填空题

Questions 1-5
Complete the form below.
Write ONE WORD AND/OR A NUMBER for each answer.
TAUBER INSURANCE Co.
Policy #:    (1)
Make & Model: Masda Marvel
Engine size: (2)
Name: Lisa Marie Heathcote
Date of Birth: (3) 1955
Password: (4)
Change valuation Yes No
Reduce value to: $(5) 

(4)处填入()

【参考答案】

Jack 1897