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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:
16/12/2017


















address-book policy-details summary other-info

Policy Details

Policy Mode *
Product * Policy Tenure *
Risk start Date *     16:11 Risk End Date 15/12/2019

Proposal Details

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
Select Fuel Type *
Date Of First Purchase *     Carrying Capacity
Ex-ShowRoomPrice * Seating Capacity
IDV
IDV for 2nd Year *
IDV for 3rd Year *
Body Type
Previous Policy Details
Claims of Previous Policy   Yes    No 
Previous Policy Type   Package    Liability 
Previous Policy Start Date *     Previous Policy End Date
Previous Policy Number *
Previous Insurance Company Name *
Transfer Of NCB(%)

Insured Declare Value Of

PA Owner Driver  Yes (Note:Nominee details are required if PA to Owner Driver cover is opted for.)
Nominee Name * Relationship With Proposer *
Electrical Accessory
Non Electrical Accessory Unnamed PA Cover to Passenger(s)
CNG/LPG/BiFuelKit
Legal Liabilty To Paid Driver Yes  No 
Named PA Cover to Passenger(s) Enter Sum Insured Enter Name(s)  
Other Discounts
Antitheft Device Discount
  Yes    No 
Automobile Association Discount
  Yes    No 
Handicap Discount
  Yes    No 
Voluntary Deductable
Hypothetication Type Financier Name
Financier Address

Digital Verification

Do you want to digitally verify your policy ?

GST Details

Inward Credit For GST Number * Yes No
GST Number *

Net Premium Final Premium