THE NEW INDIA ASSURANCE Coun? (remem tet) NO CLAIM SELF-DECLARATION 1 Mada khedan he Peon. bearing the Emirates Id No #8.%..(0&¢. 20657 Ha. Séomtirm that have not made any surance claims in the past one year and I have previously been insured with the GaIeynes | W097 3 ME Nee Le cm | understand that The New India Assurance Company, Dubai reserves the right to avoid an insurance claim should this information be incorrect. Also If The New India Assurance Company, Dubai finds any accident prior to NIA’s policy, the company has the right to send the vehicle to their panel garage for repair and the agency repair stated in the policy schedule will automatically become void. Regards, Signature: . Mobiles ..056, ~he2stge , “The New India Assurance Comony Ltd P.0 Box $701, Duba, UAE, Tel +971 43525563/3522To, The New India Assurance Co. LTD. Dubai, UAE | hereby declare that after the expiry date of my car insurance (17/08/2017) there is no accident as on 20/08/2017. Chassis No. LUCCR2629G3406015 Plate No. 152196 Kindly provide the insurance A ra (JOE NADAKKALAN KOCHAPPAN)