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Dear Customer,

Kindly fill your policy details.

Click the next button to verfiy all cover details of the policy and calculate your premium.


Today's date:
24/03/2017


















address-book policy-details summary other-info

Policy Details

Policy Mode *
Product * Policy Tenure *
Risk start Date *     17:32 Risk End Date 23/03/2019

Proposal Details

Proposer Type *   Individual     Corporate  Address Line1 *
Proposer Name * Address Line2 *
Gender *   Male    Female  Proposer State *
Mobile Proposer City *
Phone Number Area/Village *
DOB(dd/mm/yyyy) *     Pin Code *
Email Id *

Digital Verification

Do you want to digitally verify your policy ?

Vehicle Details

Vehicle Class * Registration Date *    
RTO Name *
RTO Location Zone * Registration No *
Manufaturing Year * Chassis Number *
Manufaturer Name * Engine Number *
Vehicle Model * Cubic Capacity
Date Of First Purchase     Carrying Capacity
Ex-ShowRoomPrice Seating Capacity
IDV
Gross Vehicle Weight
Body Type
Previous Policy Details
Previous Policy Type   Package    Liability  Previous Vehicle Sale Date    
Previous Policy Start Date *     Previous Policy End Date
Previous Policy Number *
Previous Insurance Company Name *
Previous Insurance Company Address

Insured Declare Value Of(Liability)

PA Owner Driver  Yes (Note:Nominee details are required if PA to Owner Driver cover is opted for.)
Nominee Name* Relationship With Proposer *
Unnamed PA Cover to Passenger(s)  Legal Liabilty To Paid Driver   Yes    No
Named PA Cover to Passenger(s) Enter IDV   Enter Name(s)
Other Covers

Hypothetication Type Financier Name
Financier Address
Net Premium Final Premium