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Damage Damage to own property/ vehicle Yes Estimate for damage / repairs R Where can the damaged item / vehicle be inspected Name Address Film Entertainment Underwriters SA Pty Ltd Directors Clive R Shelver FIISA Managing Isaac Chindotana CA SA ARM Chairman Valerie Hayter B. A. Broker Details Broker Name HP number Tel Email B. Insured Name of Insured ID Number Occupation Postal Address Cell C. I/We accept and understand that any false or incorrect information could severely prejudice the...
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