VON SAFE PAY

Non Motor Insurance

Type of Risk Cover:

Proposer 's Details:

Proposer's Name

Proposer's Address

Proposer's Trade or Occupation

How long have you been in this business? (In Years)

Less than 5 Years

Greater Than or Equal to 5 Years

Mobile No.

Email Id

Risk Details:

Particulars of the Work to be covered in detail:

Risk Location Address:

Type of Cover Opted:

Type of Voyage Required

Origin & Destination of Transit:

From

To

Last Year Policy:

Company Name

Policy Number