Shriram GI

1.Fill your details ^*

Mobile No *

Email ID *

Car Registration Number.

Your RTO Name.

2.As per IRDAI KYC Mandatory for Insurance. ^*

Document Type *

Document Number *

Document DOB *

2.We are unable to find your KYC details.Please fill the CERSAI form to apply for the KYC. ^*

Proof Type *

Proof Number *

Proof Upload *

Address Proof Type *

Address Proof Number *

Address Proof Upload *

Passport size photo Upload *

Insured DOB *

First Name *

Last Name *

Father's Name *

Mother's Name *

Residential Status *

Marital status *

Spouse Name *

3.Please take a second to conform your car details for us? ^*

Title *

First Name *

Middle Name

Last Name

Gender *

Occupation

PAN Card No

City *

Area *

Specify Your Area^*

Other Area

State *

Pincode *

Address 1 *

Address 2

4.Please take a second to conform your car details for us? ^*

Brand *

Car Model *

Body Type *

Fuel Type *

Vehicle CC *

Seating Capacity *

Registration City *

Registration date *

Manufacturing Year *

Chassis Number *

Engine No *

5.Please take a second to conform your Policy details for us? ^*

Current Policy Type *

Policy Tenure *

Transfer Of Ownership *

TP Policy Number *

TP Policy Start Date *

TP Policy End Date *

TP Policy Insurer Address *

TP Policy Insurer Name *

IDV *

min: - max:

PUCC Number

PUCC Valid from Date

PUCC Valid To Date

PUCC Issuing Authority

Do you have PUCC Certificate? *

6.Have you made an insurance claim in the last year? ^*

Previous Insurer M/s

Existing Policy Number

Prev.Policy Expiry Date

Previous Policy Tenure *

Existing Policy Type

Any Claim In Exsisting Policy

NCB Recived on Exsisting Policy(%)

NCB Applicable for current Policy(%)

No of Claims in 1st Year

No of Claims in 2nd Year

No of Claims in 3rd Year

Existing policy have Nil Depreciation cover?

7.Here's Your Sum Insured Amount ^*

8.Here's Your Basic Premium Details

Quote ID:

Policy Start date:

Policy End date:

Insured Declared Value

The maximum Sum Assured fixed by the insurer which is provided on theft or total

Your idv :

Bill Summary View Complete Breakdown

TOTAL PREMIUM
IGST

TOTAL AMOUNT

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Policy Start date:

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