Rollover Private Car - Additional Details
Motor Insurance
Renew from Other Insurer
Premium
Details
Premium Amount
Rs
(Inclusive of all applicable taxes)
Quote ID
Policy Start Date
:
Policy End Date
:
Model Name
:
Plan Type
:
View Premium break up
Covers
All fields are mandatory
Do you Need Cover for Driver / Other Passengers / Car Accessories?
Yes
No
Personal Accident Cover for Unnamed Passengers
Select
50,000
1,00,000
1,50,000
2,00,000
Accident Cover for Paid Driver
Select
50,000
1,00,000
1,50,000
2,00,000
Legal Liability to be Paid to Driver
Yes
No
Legal Liability to be Paid to Employee
Yes
No
Is the Vehicle Fitted with Fibre Glass Petrol Tank?
Yes
No
Do you Need Cover for Non-Electrical Accessories?
Yes
No
Name
Make/Model
Value
Add
Add
Remove
Add
Remove
Add
Remove
Add
Remove
Add
Remove
Remove
Do you Need Cover for Electrical Accessories?
Yes
No
Name
Make/Model
Value
Add
Add
Remove
Add
Remove
Add
Remove
Add
Remove
Add
Remove
Remove
Do you Need Cover for Towing?
Yes
No
Select
500
1000
1500
Premium Details
With Covers
Premium Amount
Rs
(Inclusive of all applicable taxes)
Quote ID
Policy Start Date
:
29/01/13
Policy End Date
:
29/01/14
Model Name
:
1
Plan Type
:
View Premium break up
Additional
Details
Registration No.
Engine No.
Chassis No.
Is the Vehicle Financed?
Yes
No
Type of Finance
Select
Hypothecation
Hire purchase
Lease
Financier Name and Location
PAN
Does the vehicle have valid Pollution Under Control (PUC) Certificate?
Yes
No
Pollution Certificate Number (PUC)
PUC Valid Upto
Nomination for PA
Name of Nominee
Age
Relationship with Insured
Choose one
Spouse
Father
Mother
Son
Daughter
Brother
Sister
Grand Son
Grand Daughter
Grand Father
Grand Mother
Father-in-Law
Mother-in-Law
Son-in-Law
Daughter-in-Law
Brother-in-Law
Sister-in-Law
Uncle
Aunt
Cousin
Nephew
Niece
Legal Guardian
Name of Guardian
Age
Relationship with Nominee
Choose one
Spouse
Father
Mother
Son
Daughter
Brother
Sister
Grand Son
Grand Daughter
Grand Father
Grand Mother
Father-in-Law
Mother-in-Law
Son-in-Law
Daughter-in-Law
Brother-in-Law
Sister-in-Law
Uncle
Aunt
Cousin
Nephew
Niece
Legal Guardian
Contact Address
Address 1
Address 2
Address 3
Address 4
City
Pincode
Vehicle Registration Address
Is the registration address same as the communication address?
Yes
No
Address 1
Address 2
Address 3
Address 4
City
Pincode
Proposal Number:
Premium Break up Details
A - Own Damage
Rs
Basic premium on Vehicle & Non-Electrical Accessories
Rs
Electrical & Electronics Accessories at 4% :
Rs
Additional Towing Charges
Rs
Bi-Fuel kit (CNG):
Rs
Add :
Fibre Glass Tank :
Rs
Less :
Automobile Association Discount :
Rs
Voluntary Deductible of
RS
0.0
:
Rs
Less : No claim Bonus :
Rs
Add:
Additional Cover for Package Policies
Depreciation Waiver Clause :
Rs
Wind Shield Glass Clause :
Rs
Life Time Road Tax Clause :
Rs
Spare Car Clause :
Rs
Invoice Price Insurance Clause :
Rs
Loss of Baggage Clause :
Rs
Engine Protector :
Rs
NCB Protector :
Rs
Key Replacement :
Rs
Tyre Cover :
Rs
Total OD Premium
Rs
B - Liability
Rs
Basic premium including premium for TPPD
Rs
Bi-Fuel kit (CNG)
Rs
Add
Personal Accident Benefits
-
Under Section III (Owner driver), CSI
Rs
15,00,000 :
Rs
Unnamed Passengers :
Rs
PA Cover to Paid Drivers :
Rs
Legal Liability
To Paid Drivers (WLL Driver)
Rs
To Employees
Rs
TOTAL LIABILITY PREMIUM
Rs
PACKAGE PREMIUM (OD+Liability)
Rs
Kerala Flood Cess @ 1%
Rs
TOTAL PREMIUM EXCLUDING TAXES
Rs
Service Tax
Rs
Swachh Bharat cess
Rs
Krishi Kalyan cess
Rs
IGST
Rs
SGST
Rs
CGST
Rs
UTGST
Rs
TOTAL PREMIUM PAYABLE
Rs
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