Registration Details

Branch Name : Mumbai Corporate Office

Registration Number*

Mobile Number*

Email Id*

Product*

Risk Start Date*

Risk End Date*

Policy Tenure*

Two Wheeler Insurance

Car Insurance

Registration Details

Product*

Registration Number*
Please Enter Valid Registration No.!

Mobile Number*

Email Id*

State*

City*

Mobile Number* Please Enter Valid Mobile No.!

Email Id*

Risk Start Date*

Risk End Date*

I agree to the Terms and Conditions

Policy Tenure*

Vehicle Details

Vehicle Class*

RTO Location Zone*

Manufacture Year*

Vehicle Registration Date*

Manufacturer Name*

Vehicle Model*

Vehicle Details*

Previous Policy Details

Do you have previous Policy?
Yes No

Previous Policy Start Date*

Previous Policy End Date*

Having a personal accident cover is mandatory by law. This provides coverage for bodily injury or death of the owner-driver in case of an unfortunate accident.

By not selecting this, you agree that you either a) already have a PA cover of 15 Lakhs or b) Do not have a valid driving license.

Claims against Previous Policy?
Yes No

NCB Declaration Received

Yes No

Renewal Notice Received

Yes No

NCB Confirmation Received

Yes No

NCB*

Having a personal accident cover is mandatory by law. This provides coverage for bodily injury or death of the owner-driver in case of an unfortunate accident.

By not selecting this, you agree that you either a) already have a PA cover of 15 Lakhs or b) Do not have a valid driving license.

Policy Type

Package Liability

Insured Declared Value (IDV)

Ex-showroom Price*

IDV*

Add On Covers Details

PA Owner Driver
Yes No

Having a personal accident cover is mandatory by law. This provides coverage for bodily injury or death of the owner-driver in case of an unfortunate accident.

By not selecting this, you agree that you either a) already have a PA cover of 15 Lakhs or b) Do not have a valid driving license.

Manufacturing Selling Price
Yes No

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Legal Liabilty To Paid Driver
Yes No

Cover provided to the driver (Under Workmen’s Compensation Act) for death or disability while driving the insured's vehicle.

Key Replacement
Yes No

This add-on reimburses you for the cost incurred due to the replacement of lost or stolen car lock or key. It holds validity up to 2 claims during a policy period.

Accidental Hospitalization Cover
Yes No

With this, the insurer provides certain emergency services like refuelling, towing, change of flat tyre, mechanic’s services and so on in case the car breaks down

Road Side Assistance Freedom
Yes No

Return to Invoice
Yes No

When you make a claim, it is settled against the depreciated value of the car. However, this Add-On Coverenables you to get the invoice value as well as registration fees, road tax and insurance.

Named / Unnamed PA Cover to Passenger(s)

CNG/LPG/BiFuelKit

Enter IDV

This cover provides protection for externally fitted LPG/CNG kit in your car

Electrical/Non Electrical Accessory

Electrical Accessory*

Cover your car's extra fitted electrical accessories like stereo, fog lamps, buzzers etc

Non Electrical Accessory*

Cover your car's extra fitted non-electrical accessories like roof rack, wheel cover, etc

De-Tariff Discount / De-Tariff Loading

De-Tariff Discount

De-Tariff Loading

Engine Protector

Damage to the engine due to leakage of lubricating oil (in an accident) or when the car is submerged in a waterlogged area and damage to the gear box will be covered.

Daily Cash Allowance

An add-on which compensates you for the cost of hiring an alternative vehicle in case your car is under repair.

Nil Depreciation Waiver

Get depreciation waiver on plastic and metal parts in case of partial loss/claim. This means when you make a claim, you will get the full claim amount without any deduction for depreciation on the value of parts being replaced.

Contact Details

This will be our primary mode of contact. We promise not to spam you.

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Tell us more about you and your Vehicle

Branch Name : Mumbai Corporate Office

Owner Details

Proposer Name*

Address Line1*

Address Line2*

City*

Area/Village*

Pincode*

Mobile Number*

Email Id*

Vehicle Details

Chassis Number *

Engine Number *

RTO Name *

Nominee Name *

Relationship With Proposer *

Enter Name(s) for Named PA Cover to Passenger(s) *

Previous Policy Details

Previous Policy Type *

Package Liability

Previous Policy Number *

Previous Insurance Company Name *

Previous Insurance Company Address

Previous Vehicle Sale Date

Vehicle Details

Branch Name : Mumbai Corporate Office

Previous policy Details

Branch Name : Mumbai Corporate Office

Standard Package

Cost Breakup

Basic TP

₹

Total Third Party Premium

₹

Basic OD

₹

Add-Ons Premium

₹

Own Damage Premium

₹

NCB Discount

-₹ 1,179

Additional Discount

-₹ 1,415

Net Premium

₹

GST(18%)

₹

Final Premium

₹

By proceeding, you accept that the information provided above is true and if found to be false, may impact claims.

Basic OD

₹

Electrical Accessories

₹

Non Electrical Accessories

₹

Nil Depreciation Waiver

₹

De-Tarif Discount

₹

Daily Cash Allowance

₹

Key Replacement

₹

Return to Invoice

₹

Accidental Hospitalization

₹

Manufacturing Selling Price

₹

Road Side Assistance

₹

Engine Protector

₹

NCB Protector

₹

NCB Discount

₹

Basic TP

₹

PA to Owner-Driver

₹

LL to paid driver

₹

Unnamed PA cover to passenger

₹

Named Pa Cover To Passenger

₹

OD Premium

₹

Total TP Premium

₹

Add-Ons Premium

₹

Additional Discount

-₹ 1,415

Net Premium

₹

GST(18%)

₹

Final Premium

₹

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Proposal

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Registration Details

Branch Name : Mumbai Corporate Office

Two Wheeler Insurance

Car Insurance

Registration Details

Vehicle Details

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Previous Policy Details

Do you have previous Policy? Yes No

Claims against Previous Policy? Yes No

Previous

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Policy Type

Insured Declared Value (IDV)

Add On Covers Details

PA Owner Driver Yes No

Manufacturing Selling Price Yes No

Legal Liabilty To Paid Driver Yes No

Key Replacement Yes No

Accidental Hospitalization Cover Yes No

Road Side Assistance Freedom Yes No

Return to Invoice Yes No

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Branch Name : Mumbai Corporate Office

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Vehicle Details

Branch Name : Mumbai Corporate Office

Previous policy Details

Branch Name : Mumbai Corporate Office

Standard Package

Cost Breakup

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Branch Name : Mumbai Corporate Office

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Do you have previous Policy?
Yes No

Claims against Previous Policy?
Yes No

PA Owner Driver
Yes No

Manufacturing Selling Price
Yes No

Legal Liabilty To Paid Driver
Yes No

Key Replacement
Yes No

Accidental Hospitalization Cover
Yes No

Road Side Assistance Freedom
Yes No

Return to Invoice
Yes No