1/23/2023
about:blank
Reliance General Insurance Co.Ltd.
7TH FLOOR, SURYA TOWER 108, THE MALL LUDHIANA LUDHIANA PUNJAB State Code(03)
GSTIN: 03AABCR6747B1ZQ
IRDA Registration Number : 103
Proposal Details
Proposal No.
PRDKIA4492208
Policy Effective Date
OD
Policy Expiry Date
OD
30-Jan-2023
29-Jan-2024
Policy Tenure TP
3 Year
Policy Effective Date
TP
30-Jan-2021
Policy Expiry Date
TP
29-Jan-2024
Proposer Details
Proposer Type
Proposer Name
Address of the Proposer
Vehicle Class
Individual
Ms. GIFTY
D/O PAWAN BANSAL,# B XI/2827, ANAJ MANDI
ROAD, BACK SIDE MARKET, COMMETTIE BARNALA
PUNJAB 148101
Private
Vehicle Details
Invoice Date
Chassis No.
Engine No.
Make Model & Variant
30-Jan-2021
MZBFF813LMN050732
D4FAMM172679
KIA SONET
CC
Place of Registration
Registration No.
Ex-showroom Price
1493
BARNALA
PB-19-T-8567
1175000
Year of Manufacture
Seating Capacity
2021
5
Insured Declared Value (IDV)
Vehicle
822500
Electrical
Accessories
Non-Electrical
Accessories
0
0
CNG/LPG
Total IDV
0
822500
Other Details
HP/Lease/Hire Pur. Agreement
with
Branch/Office of HP/Lease/Hire
Purchaser
CANARA BANK
BARNALA
Agreement Type
Branch City
Hypothecation
BARNALA
Premium Calculation
Own Damage Premium Amount (Rs.)
Basic Premium
Vehicle
Discounts
9186
Voluntary Discounts Rs. (0)
0
0
Non Electrical Accessories
0
Anti Theft Device
Electrical Accessories
0
AA Membership
Bi Fuel Kit
0
NCB (25%)
Sub Total (Basic Premium)
9186
0
2297
Handicapped Discount (0%)
0
Geographical Area Extension
0
Sub Total (Discounts)
2297
IMT 33 Premium
0
Add-Ons (ENGINE PROTECT ,KEY LOSS ,ZERO DEPRECIATION
,CONSUMABLES )
7291
IMT 23 Premium
0
Net Own Damage Premium(A)
Sub Total
9186
14180
Net Own Damage Premium
Total Premium
14180
SGST(9.00%)
1277
CGST(9.00%)
1277
Gross Premium
16734
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. 18003009 or visit any of our branch offices. You can also write to us at rgicl.services@relianceada.com . For detailed grievance redressal mechanism please visit the "Grievance
Redressal" section on our website www.reliancegeneral.co.in . 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 Reliance General Insurance Co.Ltd. after having compared/verifying the quotations and benefits offered
by other insurers.
Date: 23-Jan-2023
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.
about:blank
1/1