APPLICATION FOR INSURANCE TRANSFER

To

The Manager / Secretary

__________________________Insurance Co. Ltd.

Ref : Transfer Insurance Policy of Vehicle No.____________________________________________

Certificate of Insurance Policy No. _______________________________________________________

Dear Sir / Madam,

I / We have sold my / our Vehicle No. __________________________________________________________

To Shri / Shrimathi / M/s. ____________________________________________________________________

Insured with you under risk of Act/Third/Comprehensive Policy No. __________________________________

Valid up to ____________________________________ please transfer the right of said insurance interests in

his/her/their names and oblige.

Please charge the transfer fee and any other difference of premium, if any becomes due from the said
purchaser.

Thanking You

Yours faithfully,

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Dated:

Encl.: Certificate Policy