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Do you want to buy policy for		New Car Renew Policy
Previous Policy Type*		Comprehensive Third Party Only
Previous Policy Issued By*		Select a Company ICICI Lombard Bajaj Allianz TATA AIG Reliance General Cholamandlam MS IFFCO-TOKIO Royal Sundaram New India Assurance National Insurance United India Oriental Insurance HDFC Ergo Future Generali Bharti Axa General Shriram General Universal Sompo
Previous Policy Expiry Date*
Likely date of purchase *
City where Car is registered (RTO) *
Pincode of the Vehicle Registered Address *
Manufacturer Name *		Select a Manufacturer ALFA ROMEO ASTON MARTIN AUDI AUSTIN MOTOR BAJAJ AUTO BAJAJ TEMPO BENTLEY BMW BUICK CADILLAC CHEVROLET CHRYSLER DAEWOO DAIHATI DAIMLER FERRARI FIAT FORCE MOTORS LTD FORD HAWAKEYE HINDUSTAN HOLDEN HONDA HUMBER HUMMER HYUNDAI ICML ISUZU JAGUAR KAISER KIA MOTORS LAMBORGHNI LAND ROVER LEXUS LINCOLN MAHINDRA AND MAHINDRA MAHINDRA RENAULT MAINI MARUTI MASERATI MAYBATCH MAZDA MERCEDES-BENZ MG-B MITSUBISHI NISSAN MOTORS OPEL PEUGEOT PIAGGIO PLYMOUTH PORSCHE PREMIER ROLLS ROYCE ROVER SAN SIMGAR SIPANI SKODA SSANGYONG STANDARD MOTOR STUDE SUBARU SUZUKI SWARAJ MAZDA TATA TOYOTA TVS MOTOR VAUXHALL MOTORS VOLKSWAGEN VOLVO WILLEYS
Model *		Select a Model
Variant *		Select a Variant
Fuel Type*		Petrol Diesel Inbuilt CNG Inbuilt LPG Hybrid CC Seater
Manufacturing Year *		--Not Selected-- 20102011
Ex-Show Room Price*
Value of vehicle in previous insurance policy.*
Suggested IDV*		Variance   0 +5 +10 -5 -10
Would you like to transfer No Claim Bonus from your previous Car*		Yes No
Claims made in expiring policy *		Yes No
No Claim Bonus (NCB) in previous policy*		Select NCB 0 20 25 35 45 50 55 65   New NCB
Voluntary deductible per claim (in Rs.)*		0 2500 5000 7500 15000
Vehicle Registered in the name of an *		Individual Company
Age of Owner driver (in years)
Profession of owner driver		--Select Profession-- Practicing Chartered Accountant Central/State Government Employees Doctors registered with Government Doctors registered with Government Teacher in Govt. recognized Institutions Others
Where is the vehicle parked usually		Garage Open

Do you want Additional Covers?   No Yes
Value of Electronic Accessories (in Rs.)			Installation Date Jan Feb Nov Dec Mar Apr May Jun Jul Aug Sep Oct - 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Value of Non Electronic Accessories(in Rs.)			Installation Date Jan Feb Nov Dec Mar Apr May Jun Jul Aug Sep Oct - 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Value of LPG/CNG kit if any (in Rs.)			Installation Date Jan Feb Nov Dec Mar Apr May Jun Jul Aug Sep Oct - 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Geographical Extension Country		Yes No
Select Country		--Select Country-- Sri Lanka Bhutan Nepal Pakistan Bangladesh Maldives
Embassy Loadings		Yes No

Additional Discounts?   No Yes
Automobile Association membership?		Yes No
Membership Number
Is ARAI approved anti-theft device installed?		Yes No
Handicapped Person?		Yes No

Coverage for Additional Liabilities?   No Yes
Accident cover for un-named passengers		0" 10000 20000 30000 40000 50000 60000 70000 80000 90000 100000 110000 120000 130000 140000 150000 160000 170000 180000 190000 200000
Employees Liability		Yes No
Legal Liability cover for Paid driver		Yes No
TPPD Limit Restriction		Yes No