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Motor

Quote No. : Q2022104842

Policy Type

Annual

Cover Type

Act only

Transaction Type

New

Policy Term

1 Year

Customer Type

Individual

Organisation

Client Search

Salutatuion

First Name

Last Name

Gender:

Male

Female

Contact No.

Communication Address

Address 1

Address 2

Address 3

Pincode

City

District

State

Auto Populated

Country

Auto Populated

Is Registered address same as Communication Addresss ?

Address 1

Address 2

Address 3

Pincode

City

District

State

Auto Populated

Country

Auto Populated

PAN Number

GSTIN Number

Financiers Interest

IMD General Comments

Vehicle Make/ Model

Registration No.

RTO City & Location

Manufacturing

Policy Start Date

Reg / Purchase Date

Seating Capacity

Double

Body Type

Bike

Scooter

GVW/Carrying Capacity

Fuel Type

System IDV

IDV of Vehicle

Valid PUC

Yes

Financier’s Interest

FRL Emp ID

Engine No

Chassis No

Geographical Extension

Yes

TP Policy No

Tp Policy Start Date

TP Policy End Date

TP Previous insurer name

IMD General Comments

Previous Insurer’s Name

Previous Policy End Date

Previous Policy Number

Claim in Previous Policy

Yes

Add on cover availed in the previous policy

Yes

NCB% in Expiring Policy

Self-Inspection Details

Inspection Number

Inspection Date

Inspection Time 24 Hour format

Inspection Status

IR Number

ASD12345RF87000

Proposal Form

NCB Reserving Letter

Cover Note

Client Code	First Name	Last Name	Corporate Name	Policy Number
54026953	Sushanta	Bhowmik	Startrack	09865482
12345678	Amar	Naik	Startrack	09865482
87659054	Sunil	Naik	Startrack	09865482


Basic OD		₹ 152.43
Loading	0%	₹ 0.00
Commercial Discount	20%	₹ 0.00
Net Basic OD		₹ 152.43
Basic OD1		₹ 152.43
Basic OD2		₹ 152.43
Basic OD3		₹ 152.43
NCB	20%	₹ 30.00
Annual OD Premium		₹ 121.94
Total OD Premium		₹ 122


Basic TP	₹ 752.00
Basic TP1	₹ 752.00
PA Owner Driver	₹ 330.00
Basic TP2	₹ 1082.00
Annual TP Premium	₹ 1082.00
Total TP Premium	₹ 122


Total Premium	18%	₹ 1204
Good and Service Tax		₹ 216.72
Total Payable		₹ 1421

Motor

Communication Address

OD Package

Third Party Covers

Add On Covers

Discount

Commercial Discount

Contact

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Motor

Communication Address

OD Package

Third Party Covers

Add On Covers

Discount

Commercial Discount

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Premium Breakup

OD Calculation

OD Calculation

Premium Posting

Refer to Underwriter

Note