THE NEW INDIA ASSURANCE CO.
LTD
IRDAI Reg. No. 190. CIN - L66000MH1919GOI000526
1215, 12th Floor, Naurang House, 21, Kasturba Gandhi Marg, New Delhi
MOTOR PROPOSAL
Customer Details
Proposal No & Issue Date: N0004860637 / 28-Jun-2024 14:47
Insured Name Miss MADHUBALA
Period of Insurance 28-JUN-2024 16:00 to 27-JUN-2025 23:59
Proposal Type Bundled Motor Policy- 3 Yr TP + 1 Yr OD (Private Vehicle) 28-JUN-2024 16:00 to 27-JUN-2027 23:59
Proposal Issued On 28-Jun-2024 14:47 Vehicle Identification No. MA3SFM61SRD286574
Date of Birth 02-Mar-1998 Geographical Area India
UIN No IRDAN190RP0023V01201819
C/O KRISHAN CHAND, NANDLA (10/1), P.O TANGNU,
Insured Address DISTT. SHIMLA (H.P), (PH.NO 9588017171,7876285185), GST No & State NA | Himachal Pradesh
THANA, HIMACHAL PRADESH-171214
Accounting Code of Service 997134
Insured State & Code Himachal Pradesh-02 Place of Supply Himachal Pradesh GSTIN of Customer GSTUNREGISTERED
Motor Vehicle Details
Make Maruti Suzuki Seating Capacity 5
Model-Varient MARUTI ALTO K10 VXI+ 1L 5MT BS6 Type of Body | Colour Hatchback | SILVER SILKY METTALIC
Registration No. NEW Fuel Type Petrol
Year of Manufacture 2024 RTO Location CHOPAL | HP-08
Engine-Chassis No. K10CN1268580 - MA3SFM61SRD286574 Zone B
Cubic Capacity 998 FASTag ID
Insured Declared Value(₹)
Vehicle ₹508250 Non Electrical accessories ₹0 Electrical Accessories ₹8540 CNG/LPG Kit ₹0 Total IDV ₹516790
Premium Details(Amount in ₹)
Own Damage Section (A) Liability Section (B)
Basic Own Damage Premium ₹ 3089 Basic Third Party Liability ₹ 6521
Electrical Accessories Compulsory PA Cover Premium [3 Year],(Sum Insured 15 lakhs) ₹ 825
1. STERIO of value Rs.8540 ₹ 342 P.A Cover to Unnamed Passengers 5 Person of Rs200000 each (IMT-16) ₹ 1500
Basic Premium ₹ 3431 Legal Liability (WC) to Driver (IMT-28) ₹ 150
Deductibles Net Liability Premium (B) ₹ 8996
Anti-Theft Device (IMT-10) ₹ 86 Total Premium (A+B) ₹ 16726
₹ 86 IGST @18% ₹ 3010.68
Sub-Total Deductibles
Gross Premium Paid ₹ 19737
Add- On Coverages
Zero Depreciation(IRDAN190RP0023V01201819/A0047V01201819) ₹ 2326
Loss of Key(IRDAN190RP0023V01201819/A0054V01201819) ₹ 250
Consumables(IRDAN190RP0042V01100001/A0058V03201819) ₹ 517
Engine Protect(IRDAN190RP0023V01201819/A0051V01201819) ₹ 775
HEV(IRDAN190RP0023V01201819/A0047V01201819)
Return to Invoice(N/A) ₹ 517
Net own Damage Premium (A) ₹ 7730
Nominee Details
Nominee Name: UMA DEVI Age: 48 Relation: Mother
Note:- Policy Issuance is subject to realization of premium
Declaration
I/ We hereby Declare and warrant that the above statements are true and complete. I/ We desire to effect an insurance as described herein with the company and I/ We agree that this
proposal and declaration shall be the basic of contract between me/us and the company and I/We agree to accept a policy subject to the conditions prescribed by the company.
Liability of the company only on receipt of premium and acceptance of policy by company. I/We hold a valid and effective PUC and/or fitness certificate , as applicable , for the vehicle
mentioned herein and undertake to renew the same during the policy period.
Insurance Act 1938 Section 41 - Prohibition of rebates
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 prospectuses or tables of the Insurer. ANY PERSON MAKING DEFAULT IN
COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE WHICH MAY EXTEND TO TEN LAKH RUPEES.
Date: 28-Jun-2024 Proposer's Signature
The Proposed Proposal is sourced and will be serviced through:
MARUTI SUZUKI INSURANCE BROKING PRIVATE LIMITED
Direct Broker(General) IRDAI License No. 428, valid till – 01 February 2027, Mail ID, support@msibpl.co.in, Contact: 33774477 (Prefix 011/022/033/044)
