Car Insurance Data Collection Form
PERSONAL
DETAILS
Title Mr
First Name Eric
Surname Asare
Date of Birth 05/03/98
Marital Status Divorced
Children Under None
16
Current None
Occupation
Sector None
CONTACT
DETAILS
Door No: 56
Address Devon road
Barking
Essex
Postcode IG11 9XY
Telephone 020844534354656
Car Details
Make Bugatti
Model Veyron super sport
Registration AUSDHUHE
Year 2014
Colour Black
Miles Driven 220
Seats 2
Doors 2
Left/Right hand Right
drive
INSURANCE DETAILS
Cover Comprehensive: Third Party:
Where kept Street: Garage: yes Driveway:
overnight
Cover to start 6/2/14
date:
Annual or Annual: Monthly:yes
monthly
payment
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