IFFCO Tokio General Insurance Co.Ltd.

IFFCO Tower,Plot No 3,Sector 29,Gurgaon,Haryana-122001

Proposal
Private Car Package Policy
Address:
MOHALLA-NEW RAM NAGAR.

18668.34
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Name of Proposer

KRISHNA LAL SINGH

Inception

24/01/2014

Proposer's Date of Birth

30/04/1969

Policy Expiry Date

23/01/2015

Quote

QUTIFFICO7

Proposal Issue Date

25/04/2014

RTO Location

ALLAHABAD

Registration Date

2014-04-24

PRIVATE CAR VEHICLE DETAILS

Registration Number

UP04BLM9088

Customer Type

CORPORATE

Engine Number

GPD4K64967

Cubic Capacity

5500

Chassis Number

D5K69130

Year of manufacture

2013

Registration City

ALLAHABAD

Registration State

24

Make of the Vehicle

Mahindra

Model Description

BOLERO SLX 2WD 7

Seating Capacity (including driver)

Net Premium (in Rs.)

7
16341.57

INSURED'S DECLARED VALUE (in Rupees)

For the Vehicle

For Trailers

Non Elec Acc.

Electrical/
Electronic

Value of CNG/LPG
Kit

0.0

0.00

0.00

CNG

380000.0

A- OWN DAMAGE
Basic premium on Vehicle (OD)

Rs.

B-LIABILITY
12703.40

Electrical Accessories Premium (IMT 24)

0.00

Non-Electrical Accessories Premium

0.00

Bi-fuel kit Premium (IMT 25)

0.00

b) Fibre Glass Tanks

380000.0

Rs.

Basic premium including premium for TPPD

3424.00

Bi-fuel kit (CNG)

0.00

Total (E)

3424.00

Add:

Add:
a) Geographical Area Extn. (IMT 1)

Total IDV

0.00
0.00

a) Compulsory PA Cover to Owner Driver

100.00

b) PA Cover to Named Passenger (IMT 15)

350.00

c) PA Cover to Unnamed Passenger (IMT 16)

0.00

d) PA Cover to Paid Driver (IMT 17)

Sub Total (A)

12703.40

0.00

Sub Total (F)

450.00

Less:
a) Discount for Anti-theft devices (IMT

-285.83

Legal LiabilityTo Paid Driver (IMT 28)

b) Automobile Association Discount (IMT 8)

0.00

Legal Liability To Employees (IMT 29)

c) Discount % for Voluntary Deductible (IMT 22 A)

0.00

Sub Total (G)

d) NCB Discount %

0.00

50.00
0.00
50.00
3924.00

TOTAL LIABILITY PREMIUM (H =E+ F+G)

Total Discount (B)

-285.83

16341.57

NET PREMIUM (I= D+H)

Add On Covers:
Depreciation Waiver Covers (Zero Depreciation)

Sub Total (C)

TOTAL OWN DAMAGE PREMIUM (D=A-B+C)

0.00

0.00
12417.57

Add: Service Tax

2326.77

Educational Cess

0.00

Total Tax (J)

2326.77

TOTAL PREMIUM PAYABLE (I+J)

16341.57

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IFFCO Tokio General Insurance Co.Ltd.

IFFCO Tower,Plot No 3,Sector 29,Gurgaon,Haryana-122001
Name of Proposer

KRISHNA LAL SINGH

Quote

QUTIFFICO7

Declaration I/WE hereby declare and state that the above statements made by me/us are true and complete .I/we desire
to effect an insurance as describe here in with
and I/we agree that this proposal
and declarations shall be the basis of contract between me/us and the
and I/we
agree to accept the policy subject to the conditions specified by the Insurance Company in the policy.
I/we agree to receive the policy document (without enclosing the terms and conditions of policy) from the company and
authorize the company to display Terms and Conditions of the policy on its website that enables access by me.

Date:
Proposer Signature
Proposal Form Completed

Signature/ Stamp of
Important Notes :
1. This quotation is based on information provided to us and is subject to relevant proofs being

and inspection

of vehicle at the time of issuance of

Quote is subject to change based on
and in case actual
information at the time of issuance differs from the above.
2. I / We declare that the rate of NCB claimed by me/us is correct and that no claim as arisen in the expiring
(copy of the policy enclosed). I/We further undertake that if this declaration is found to be incorrect, all
policy in respect of Section I of the Policy will stand forfeited.
3. This quote is valid for 01 day from quote issuance date.
4. This submission is only a quotation and not an insurance policy or cover note. The insurance coverage
after issuance of policy on receipt of payment of premium subject to terms of policy.
5. The premium quoted is for an insurance period
to 23/01/2015
24/01/2014
6. You are requested to return duly signed copy of this quote as a confirmation of acceptance of the terms and
reconfirmation of information provided above.
7. Alternately you may send your objection, what so ever with regard to the above quote or the terms and condition of
policyissued,within 7 days from the date of this quote,failing which it will be concluded that you are fully satisfied and have
accepted the quote including the terms and condition of the policy and the correctness of the information provided above.
8. Policy would be issued after tendering full premium quoted above and subject to inspection of vehicle where required.
9. Please furnish us the following information for issuance of policy. a) Previous insurance policy copy / Renewal Notice
b) NCB confirmation letter c) Copy of Registration certificate d) Copy of driving license Insurance.
10. 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 or risk relating to lives or property in India, any rebate of the

11. The Above quote will be valid if the policy is bought online.

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