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Date of Birth: |
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| M1 License Date: |
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| M2 License Date: |
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| M License Date: |
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| Did you take a Riders
Training Course: |
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| Any
tickets in the last three years? |
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| If
yes, how many? |
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| Any claims in last 6
years? |
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| Apart from
liability, what other coverage are you looking for with respect
to the bike? |
Note: Comprehensive includes Vandalism, Missiles and Falling
or Flying Objects whereas Specified Perils doesn’t |
| Liability Limit: |
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| Collision Deductible
amount: |
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| Comprehensive Deductible
amount: |
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| Specified Perils
Deductible amount: |
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| Year, make and model: |
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| #
of CC's |
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| Approximate value of bike: |
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| Modified or Customized: |
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| Current Insurance
Company for your bike: |
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| How
many years with current insurance company |
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| Do you belong to any
Riders Associations or Clubs? |
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