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Proposal Preview

Magma HDI General Insurance Company LTD

5TH Floor, UNIT NO. 501, ECOSPACE BUSINESS PARK
BLOCK-4A ACTION AREA II New Town Rajarhat IRDAI
Registration No. : 149
GSTIN: 19AAGCM1685C1ZG

Proposal Details

Proposal No. Policy Effective Date 02- Policy Expiry Date 01-Jan-
Policy Tenure 1 Year
PDGPROD12212786 Jan-2024 2025
TP Policy Effective Date 02- TP Policy Expiry Date 01-
Jan-2024 Jan-2025
Period of Compulsory PA Cover 02-Jan-2024 to 01-Jan-
2025
Proposer Details

Proposer Name Address of the Proposer

Proposer Type Vehicle class GSTIN
Mr. SUBHADIP 5/3A KALI CHARAN SETT LANE KMC SINTHI KOLKATA
Individual Private NA
DAS WEST BENGAL 700030
Vehicle Details
Make Model & Variant
Invoice Date Chassis No. Engine No. RENAULT KWID CC / GVW / KW
02-Jan-2021 MEEBBA008LC753321 B4DA416E025631 Climber Option Petrol 999
EASY-R 1.0 Sce
Place of
Registration No. Invoice Value Year of Manufacture Seating Capacity
Registration
WB-08-K-0334 547207 2020 5
KOLKATA
Insured Declared Value (IDV)
Vehicle Electrical Accessories Non-Electrical Accessories BiFuel Total IDV
328324 0 0 0 328324
Financier Details
Financier Name Financier City Agreement Type
HDFC BANK LTD. KOLKATA Hypothecation
Premium Calculation
A. Own Damage Premium
Amount
Basic Premium Amount (Rs.) Discounts
(Rs.)
Vehicle 4313 NCB (0%) 0

Non Electrical Accessories 0 Anti Theft Device 0

Electrical Accessories 0 AA Membership 0
Bi-Fuel Kit 0 Voluntary Discounts Rs. 0 0
Sub Total (Basic Premium) 4313 Handicap Discount 0
Geographical Area Extension 0 Sub Total (Discounts) 0
IMT 23 Premium 0
Sub Total 4313
Add-Ons ( Year 1 Zero Depreciation
2954 Net Own Damage Premium(A) 7267
+ Consumables )

B. Liability Premium

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Basic Third Party Liability Premium

2094 PA Cover Per(10000) Persons for Driver (0) 0
(including TPPD)
Third Party Liability Geographical Area
Third Party Liability For Bi-Fuel Kit 0 0
Extension
Compulsory PA Cover for Owner Driver PA Cover (10000 Per Person) for 5 Unnamed
400 25
(1500000) Persons
Legal liability to Driver(1) 50 Third Party Liability for IMT-34 0
Net Liability Premium (B) 2569

Total Premium (A+B) 9836

SGST(9.00%) 886
CGST (9.00%) 886
Gross Premium 11608
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 Magma HDI General Insurance Company LTD and I/ we agree that this proposal and declarations shall be the basis of contract between me/ us and
the Magma HDI General Insurance Company 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 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.
Nominee Details

Nominee Name Age Relationship with Insured

MRS.DAS 45 SPOUSE

MISP Name: VIBRANT MOTORS PRIVATE LIMITED

MISP Code: MISPMNRKOKA1707A

Designated Person Date: 29-Dec-2023

DP Name: RAHUL ROY
DP Code: DPDNRKOKA92254 Proposer Signature
Proposal Form Completed by:
Dealer Code : KOKA
Dealer Agency Name : VIBRANT MOTORS PVT LTD

Signature / Stamp of Dealer

Section 41 INSURANCE LAWS (AMENDMENT) ACT,2015 – 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 or
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 prospectus or tables of the Insurer.
2. If any person fails to comply with sub-regulation (1) above, he shall be liable to payment of a fine which may extend to Ten Lakh Rupees.

Proposer Signature

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