RENEW YOUR INSURANCE POLICY

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Current Policy Details

Policy No.

Product Type

Policy Period

To

Gross Premium

Insurance Company

Questionary

1. If policy is transferred from one customer to other customer

Transfer case

Yes No

2. Whether there is any claim on current policy

Claim

Yes No

Proposer Details

* Please enter correct contact number and E-mail Id as SMS and Email will be sent for the renewed policy number.

Proposer Type

Individual Corporate

Proposer Name*

Select Mr. Ms. Dr. Col. Brig. Maj. Mrs. Capt. Wg Cdr Lt. Col. Justice Adv Rev Prof Shri CDR. WG CDR (Retd) Gp.Capt. Smt. SISTER Lt.Gen SQN LDR Sub Major LT. CDR FLT.LT. SARDAR Rt Rev Warrant Off. Mohd Fly Offr. SGT. SLT Baba Sant Maj. Gen Most Rev. Subedar FR. Gr.Capt ADD.SECY MCERA Bro. LT. SUB LT HAV. CMDE General FG OFFR AIR CMDE

*

Date of Birth*

Gender

Male Female

Address1 *

Mobile No *

Address2

PanCardNumber

Address3

Occupation

--Select-- Business Others--Specify Profession Service

State*

--Select-- ANDAMAN ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU JHARKHAND KARNATAKA KERALA LADAKH LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ODISHA PUDUCHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL

Pin Code*

City*

Landline

EmailID *

Company Name *

Select Lessee M/S SHREE THE

Contact No. *

CompanyAddress *

State *

--Select-- ANDAMAN ISLANDS ANDHRA PRADESH ARUNACHAL PRADESH ASSAM BIHAR CHANDIGARH CHHATTISGARH DADRA AND NAGAR HAVELI DAMAN AND DIU DELHI GOA GUJARAT HARYANA HIMACHAL PRADESH JAMMU JHARKHAND KARNATAKA KERALA LADAKH LAKSHADWEEP MADHYA PRADESH MAHARASHTRA MANIPUR MEGHALAYA MIZORAM NAGALAND ODISHA PUDUCHERRY PUNJAB RAJASTHAN SIKKIM TAMIL NADU TELANGANA TRIPURA UTTAR PRADESH UTTARAKHAND WEST BENGAL

City *

Pin Code *

Contact Person Name *

Select Mr. Ms. Dr. Col. Brig. Maj. Mrs. Capt. Wg Cdr Lt. Col. Justice Adv Rev Prof Shri CDR. WG CDR (Retd) Gp.Capt. Smt. SISTER Lt.Gen SQN LDR Sub Major LT. CDR FLT.LT. SARDAR Rt Rev Warrant Off. Mohd Fly Offr. SGT. SLT Baba Sant Maj. Gen Most Rev. Subedar FR. Gr.Capt ADD.SECY MCERA Bro. LT. SUB LT HAV. CMDE General FG OFFR AIR CMDE

Designation *

Email ID*

Mobile No. *

Landline

Nominee Details

Nominee Name *

--Select-- Capt. Wg Cdr Lt. Col. Lt.Gen Sub Major Smt. SQN LDR SARDAR Gp.Capt. FLT.LT. Mr. Ms. Dr. Col. Brig. Maj. Mrs. Prof Shri CDR. WG CDR (Retd) Justice Adv Rev SISTER LT. CDR Rt Rev Warrant Off. Mohd Fly Offr. SGT. SLT Baba Sant Maj. Gen Most Rev. Subedar FR. MCERA Gr.Capt ADD.SECY Bro. LT. SUB LT HAV. CMDE General FG OFFR AIR CMDE

Relationship *

--Select-- BROTHER DAUGHTER FATHER MOTHER OTHER SISTER SON SPOUSE

Age *

Gender *

Male Female

Name of Appointee

--Select-- Capt. Wg Cdr Lt. Col. Lt.Gen Sub Major Smt. SQN LDR SARDAR Gp.Capt. FLT.LT. Mr. Ms. Dr. Col. Brig. Maj. Mrs. Prof Shri CDR. WG CDR (Retd) Justice Adv Rev SISTER LT. CDR Rt Rev Warrant Off. Mohd Fly Offr. SGT. SLT Baba Sant Maj. Gen Most Rev. Subedar FR. MCERA Gr.Capt ADD.SECY Bro. LT. SUB LT HAV. CMDE General FG OFFR AIR CMDE

Relationship*

--Select-- BROTHER DAUGHTER FATHER MOTHER OTHER SISTER SON SPOUSE

Has Valid Licence No* Yes No

Financier Details

Name.

Branch

Vehicle Details

* In case of special registration number, please contact TTIBI – 08040449900

Chassis No.

Engine No.

Model

Variant

Manufacturer

Vehicle Class

Registration Place (RTO) *

Registration No *

     

Renewal policy Details

Policy Period

To

IDV

Insurance Company *

Select

GSTIN

Product Type *

Select

Consumables Cover

Yes No

Depreciation Cover

Yes No

Engine Protect

Yes No

Key Protect

Yes No

Tyre & Alloy Cover

Yes No

Personal Belongings Cover

Yes No

RTI Cover

Yes No

Sports Equipment Cover

Yes No

Golf Kit Inoice Value