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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:
18/01/2017


















address-book policy-details summary other-info

Policy Details

Policy Mode *
Product * Policy Tenure *
Risk start Date *     04:52 Risk End Date 17/01/2019

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 *

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)
CNG/LPG/BiFuelKit
Other Covers
Hypothetication Type Financier Name
Financier Address
Net Premium Final Premium