3/25/25, 5:33 PM about:blank
Proposal Preview
The New India Assurance Co Ltd
4 Mary Gold, Shanajaf Road, Lucknow - 226001. IRDAI Registration
No. : 190
GSTIN: 09AABCC6633K7ZB
Proposal Details
Proposal No. Policy Effective Date 04- Policy Expiry Date 03-Apr-
Policy Tenure 1 Year
PDGPROD16362172 Apr-2025 2026
TP Policy Effective Date 04- TP Policy Expiry Date 03-
Apr-2025 Apr-2026
Period of Compulsory PA Cover 04-Apr-2025 to 03-Apr-
2026
Proposer Details
Address of the Proposer
Proposer Name
Proposer Type E-101 PARSVNATH MAJESTIC FLOORS INDIRAPURAM Vehicle class GSTIN
Ms. SURABHI
Individual SHIPRA SUN CITY GHAZIABAD UTTAR PRADESH Private NA
BISHT
201014
Vehicle Details
Make Model & Variant
Invoice Date Chassis No. Engine No. RENAULT KWID RXT CC / GVW / KW
04-Apr-2021 MEEBBA007M3767048 B4DA416E033475 Option Petrol EASY- R 999
1.0 Sce
Place of
Registration No. Invoice Value Year of Manufacture Seating Capacity
Registration
UP-14-ES-4085 651000 2021 5
GHAZIABAD
Insured Declared Value (IDV)
Vehicle Electrical Accessories Non-Electrical Accessories BiFuel Total IDV
325500 0 0 0 325500
Financier Details
Financier Name Financier City Agreement Type
-- - --
Premium Calculation
A. Own Damage Premium
Amount
Basic Premium Amount (Rs.) Discounts
(Rs.)
Vehicle 3661 NCB (45%) 1648
Non Electrical Accessories 0 Anti Theft Device 0
Electrical Accessories 0 AA Membership 0
Bi-Fuel Kit 0 Voluntary Discounts Rs. 0 0
Sub Total (Basic Premium) 3661 Handicap Discount 0
Geographical Area Extension 0 Sub Total (Discounts) 1648
IMT 23 Premium 0
Sub Total 3661
Add-Ons ( Year 1 Zero
4069 Net Own Damage Premium(A) 6082
Depreciation+Consuamble )
B. Liability Premium
about:blank 1/2
3/25/25, 5:33 PM about:blank
Basic Third Party Liability Premium
2094 PA Cover Per(0) Persons for Driver (0) 0
(including TPPD)
Third Party Liability Geographical Area
Third Party Liability For Bi-Fuel Kit 0 0
Extension
Compulsory PA Cover for Owner Driver
325 PA Cover ( Per Person) for 0 Unnamed Persons 0
(1500000)
Legal liability to Driver(1) 50 Third Party Liability for IMT-34 0
Legal liability to Employees (For
0 Net Liability Premium (B) 2469
Persons, IMT 29)
Total Premium (A+B) 8551
IGST(18.00%) 1540
Gross Premium 10091
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 The New India Assurance Co Ltd and I/ we agree that this proposal and declarations shall be the basis of contract between me/ us and the The New
India Assurance 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 hold a valid and effective PUC and/or fitness certificate, as applicable, for the vehicle mentioned herein and undertake to renew the same during the policy period.
Nominee Details
Nominee Name Age Relationship with Insured
BHAGAT SINGH BISHT 30 FATHER
MISP Name: ACTIVE MOTORS PRIVATE LIMITED
MISP Code: MISPMNRNOJA4313Q
Designated Person Date: 25-Mar-2025
DP Name: RAMA CHAUHAN
DP Code: SPSNRNOJA34913 Proposer Signature
Proposal Form Completed by:
Dealer Code : NOJA
Dealer Agency Name : ACTIVE MOTORS PRIVATE LIMITED
Signature / Stamp of Dealer
Section 41 INSURANCE LAWS (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 or
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 may be allowed in accordance with the prospectus or tables of the Insurer.
2. If any person fails to comply with sub-regulation (1) above, he shall be liable to payment of a fine which may extend to Ten Lakh Rupees.
Proposer Signature
about:blank 2/2
