18/12/2011

Ca In

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De ail fo Polic N mbe MOT256824798

Dea Mohammad Kam Welcome, o We ill po o Doc men . ca i no in

l in ed ihJ Ca In ance. o o king da . Yo can al o p in a cop of he polic f om Polic

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The follo ing info ma ion abo o and o J Ca In ance polic fo m he ba i of o ag eemen o in e o ca . O ag eemen elie on he acc ac of he info ma ion o ha e gi en . Plea e call J Ca In ance on 13 13 26 o email on con ac @j ca in ance.com.a if an info ma ion i inco ec . We ill hen make he change and end o a ne polic ched le. Op ion Incl ded Thi d Pa Fi e And Thef Thi op ion inc ea e o anda d Thi d Pa P ope fo he c en ma ke al e of o ca p o $10,000. Polic No Polic pe: Ca e: Pe iod of Co e Po code of in add e : ed

Damage co e o incl de lo

o damage a i ing o

of fi e and hef

MOT256824798 Thi d Pa Fi e and Thef P i a e - P i a e U e (Incl. Comm ing To/F om Wo k) 18 Dec 2011 o midnigh 18 Dec 2012 3072

Yo ca WQM 939 1998 MITSUBISHI MIRAGE CE F/INJ 3D HATCHBACK 4 CYL AUTO Yo ad i ed o ca ha no n epai ed damage Dec 2011 $2,000

P cha e da e: To al ca p cha e p ice:

E ce e The e a e he e ce S anda d E ce

o m

con ib e o each claim:

Co e Thi d Pa P ope Damage p o $20 million. $550 Fo an addi ional p emi m o can al o e end o co e o Fi e and Thef Damage fo c en ma ke al e p o $10,000 Modifica ion Ai Fil e e ha e ag eed o co e

If applicable, o ma al o need o pa one o mo e of he follo ing e ce e in addi ion o he e ce e li ed abo e. Age E ce e Female D i e

Aged 16 - 21

$650 Non- anda d acce

o ie

e ha e ag eed o co e

Female D i e Aged 22 - 24 Male D i e Aged 16 - 21 Male D i e Aged 22 - 24 D i ing Hi o The d i e a e M Ha an The combined hi o of d i e Claim and Acciden Nil
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$550 Ai Condi ioning, Ala m, Cen al Locking, Floo Ma , Ke le $700 En , Tin ed Windo $600 Endo emen Nil Receip Receip No. Receip Da e

fo he pa

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47538954 18 Dec 2011

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18/12/2011

Ca In

ance

Thefts Nil Licence Suspensions/Cancellations & Disqualifications Nil

Total Annual Pa ment Premium Amount Ta e Incl ded GST S amp D Incl de Benefi and Op ion Thi d Pa Fi e And Thef Total Pa ment Amount (includes GST)

$262.00 $29.09 $32.00

$90 $352.00

Cooling Off Af e hi co e begin , o ha e 21 da o con ide he info ma ion in he P od c Di clo e S a emen . Thi i called he 'cooling off pe iod'. If o decide o cancel o polic , ei he d ing he cooling off pe iod o a an o he ime, e'll ef nd he ne pi ed po ion of he p emi m le an non ef ndable a e and le $30 of p emi m (pl an a e ) hich e keep o co e o ea onable admin co .

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