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IFFCO Tokio General Insurance Co. Ltd.

Iffco Towers Plot No 3 Sector 29 GURGAON - 122001,HARYANA
IRDA Registration Number: 106

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 28- Motor Liability Period 28-
Proposal No. Proposal Date. Cover Type. 1 YEAR Motor Liability Policy No
Apr-2024 To 27-Apr- Apr-2023 To 27-Apr-
PPVBU17390294 03-Apr-2024 STANDALONE OD 18249442 ( ITG )
2025 2026
Proposer Details
Address of the Proposer
Proposer Name
Proposer Type S/O A NAGESWARA RAO 31-15-31/2A KATURI VARI Vehicle Usage
Mr. ANUMOLU
Individual STREET MACHAVARAM VIJAYAWADA NTR ANDHRA Private
KRUPALAKSHMANKUMAR
PRADESH 520004
Vehicle Details
Invoice Date Chassis No. Engine No. Make Model & Variant KW
28-Apr-2023 MAT635005NLN14372 TZ230XS56FJ22052710 NEXON EV NEXON EV XZ+ LUX 97
Place of Registration Registration No. Invoice Value Year of Manufacture Seating Capacity
VIJAYAWADA AP-39-SR-4536 1875000 2022 5
Other Details
Branch/Office of HP/Lease/Hire
HP/Lease/Hire Pur. Agreement with Agreement Type Loan Account/Contract No
Purchaser
STATE BANK OF INDIA Hypothecation 984811975433
KRISHNA - PORANKI
Insured Declared Value (IDV)
Vehicle Electrical Accessories Non-Electrical Accessories CNG/LPG Total IDV
1500000 0 0 0 1500000
Premium Calculation
A.Own Damage Premium
Basic Premium Amount (Rs.) Deductibles Amount (Rs.)
Vehicle 12537 Voluntary Discounts Rs. (0) 0
Non Electrical Accessories 0 Anti Theft Device 0
Electrical Accessories 0 AA Membership 0
Bi Fuel Kit 0 NCB (20%) 2508
Sub Total (Basic Premium) 12537 Handicapped Discount (0%) 0
Geographical Area Extension 0 Sub Total (Discounts) 2508
IMT 23 Premium 0
Sub Total 12537
Add-Ons 10650 Net Own Damage Premium(A) 20679

Total Premium 20679

CGST Premium (9%) 1862
SGST Premium (9%) 1862
Total GST Premium (18%) 3724
Gross Premium 24403
Add-on: Return To Invoice, Consumables, Nil Depreciation, Towing
Payment Details ( MULTIPLE PAYMENT MODE )
MISP Details
MISP Name:
MISP Code: MISP Pan No:
GARAPATI AUTOVENTURES PRIVATE
TMIBASL/MISP/AACCG8881E AACCG8881E
LIMITED

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 IFFCO Tokio General Insurance Co. Ltd.
and I/ we agree that this proposal and declarations shall be the basis of contract between me/ us and the IFFCO
Tokio General 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: 03-Apr-2024
Proposer Signature/ Thumb Impression

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