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Motor user details Policies

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Buy Motor Policy Online

** All amounts in INR

Existing policy company name

United India Insurance Co. Ltd.

Address of previous Insurance Company

17 RANGARAJ MAIN ROAD, Tnagar,CHENNAI

Email of previous Insurance Company

rajaexp@gmail.com

Phone Number of previous Insurance Company

09840364573

Existing policy number

23145643

Existing policy start date

16/01/2014

Existing policy expiry date

31/01/2015

Full name of Insured

kumar dev

Address for Communication

55 ganapth street tnagar

State

TAMIL NADU

City

CHENNAI

Pin Code

600024

Email address

raviraj@gmail.com

Mobile number

9868578748

Occupation

BUSINESS

Type of Vehicle *

MOTORISED-TWO WHEELERS

Type of Policy

PACKAGE POLICY

RTO Zone

Zone A - Ahmedabad, Bangalore, Chennai, Hyderabad , Kolkata, Mumbai, New Delhi and Pune.

City of Purchase

CHENNAI

Manufacturer Name *

HONDA SCOOTER

Model *

ACTIVA

Variant *

DLX

Cubic Capacity of vehicle

109

Seating capacity including driver

Date of first registration of Vehicle

09/01/2014

Date of purchase of vehicle

09/01/2014

Is vehicle using non-conventional source of fuel ? *

No

Type of Fuel

NA

Extension of Geographical area required ? *

No

If extended Geographical area selected then Countries available in

NA
that area
Do you wish to opt for higher deductible over and above the
compulsory ? *

No

If Higher Deductible then amount selected

NA

Are you a member of Automobile Association of India ? *

No

Registration Number

NA

Is vehicle fitted with anti theft device ? *

No

Item Name

NA

Cost

NA

Manufacturer's Name

NA

Do you wish to cover legal liability to driver ? *

No

Do you wish to cover legal liability to other employee ? *

No

Number of employee(s)

NA

Do you wish to have PA cover for unnamed persons ? *

No

Capital Sum Insured

NA

Do you have a CNG/ LPG Kit ? *

No

Value

NA

Description

NA

Is CNG/LPG registered with RTO ?

No

Non Electrical Accesories Value

NA

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Motor user details Policies

Non Electrical Accesories Description

NA

Electrical Accesories Value

NA

Electrical Accesories Description

NA

Side Car Accessories Value

NA

Side Car Accessories Description

NA

Organisation Name

NA

Membership number

NA

Member Declaration

NA

Were there any claims in expiring policy?

No

% of NCB enjoyed in existing policy

Own Damages Premium

609

Third Party Premium

514

NCB Discount percentage

No claim bonus discount amount

Service Tax

139

Premium

1262

Sum Insured or IDV

39617

Start date of new policy *

01/02/2015

End Date of new policy *

31/01/2016

State of oriental insurance Office

TAMIL NADU

City/Town

CHENNAI

Branch/Office

DO 4 CHENNAI

Vehicle Registration Number

TN-09-SB-1421

Engine Number *

5674362511

Chassis Number

8740234532

Color *

Metallic BROWN

Has an insurance company ever declined/cancelled the proposal

and refused to renew/impose special conditions? *

No

Hypothecation Type *

NA

Name of Company

NA

Address of Company

NA

State

NA

City

NA

Pin Code

NA

NCB declaration*
I/ we declare that the rate of NCB claimed by me/us is correct and that no claim has 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 also undertake that the name, address, telephone number of my/ our current insurer, the policy number, type of cover and policy period supplied by me/ us in proposal form on
the portal of The Oriental Insurance Company Limited are correct and true to the best of my knowledge and in the event of the same being found incorrect, it will be treated as
misrepresentation of material fact on the proposed policy and as such all the benefits under the policy in respect of Section I of the Policy will stand forfeited. I also undertake to
preserve the existing policy and to produce the same to the OIC for verification on demand.
Declaration *
I/we hereby declare that the statement made by me/us in this proposal form is true to the best of my/our knowledge and belief and I/we hereby agree that this declaration shall
form the basis of the contract between me/us and the OICL. I/we also hereby declare that if any additions or alterations are carried out after the submission of this proposal form
then the same would be conveyed to the insurer immediately. I/we also understand that if any incorrect details are entered , the claim may not be awarded.
Agree

Back

Disagree

Confirm and Proceed to Payment

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