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O BOX 7390 Dar Es Salaam Tanzania t 255 22 266 4204/4209 f 254 22 266 210 Website www. heritagetanzania.com https //www. Facebook. com/heritagetanzania/ CLAIM FORM MOTOR ACCIDENT 1 POLICY NO. Name of Insured EXPIRY DATE IMPORTANT NOTICE 1. 13 INDEPENDENT WITNESS If Driver or Passenger Apparent injuries PASSENGERS IN YOUR VEHICLE Tel. No. and Address I DECLARE that these particulars are true and correct and undertake to forward immediately and unanswered any correspondence relating to this...

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