Part 2. Complete the form below. Write no more than two words or a number for each answer.

TAUBER INSURANCE Co

Example                          Answer

Insurance type:              Vehicle

Policy:                             (6) _{…………………………………}

Make & Model:              Masda Marvel

Engine size:                    (7) _{…………………………………}cc

Name:                             Lisa Marie Heathcote

Date of Birth:                 (8) _{…………………………………}1955

Password:                       (9) _{…………………………………}

Change valuation?         Yes

                                        No

Reduce value to:            (10) $ _{…………………………………}

Notes to be added to policy:

Add new driver:            

Name:                             Samel Michaels

Age:                                28

Relationship to main driver:   (11) _{…………………………………}

Reason:                           (12) _{…………………………………}

Client / new driver to provide:

                                        * Verified (13) _{…………………………………}of driver licence

                                        * Clean driving (14) _{…………………………………}

Start date:

                                        * (15) _{…………………………………}

                                        * Full cover when paperwork appoved