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The Oriental Insurance Co. Ltd.
Oriental House A-25/27, Asaf Ali Road NEW DELHI - 110002,DELHI
IRDA Registration Number: 556
Broker Details
TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD, 1ST FLOOR, AFL HOUSE,
LOK BHARTI COMPLEX, MAROL MAROSHI ROAD, ANDHERI (EAST), MUMBAI - 400 059, 022– CIN Number: U50300MH1997PLC149349
62379515
License Validity: 13-MAY-23 To 12-MAY-
Category: Composite Broker IRDAI Lic. No: 375
26
Proposal Details
Own Damage Period 22- Motor Liability Policy No OG- Motor Liability Period 22-
Proposal No. Proposal Date. Cover Type. 1 YEAR
Mar-2024 To 21-Mar- 23-9910-1825-00141454 Mar-2023 To 21-Mar-
PPVBU17208805 17-Mar-2024 STANDALONE OD
2025 ( BAG ) 2026
Proposer Details
Address of the Proposer
Proposer Type Proposer Name Vehicle Usage
S/O MANBIR SINGH NEAR BABA BALAKNATH MANDIR
Individual Mr. AKASH CHOUDHARY Private
KASHINATH NAGAR GHAZIABAD UTTAR PRADESH 245101
Vehicle Details
Invoice Date Chassis No. Engine No. Make Model & Variant CC
22-Mar-2023 MAT627026PLB28197 REVTRN21BWXM40156 NEXON NEXON (P) XM (S) BS6 1199
Place of Registration Registration No. Invoice Value Year of Manufacture Seating Capacity
HAPUR UP-37-V-7456 1004500 2023 5
Other Details
Branch/Office of HP/Lease/Hire
HP/Lease/Hire Pur. Agreement with Agreement Type Loan Account/Contract No
Purchaser
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Insured Declared Value (IDV)
Vehicle Electrical Accessories Non-Electrical Accessories CNG/LPG Total IDV
803600 0 0 0 803600
Premium Calculation
A.Own Damage Premium
Basic Premium Amount (Rs.) Deductibles Amount (Rs.)
Vehicle 6411 Voluntary Discounts Rs. (0) 0
Non Electrical Accessories 0 Anti Theft Device 161
Electrical Accessories 0 AA Membership 0
Bi Fuel Kit 0 NCB (0%) 0
Sub Total (Basic Premium) 6411 Handicapped Discount (0%) 0
Geographical Area Extension 0 Sub Total (Discounts) 161
IMT 23 Premium 0
Sub Total 6411
Add-Ons 4742 Net Own Damage Premium(A) 10992
Total Premium 10992
IGST Premium (18%) 1979
Total GST Premium (18%) 1979
Gross Premium 12971
Add-on: Nil Depreciation
Payment Details ( MULTIPLE PAYMENT MODE )
MISP Details
MISP Name: MISP Code: MISP Pan No:
ANJNEY AUTOMOBILES PRIVATE LIMITED TMIBASL/MISP/AAWCA4240M AAWCA4240M
Declaration I/ we hereby declare and state that the above statements made by me/ us are true and complete. No
part of it is false. I/ we desire to effect an insurance as describe herein with The Oriental Insurance Co. Ltd. and I/ we
agree that this proposal and declarations shall be the basis of contract between me/ us and the The Oriental
Insurance Co. Ltd. and I/ we agree to accept the policy subject to the condition specified by the Insurance Company.
I/ we agree to receive the policy document (without enclosing the terms and conditions of policy) from the company
and authorise the company to display Terms and Conditions of the policy on its website that enables access by me.
I hereby confirm that I have mandated to place my insurance cover and have read and agreed on the terms and
conditions and also give my unconditional consent for receiving a call from TATA MOTORS INSURANCE BROKING AND
ADVISORY SERVICES LTD or its affiliated entities on my number even if the number is enrolled under NDNC/DND
registry
Date: 17-Mar-2024
Proposer Signature/ Thumb Impression
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INSURANCE ACT 1938, SECTION 41- PROHIBITION OF REBATES
1.No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect
of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on
the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with
the published prospectuses or tables of the insurer.
2.Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
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