The New India Assurance Co. Ltd.
The New India Assurance Co Ltd Bangalore Auto Hub (770000), 1st Floor (Above
SBI), No. 22 J. C. Road, Bengaluru – 560 002
Servicing Branch GSTIN Number. : 29AAACN4165C2ZM , PAN No. : AAACN4165C
IRDA Regn. No. : 190
PROPOSAL DETAILS
PERIOD OF LIABILITY(TP)
PROPOSAL NUMBER AND DATE PERIOD OF OWN DAMAGE(OD) COVER
COVER
P33686587 & 10-Sep-2025 13-Sep-2025 To 12-Sep-2026 To
PREVIOUS POLICY DETAILS
PERIOD OF OD TP POLICY PERIOD OF TP
OD POLICY INSURER OD POLICY NUMBER TP POLICY INSURER
POLICY NUMBER POLICY
13-Sep-2024 To 12- 13-Sep-2023 To
HCG 2302206803750500000 CGI TCH/97744633
Sep-2025 12-Sep-2026
INSURED DETAILS Individual
PAY AS YOU
NAME GSTIN PANCARD NUMBER UIN
DRIVE / USE
Mrs. GEETA ASDFG3541N 0 0 KM
ADDRESS DATE OF BIRTH
HOUSE NO 293 SECTOR 55 GHATA GURGAON HARYANA 122011 11-Sep-1982
NOMINEE MOBILE
NOMINEE NAME NOMINEE AGE EMAIL ID
RELATIONSHIP NUMBER
Mr. XYZ 32 BROTHER 9999999999 geeta@gmail.com
VEHICLE DETAILS
ENGINE YEAR OF
VARIANT MAKE / MODEL CHASSIS NUMBER
NUMBER MANUFACTURE
Toyota /
FORTUNER SIGMA 4 LEGENDER (AT) FRNL4 MBJBA3FSX00846077~0823 1GDA741321 2023
FORTUNER
SEATING
HYPOTHECATION / LEASE INVOICE DATE CC/KW/GVW FUEL TYPE
CAPACITY
-- / - 13-Sep-2023 2755 7 DIESEL
GEOGRAPHICAL REGISTRATION VEHICLE
GEOGRAPHICAL AREA EXTN. RTO CITY
AREA NUMBER USAGE
NA India SIRSA HR-24-Y-0005 Private
INSURED DECLARED VALUE (Rs.)
NON ELECTRICAL ELECTRICAL CNG /
AGE VEHICLE BODY TOTAL
ACCESSORIES ACCESSORIES LPG
2 4197275 0 0 0 0 4197275
PREMIUM CALCULATION
A. OWN DAMAGE (OD) SECTION Amount (Rs.) B. LIABILITY (TP) SECTION Amount (Rs.)
BASIC PREMIUM BASIC PREMIUM
VEHICLE 28063 THIRD PARTY LIABILITY ( INCLUDING TPPD ) 0
NON ELECTRICAL ACCESSORIES 0 GEOGRAPHICAL AREA EXT. ( IMT-1 ) 0
ELECTRICAL ACCESSORIES (IMT-24) 0 BI FUEL KIT 0
BI FUEL KIT (IMT-25) 0 SUB TOTAL (THIRD PARTY LIABILITY) 0
BODY PREMIUM 0
SUB TOTAL (BASIC PREMIUM) 28063 PERSONAL ACCIDENT (PA) COVER
COMPULSORY PA COVER FOR OWNER DRIVER (IMT-15)
GEOGRAPHICAL AREA EXT (IMT-1) 0 0
Rs. 15 LAC
IMT 23 0 PA COVER FOR PAID DRIVER (IMT-17) Rs. 2 LAC 0
SUB TOTAL 28063 PA COVER (0 FOR 7 UNNAMED PERSONS) (IMT-16) 0
DISCOUNTS SUB TOTAL (PA COVER) 0
VOLUNTARY DEDUCTIBLE (IMT-22A) 0 LEGAL LIABILITY
ANTI THEFT DEVICE (IMT-10) 0 PAID DRIVER (IMT-28) 0
AA MEMBERSHIP (IMT-8) 0 EMPLOYEE (FOR 0 PERSON) (IMT-29) 0
HANDICAPPED DISCOUNT (IMT-12) 0 NON-FARE PAYING 0 PASSENGER (IMT-37) 0
UNNAMED 0 PASSENGER ON AMBULANCE/HEARSES
NCB (25%) 7016 0
(IMT- 46)
SUB TOTAL (DISCOUNTS) 7016 SUB TOTAL (LEGAL LIABILITY) 0
NET LIABILITY PREMIUM (B) 0
ADD-ONS 43860 TOTAL PREMIUM (A+B) 64907
THEFT AND CONVERSION RISK (IMT-43) 0
INDEMNITY TO HIRER (IMT-44) 0
PAY AS YOU DRIVE / USE DISCOUNT 0 IGST (18%) 11683
NET OWN DAMAGE PREMIUM (A) 64907 GROSS PREMIUM PAID 76590
ADD-ON COVERS OPTED IN THE PROPOSAL
CONSUMABLES NIL DEPRECIATION ENGINE PROTECT
- - KEY PROTECT
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