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Insured Details

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Insured Declared Value

Ex-showroom Price

Premium

Personal Details Edit

Please select title Title*

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Date of Birth*

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Please enter valid PAN no. PAN No.

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Send me the hard copy of my policy
Owing to ongoing pandemic the courier services are impacted. To ensure on time delivery, policy copy will be shared digitally on your mobile number/email ID. If you wish to receive policy document in hardcopy, please tick the option. Please note this facility of providing policy copy using digital mode is applicable only up to March 31, 2022 Read more

Nominee Details

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Please select relationship Relationship with Insured*

Date of Birth*

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I want to update GSTIN/UIN number

Please enter complete GSTIN number GSTIN/UIN Number* e.g.11AAAAA1111A1Z1

PAN number PAN Number

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Vehicle Details Edit

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Please enter Engine number Engine Number

Please enter Chassis number Chassis Number *

Please select Hypothecation/Loan Hypothecation/Loan

Please enter financier name Financier Name*

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Previous Own Damage Policy Details

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New Policy Start Date

Please enter Previous policy number Previous Policy Number*

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My previous policy was a full year policy without change of ownership

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Premium Summary View Breakup

Policy Start Date	Policy End Date	Insured Declared Value	Two Wheeler Premium	Tax	Personal Protect Cover	Total Premium
		`	`	`	`	`

Premium Breakup

A. Own Damage

Basic Premium `0

Electrical Accessories Premium `0

Non-electrical Accessories Premium `0

Road Side Assistance Premium `0

Zero Depreciation Premium `0

Return to Invoice Premium `0

Sub Total (A) `0

Anti-theft Discount`0

Automobile Membership Discount `0

Deduct 0% for NCB`0

Total Discount (B) `0

Total Own Damage Premium (C = A - B)`0

Break in Loading`0

Other Loading `0

Total Loading (L)`0

Package Premium (G = C + F + L)`0

Tax `0

Special Discount:`0

Total Two Wheeler Policy Premium:(H)`0

B. Liability

Basic Premium including premium for Third party`0

Total (D)`0

PA for Unnamed Passenger `0

Compulsory PA Cover for Owner Driver `0

Total (E)`0

Total Liability Premium (F = D + E)`0

C. Personal Protect Cover

Personal Protect Cover`0

GST (%)`0

Personal Protect Policy Premium (I)`0

Total Premium Payable (H+I)`0

I/We do hereby declare that I/we have read and understood the entire text, features, disclosure, benefits, terms and conditions of the policy and I/we further declare that the information furnished above are true to the best of my/our knowledge and no material information, which may be relevant, has been withheld or not disclosed In case any of the information above is found false during verification at a later date, the company would have the right to cancel the policy and premium amount paid will be forfeited.

I/We also declare that any additions or alterations if carried out after the submission of this proposal form then the same would be conveyed to the insurer immediately. I/We declare that the rate of NCB claimed by me/us is correct and that no claim as arisen in the expiring policy period (copy of the policy enclosed).

I/We further undertake that if this declaration is found to be incorrect, all benefits under the policy in respect of Section I of the Policy will stand forfeited. I hold a valid and effective PUC and/or fitness certificate, as applicable, for the vehicle mentioned herein and undertake to renew the same during the policy period. ...Read More

I accept the declaration and agree with the Terms and Conditions
Date: Insurance is the subject matter of solicitation. Product code - Misc 13

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