Insurance Application -
New Insurance Policy (MUMBAI Only)
Asset Details ( Car to be Insured )
Car Make
:
Manufacturer
IMPORTED
DAEWOO MOTORS
DAIMLERCHRYSLER INDIA
FIAT INDIA
FORD INDIA
GENERAL MOTORS
HINDUSTAN MOTORS
HONDA SIEL
HYUNDAI MOTOR
MAHINDRA AND MAHINDRA
MARUTI UDYOG
MITSUBISHI MOTORS
SAN MOTORS
SKODA AUTO
TELCO
TOYOTA KIRLOSKAR
*
Model
:
* Showroom
(Rs) :
*
Chassis No
:
*
Engine No
:
*
Other Features :
A/C
Power Steering
Auto Transmission
Metallic Color
Place of Registration :
*
Is the Car under a Finance Contract
No
Hypothecation
H/P
Lease
*
If a Finance Contract exists - Name of Bank / Finance Co
INSURANCE POLICY DETAILS
Name of Policy Holder :
*
Insurance Company you prefer :
Select Insurance Company
The New India Assurance Co. Ltd
The Oriental Insurance Co. Ltd
The National Insurance Co. Ltd
The United India Insurance Co. Ltd
*
Address
of Policy Holder
(As you would want it to appear on the Insurance Policy)
The address in the policy is same as that which appears in the RTO registration book
Street 1
Street 2
Street 3
Tel.No (Office)
(Office)
(Res)
Fax.No
Contact Person
:
Contact Tel.No
:
Your E-Mail i.d.
*
Addition info and your remarks :
Fields marked
*
are required fields