Shriram GI

1.Fill your details ^*

Mobile No *

Email ID *

Bike Registration Number.

Your RTO Name.

2.Do you have previous insurance details or history? ^*

3.Who was your previous insurer? ^*

4.And can you tell us when your existing insurance expires? ^*

5.Have you made an insurance claim in the last year? ^*

6.Now we'll need to know your previous No-Claim Bonus. ^*

Previous No Claim Bonus(NCB%)

a discount in premium offered by insurance companies if a vehicle owner has not made a single claim during the term of the motor insurance policy

7.What was your Previous Policy Type? ^*

Motor Package Policy

Motor Liability Only Policy

Bundled Policy

OD only Policy

8.Please take a second to conform your Existing Policy details for us? ^*

Existing Policy Number *

Previous Policy Tenure *

Previous Policy NCB

Do previous policy have Nil Depreciation cover?

9.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 *

10.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? *

11.Here's Your Sum Insured Amount ^*

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

You're almost there

1.Is the vehicle purchased on loan? ^*

Financier Category *

Financer Name *

Financer Type *

Agreement Number

Address

City-Pincode

3.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

4.Upload Document

Choose document type

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

5.Please update your nominee details

Nominee Name *

Nominee Age *

Nominee Relationship *

Quote ID:

Policy Start date:

Policy End date:

Insured Declared Value

Quote ID:

Policy Start date:

Policy End date:

Insured Declared Value

Amount

Number Of Employees