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Rect this to the Insurance Company for action. 4. All questions on this form must be answered. 5. Repairs must not be authorized without prior authority of the Insurance Company. MOTOR ACCIDENT REPORT FORM INSURED POLICY VEHICLE USE COMMERCIAL VEHICLES DRIVER Name Business/Occupation Address Code Town Email Address Tel. No. (Land Line) Tel. No. (Cell Phone) Number Expiry Date Name of Hire Purchase or Finance Company Make & Model Reg. No. of Vehicle Carrying Capacity Reg. No. of Trailer Ca.

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