *

Reference No.

Insured Name

Vehicle No.

Cover Note No.

Principal Code *

Class Code *

Effective Date

Expired Date

Policy No.

Policy Date

Status

Remarks

Policy Type *

Show Remarks in invoice

Drivers

Driver 1

Driver 2

Driver 3

Driver 4

Premium

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Policy Type *

Premium

Total Comm. %

Sum Insured

Premium Adj.

Total Comm. RM

Total Rebate %

Agreed Value

Total Rebate RM

All Riders

All Riders Premium

Comm. After Rebate RM

Loading % (Vehicle)

Loading % (Age)

Loading Premium

Company Comm. %

NCB Rate %

NCB Amount

Company Comm. RM

Windscreen

Windscreen Premium

Excess

Extra Benefits with Comm.

Debtor Comm.

Extra Benefits without Comm.

Introducer Comm.

Gross Premium Adj.

Gross Premium

Principal RM

Tax

Principal Adj.

Tax Amount

Principal Payment Mode

Stamp Duty

Total Pemium

Other Amount

Company Rebate

Roadtax

Total Amount

Insured A/C

DATE	DN / CN / OR / PV	CLASS / VEHICLE	DESCRIPTION	BANK A/C	DEBIT	CREDIT	BALANCE

Agent A/C

DATE	DN / CN / OR / PV	CLASS / VEHICLE	DESCRIPTION	BANK A/C	DEBIT	CREDIT	BALANCE

Principal A/C

DATE	DN / CN / OR / PV	CLASS / VEHICLE	DESCRIPTION	BANK A/C	DEBIT	CREDIT	BALANCE

Endorsement Listing

Id	Date	D/C Note	Endorsement No.	Gross Premium	Net Premium	Status	Action

New Detail

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CN No.

CN Date

Permit *

Company Code *

Reference No.

Insured Name

Vehicle No.

Cover Note No.

Principal Code *

Class Code *

Effective Date

Expired Date

Endorsement No.

Endorsement Date

Status

Remarks

Show Remarks in invoice

Drivers

Driver 1

Driver 2

Driver 3

Driver 4

Premium

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Endorsement Type

NCB Type

Policy Type

Premium

Total Comm. %

Sum Insured

Premium Adj.

Total Comm. RM

Total Rebate %

Agreed Value

Total Rebate RM

All Riders

All Riders Premium

Comm. After Rebate RM

Loading Premium

Company Comm. %

NCB Amount

Company Comm. RM

Windscreen

Windscreen Premium

Excess

Extra Benefits with Comm.

Debtor Comm.

Extra Benefits Without Comm.

Introducer Comm.

Gross Premium

Gross Premium Adj.

Principal RM

Tax

Principal Adj.

Tax Amount

Principal Payment Mode

Stamp Duty

Total Pemium

Other Amount

Roadtax

Company Rebate

Total Amount

Insured Details

Attn:

Type

Insured Name

NRIC/ ID

Date of Birth

Age

Gender

Race

Marital Status

Occupation

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Remarks

Insured Details

Type

Insured Name

Mother Company

Business Nature

Company No.

SST No.

SST Date

Person Contact

Remarks

Address & Contacts

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Contact No. 3

Fax No.

Risk Address & Contacts

Address

Postcode

City

State

Contact No. 1

Contact No. 2

Fax No.

Vehicle Information

Vehicle No.

Vehicle Model

Engine No.

Vehicle Body

Chassis No.

Year Make

KG/(CC)

Color

Log. Book

Use of Vehicle

Finance

Seat

Excess

Roadtax

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