8/18/2019 Under Insured Declaration

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UNDER INSURED DECLARATION

Motor Cover Note No :

Vehicle No :

I/ We ………………………………………………………………………………   hereby confirmed

that I/ We am/are aware of my/ our estimate value for my/our car insured under the abovementioned

 policy is below the market price and in view of this under insurance, the insurance principle of

“AVERAGE” will apply and I/ We confirmed and agreed that I/We will be my/our own insurer for

the difference and will bear a rateable proportion of the loss should any own damage claim crises.

And I/We hereby further confirmed and aware that should any major claim crises, and in view of the

sum insured below the market price, I/We hereby agreed that I/We shall accept settlement of any owndamage claim presented by me/us on a ‘TOTAL LOSS BASIS’ in the event that the estimate of

repairs as a adjust by a Licensed Adjuster be such that it will be uneconomical for the Insurers to

settle by any other mode of settlement normally practiced in the insurance market.

I/We finally confirmed that the above has been fully explained to me/us by the undersigned and that

I/We fully comprehend the above text.

Dated this day of ………………………………………… 

Signature of Insured : ……………………………………………………………… 

 Named of insured : ……………………………………………………………… 

I/C No : ……………………………………………………………...

Explained By : ………………………………………………………………. 

 Name : ………………………………………………………………. 

I/C No : ……………………………………………………………….