LOGOUT

( ROLE NAME: INSURANCE )

Due to technical erro

Data Preview

ICICI Lombard General Insurance Company

Tower D, Twelth Floor, Global Business Park, Mehrauli, Gurgaon Road, Gurgaon, Haryana 122002 GURGAON HARYANA State Code(06)
GSTIN: 06AAACI7904G1ZR
IRDA Registration Number : 115

Proposal Details

Proposal No. Policy Effective Date OD Policy Expiry Date OD Policy Tenure TP Policy Effective Date TP
PRDKIA8397111 09-Mar-2024 08-Mar-2025 3 Year 09-Mar-2023

Policy Expiry Date TP

08-Mar-2026

Proposer Details

Proposer Type Proposer Name Address of the Proposer Vehicle Class

Individual Mrs. MINAKSHI PORWAL FLAT NO 204 AYAACHI APTS PLOT NO GH1 NEAR DPS SCHOOL SEC Private
45 GURGAON HARYANA 122003

Vehicle Details

Invoice Date Chassis No. Engine No. Make Model & Variant
09-Mar-2023 MZBFB811LPN276918 G3LCPV056996 KIA SONET

CC Place of Registration Registration No. Ex-showroom Price

998 GURGAON HR-98-J-5334 1049000

Year of Manufacture Seating Capacity

2023 5

Insured Declared Value (IDV)

Vehicle Electrical Accessories Non-Electrical Accessories CNG/LPG Total IDV

839200 0 0 0 839200

Other Details

HP/Lease/Hire Pur. Agreement with Branch/Office of HP/Lease/Hire Purchaser Agreement Type Branch City
-- - Not Financed --

Premium Calculation

Own Damage Premium Amount (Rs.)

Basic Premium Discounts

Vehicle 5611 Voluntary Discounts Rs. (0) 0

Non Electrical Accessories 0 Anti Theft Device 141

Electrical Accessories 0 AA Membership 0

Bi Fuel Kit 0 NCB (20%) 1094

Sub Total (Basic Premium) 5611 Handicapped Discount (0%) 0

Geographical Area Extension 0 Sub Total (Discounts) 1235

Add-Ons (ZERO DEPRECIATION ,CONSUMABLES ,ENGINE PROTECT ,RETURN

IMT 33 Premium 0 8775
TO INVOICE ,TYRE COVER ,ROAD ASSIST )

IMT 23 Premium 0 Net Own Damage Premium(A) 13151

Sub Total 5611 Net Own Damage Premium

Total Premium 13151

SGST(9.00%) 1184

CGST(9.00%) 1184

Gross Premium 15519

DECLARATION I/We hereby declare that the statements made by me/us in this proposal form, including document(s) attached, are true and correct, to the best of my/our knowledge and belief and nothing materially affecting the risk has/have been concealed by me /us. I
/We hereby agree that this declaration shall form the basis of the contract between me/us and the insurer and shall form part of the insurance contract. I/We also declare that if any additions or alterations are carried out after the submission of this proposal form then the
same would be conveyed to the insurer immediately.
DISCLAIMER
GRIEVANCE CLAUSE:
For resolution of any query or grievance, Insured may contact us our toll free no. 1800 2666 or visit any of our branch offices. You can also write to us at customersupport@icicilombard.com . For detailed grievance redressal mechanism please visit the "Grievance
Redressal" section on our website www.icicilombard.com . Or You may also contact SMC Insurance Brokers Pvt. Ltd. Insurance Grievance Redressal No. : 1800-2666-9666
MANDATE:
I/we give my mandate for dealing of Insurance/Claims of my/our vehicle to SMC Insurance Brokers Pvt. Ltd. and request for insurance of my/our car with M/s ICICI Lombard General Insurance Company after having compared/verifying the quotations and benefits offered
by other insurers.
Date: 21-Feb-2024 Proposer Signature/ Thumb Impression

INSURANCE ACT 1938, SECTION 41, 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 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 be allowed in accordance with the published prospectuses or tables of the Insurer.

ISP/DP Policy Issuance Confirmation Number (PICN)

ISP/DP Name: DEEPAK SAWHNEY-DP249

Mandate Form * Choose file No file chosen Note : .jpg , .jpeg or .pdf files allowed

Previous Policy Doc Choose file No file chosen

PUC Document Choose file No file chosen

KYC1 (as applicable) Choose file No file chosen

KYC2 (as applicable) Choose file No file chosen

KYC3 (as applicable) Choose file No file chosen

Back Verify KYC

Print Proposal Save Proposal

Powered By : VISoF from Binary Semantics