Shriram GI

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1.Fill your details ^*

Mobile No *

Email ID *

Bike Registration Number.

Your RTO Name.

2.Please take a second to conform your bike details for us? ^*

Brand *

Bike Model *

Body Type *

Fuel Type *

Vehicle CC *

Seating Capacity *

Registration City *

Registration date *

Manufacturing Year *

Chassis Number *

Engine No *

3.Tell us your Policy details? ^*

Current Policy Type *

Policy Tenure *

Transfer Of Ownership *

TP Policy Number *

TP Policy Start Date *

TP Policy End Date *

TP Policy Insurer Address *

TP Policy Insurer Name *

IDV *

min: - max:

PUCC Number

PUCC Valid from Date

PUCC Valid To Date

PUCC Issuing Authority

NCB Applicable for current Policy(%)

Do you have PUCC Certificate? *

4.Here's Your Sum Insured Amount ^*

Period of Insurance(Years)

4.Here's Your Basic Premium Details

Quote ID:

Policy Start date:

Policy End date:

Insured Declared Value

The maximum Sum Assured fixed by the insurer which is provided on theft or total

Your idv :

Bill Summary View Complete Breakdown

TOTAL PREMIUM
IGST

TOTAL AMOUNT

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1.Is the vehicle purchased on loan? ^*

Financier Category *

Financier Name *

Financier Type *

Agreement Number

Address

City-Pincode

2.Could you please confirm your details again? ^*

Title *

First Name *

Middle Name

Last Name *

Gender *

Occupation

PAN Card No

City/Town/Village *

Area *

Specify Your Area *

Other Area

State *

Pincode *

Address 1 *

Address 2

3.Upload Document

Choose document type

Document type	File name	Action
RC copy	gotham-rounded-medium-cufonfonts.zip

4.Please update your nominee details

Nominee Name *

Nominee Age *

Nominee Relationship *

Here's your order summary

Quote ID:

Policy Start date:

Policy End date:

Insured Declared Value

The maximum Sum Assured fixed by the insurer which is provided on theft or total

Bill Summary View Complete Breakdown

TOTAL PREMIUM
IGST

TOTAL AMOUNT

Promo Code

Covers

Personal Accident-Owner cover excluded

Yes No

Reason

CPA Policy Number

Sum Insured

Insurance Company

CPA Valid from Date

CPA Valid To Date

PA Policy Term

Nominee Name

Nominee Age

Relationship

Limited Third Party Property Damage

Personal accident for Passengers (Un-Named Persons)

Sum Assured

Nil Depreciation Cover

Voluntary deductible chosen over and above Compulsory deductible

Amount

Cover For Installed Accessories

Value of Electrical Accessories

Value of Non-Electrical Accessories

Value of CNG/LPG Kit

Wish to have Legal liability cover?

Number Of Employees

I agree to the Terms and Conditions

Please Select Your Mode Of Payment

CSC

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Bike Details

Your Bike Registration No.

Brand

Bike Model

Body Type

Registration City

Registration Date

Manufacturing Year

Chassis Number

Engine Number

Personal Details

First Name

Last Name

PAN Card No

Email ID

Mobile Num

Address1

City/Town/Village

Area

Schedule of Premium

Cover Description	Sum Insured	Premium

Conditions and Warranties

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