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20100112120241723

20100112120241723

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Published by: Noor Fazilah Mohd Rashidi on Feb 26, 2011
Copyright:Attribution Non-commercial

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02/26/2011

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.,
QUESTIONNAIRE
-
,
,
ARMOUREDCAROPERATORS
PROPOSALFORM
LSW630
 
Beforeanyquestionisansweredreadcarefullythedeclarationattheendofthisproposalwhichyouarerequiredto
sign.CheckYes
I
Noboxes
asappropriate.
A.
GENERAL
LFullnameofproposer(s)
(in
this
proposalform"you"
referstotheanswertothis
question)2.Name
underwhich
you
trade
3.Listfull
address
ofallyour
business
andyour
principalofficetelephoneandfacsimilenumbers(includingareacodes)
4.Namesunder
which
you
havepreviouslytradedPremises
1
Premises
2
Premises
3
(Continueonaseparatesheet
if
necessary)Mainoffice
te1.no:
Mainofficefax
no:
(Continueonaseparate
sheet
if
necessary)
2
 
5.Namesofofficersandowners,theiraddressesandsocialsecuritynumbers(Continueonaseparatesheetifnecessary)
(a)at
yourpresentaddress
6.
Howlonghaveyoubeen
in
businessascarriers?
(b)
elsewhere
G
Doyouactasalimitedbranchordepositoryforanybankorbankingorganization
?
IfYes,identifyeachandeverysuchbankorbankingorganization
Ie
8,Haveyoubeenorareyoucurrentlyinsured?IfYes,state:
(a)
Namesof:
[i)
insurers
[ii]
brokers
OT
agents
(b)
renewaldateofinsuranceYes
No
(Continueon
a
separatesheetifnecessary)YesNo
3

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