Long Term Policy

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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:

Policy Details

Policy Mode *
Product *		Policy Tenure *
Risk start Date *	Mandatory! Invalid date! 06:04 Date out of range!	Risk End Date	24/04/2026

Proposal Details

Type *	Individual	Address Line1 *
Proposer Name *		Address Line2 *
Gender *	Male Female	Proposer State *
Mobile *		Proposer City *	Please wait...
Phone Number		Area/Village *	Please wait...
DOB(dd/mm/yyyy) *	Mandatory! Invalid date! Date out of range!	Pin Code *
Email Id *

Vehicle Details

Vehicle Class *		Registration Date *	Mandatory! Invalid date! Date out of range!
RTO Name *	RTO Registration Name.
RTO Location Zone *	Ahmedabad,Bengaluru,Chennai,Hyderabad,Kolkata,Mumbai, New Delhi & Pune Lies in Zone A. For Rest Of India Please Refer Zone B. Please wait...	Registration No *

Manufaturing Year *		Chassis Number *
Manufaturer Name *		Engine Number *
Vehicle Model *		Cubic Capacity
Select Fuel Type *	Fuel Type.
Date Of First Purchase *	Mandatory! Invalid date! Date out of range!	Carrying Capacity
Ex-ShowRoomPrice *	Please Enter Ex-ShowRoomPrice	Seating Capacity
IDV
IDV for 2nd Year *		IDV for 3rd Year *
Body Type		PUC Number
PUC Center		PUC Valid Upto	Mandatory! Invalid date! Date out of range!

Previous Policy Details

Yes

No

Claims of Previous Policy	Yes No
Previous Policy Type	Package Liability

Previous Policy Start Date *	Mandatory! Invalid date! Date out of range! Invalid date! Date out of range!	Previous Policy End Date
Previous Policy Number *		Renewal Notice Received
Previous Insurance Company Name *		NCB Confirmation Received
Transfer Of NCB(%)		NCB Declaration Received

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	Please Enter Sum Insured for Electrical Accessory
Non Electrical Accessory	Please Enter Sum Insured for Non Electrical Accessory	Unnamed PA Cover to Passenger(s)	Please Enter Sum Insured for Unnamed PA Cover to Passenger(s)
CNG/LPG/BiFuelKit		Legal Liabilty To Paid Driver	Yes No
Named PA Cover to Passenger(s) Please Enter Named PA Cover IDV greater than 10000	Enter Sum Insured Enter Name(s)

De-Tariff Discount		De-Tariff Loading
Other Covers	Yes No
Private Carriers	Limited to Own premises

Other Discounts

Yes

No

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 ?

Yes

No

GST Details

I agree to the terms & conditions & I confirm that my vehicle has a valid PUC certificate.
Inward Credit For GST Number *	Yes No
GST Number *

Net Premium		Final Premium