Nitol Insurance | e-insurance

Bank Name

Bank Branch Name

Insued Name With S/O

Postal Address

Borrower Loan A/c

Policy No

Date

Mobile No

CNIC No

Description of Animal

Animal Name

Date Of Birth/Age

Colour

Breed

Sex

Tag/Tatoo

Date of Purchase

Purchase Price (Tk)

Sum Insured(Tk)

#	Name	Colour	Sex	Purchase Date	Price	Sum Insured	Action

I certify that the animal(s) particulars, value and other information's are correct of any knowladge and belief.

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(6th Floor), Tower-2, Plot-2, Road-144,
Gulshan-1, Dhaka, Bangladesh.