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Information of the insured person

Full name	AXMEDOV SHUXRAT MAXMUTOVICH
ID / Passport	AA 5061419
PINI	31606840190015
Address	ЯНГИ ХАЁТ МФЙ, 12 МАВЗЕ, uy:30 xonadon:38
Phone number	998997200173

Owner data

Full name

AXMEDOV SHUXRAT MAXMUTOVICH

Vehicle information

Vehicle make and model	NEXIA 3
Year of issue	2019
Gov Number	01H283EB
Vehicle body (chassis) number	XWBTF69V1KA048034
Vehicle engine number	B15D211190237GRXX0529
Vehicle registration certificate	AAF 0549179

Information about Polis

Insurance policy validity period
Insurance amount	null
Insurance premium	null

I certify that the information I have provided in this application form is accurate and complete and that I have read the rates and premiums to be paid. In addition, I undertake to notify of any changes to the subject matter of insurance during the term of the Contract.

Contacts

Designation	MAXDORA
TIN	306334591
Address	Chilonzor 2/2
Phone number	998997200173

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