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| Full name | AXMEDOV SHUXRAT MAXMUTOVICH |
| ID / Passport | AA 5061419 |
| PINI | 31606840190015 |
| Address | ЯНГИ ХАЁТ МФЙ, 12 МАВЗЕ, uy:30 xonadon:38 |
| Phone number | 998997200173 |
| 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 |
| Insurance amount | zz |
| Insurance premium | 56 000,00 UZS |
| Policy period | с 15.03.2022 по 14.03.2023 |
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.
