INSURANCE APPLICATION FOR ROAD TO SAIGON 2018 Driver 1 (Proposer) Have you previously taken part in an organised rally? Yes No If Yes, please list these events? Name: Address: Postal/Zip Code: Type of Licence: Licence Number: (e.g. Full International) Date Passed Test: Country of Issue: Date First Licence Obtained: Nationality: Occupation: Date of Birth: Industry / Trade: Passport Number: Expiry Date: Driver 2 / Co-Driver Have you previously taken part in an organised rally? Yes No If Yes, please list these events? Name: Address: Postal/Zip Code: Type of Licence: Licence Number: (e.g. Full International) Date Passed Test: Country of Issue: Date Licence Obtained Nationality: Occupation: Date of Birth: Industry / Trade: Passport Number: Expiry Date: If additional drivers are required, please show full details on the supplementary page provided Your Vehicle PLEASE ATTACH A PHOTOGRAPH – Are you the owner of the vehicle? Yes No If not, please provide name of owner and the nature of your relationship : Make/Model: Year of Make: VIN / Chassis No: Engine Capacity: Passenger capacity: Current Value in GBP: £ (including driver) Please Note: Tysers do not verify the current values of the vehicle, failure to supply the correct value may lead to the vehicle being underinsured.
INSURANCE APPLICATION FOR ROAD TO SAIGON 2018 Driver 1 (Proposer) Have you previously taken part in an organised rally? Yes No If Yes, please list these events? Name: Address: Postal/Zip Code: Type of Licence: Licence Number: (e.g. Full International) Date Passed Test: Country of Issue: Date First Licence Obtained: Nationality: Occupation: Date of Birth: Industry / Trade: Passport Number: Expiry Date: Driver 2 / Co-Driver Have you previously taken part in an organised rally? Yes No If Yes, please list these events? Name: Address: Postal/Zip Code: Type of Licence: Licence Number: (e.g. Full International) Date Passed Test: Country of Issue: Date Licence Obtained Nationality: Occupation: Date of Birth: Industry / Trade: Passport Number: Expiry Date: If additional drivers are required, please show full details on the supplementary page provided Your Vehicle – PLEASE ATTACH A PHOTOGRAPH Are you the owner of the vehicle? Yes No If not, please provide name of owner and the nature of your relationship : Make/Model: Year of Make: VIN / Chassis No: Engine Capacity: Passenger capacity: Current Value in GBP: £ (including driver) Please Note: Tysers do not verify the current values of the vehicle, failure to supply the correct value may lead to the vehicle being underinsured.
Application-Form-Road-to-Saigon.docx