Proposal Preview

Universal Sompo General Insurance Company Ltd

KLS Tower,Plot No EL 94 EL-94, TTC Industrial Estate MIDC, Mhape, Navi Mumbai Maharashtra (State Code-27)
Navi Mumbai 400710
GSTIN: 27AAACU8917F1Z6
Proposal
Policy Details
Proposal No. Policy Effective Date Policy Expiry Date
P30043104 08/10/2024 07/10/2025
Proposer Details
Proposer Type Insured Name Address of the Insured GSTIN Occupation
Individual Mr. PURNANAND VIDYARTHI NA,Navi Mumbai,Maharashtra(State Code-27),400614 NA NA
Vehicle Details
Date of First Sale Chassis No. Engine No. Make Model & Variant CC
08/10/2020 MAKGN266JL4000715 L15ZD1201598 CITY 1.5 ZX CVT 1497
Place of Registration Registration No. Invoice Value Year of Manufacture Seating Capacity
Navi Mumbai MH43BU4845 RS. 1461050 2020 5
Insured Declared Value (IDV)
Vehicle Electrical Accessories Non-Electrical Accessories Bi Fuel Kit Total IDV
730525 0 0 0 730525
Other Details
HP/Lease/Hire Pur. Agreement with Branch/Office of HP/Lease/Hire Purchaser Agreement Type
-- - --
Calculation
A.Own Damage Premium Amount (Rs.) B. Liability Premium Amount (Rs.)
Basic Premium Third Party Liability
Vehicle 15152 Liability Premium 3416
Non Electrical Accessories 0 Sub Total (Third Party Liability) 3416
Electrical Accessories 0 PA Cover
Compulsory PA Cover for Owner Driver
Bi Fuel Kit 0 325
Nominee: NA (NA) (26 Years)
Sub Total (Basic Premium) 15152 Additional PA cover for Paid Driver 0
Geographical Area Extension 0 Additional PA Cover (40000 Per Person) for 5 Persons 100
Sub Total 15152 Sub Total (PA Cover) 425
Discounts Legal Liability
Voluntary Discounts RS. (0) 0 Paid Driver 50
Anti Theft Device 379 Employees (for 0 persons) 0
AA Membership 0 Sub Total (Legal Liability) 50
Geographical Area Ext.(TP) 0
Handicap (0%) 0 Net Liability Premium(B) 3891
NCB (0%) 0 Total Premium (A + B) 32065
Sub Total (Discounts) 379 SGST (9%) 2886
Add-Ons 13401 CGST (9%) 2886
Net Own Damage Premium(A) 28174 Gross Premium 37837

Add On Details
Nil Depreciation (Including Taxes) 13794
Engine Protect Cover (Including Taxes) 1726

Key Protect Cover (Including Taxes) 295

SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply: Maharashtra (State Code-27)
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 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 any additions or alterations are carried out after the submission of this proposal
form then the same would be conveyed to the insurer immediately.
NCB DECLARATION:
"I/We declare that the rate of NCB claimed by me/us is correct and that no claim arisen in the expiring policy period (copy of the policy enclosed). I/We further undertake
that if this declaration is found to be incorrect, all benefit under the policy in respect of Section 1 of the policy will stand forfeited."
MANDATE:
I/we give my mandate for dealing of insurance/Claims of my/our vehicle to M/s SMC INSURANCE BROKERS PVT. LTD. and request for insurance of my/our car with M/s
Universal Sompo General Insurance Company Ltd after having compared/ verifying the quotations and benefits offered by other insurers.
Disclaimer:
This proposal is for Own Damage section only and the cover ceases in case the Third Party policy declared by the insured at the time of purchasing this policy & as
mentioned herein, is not valid for the concurrent period.
Proposal form processed by: PRAMOD ANANT JADHAV (HALLMARK HONDA)
Date: 05/10/2024

Proposer Signature
INSURANCE ACT 1938, SECTION 41- PROHIBITION OF REBATES
1.No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take our 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 our 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 insures.
2.Any person making default in complying with the provisions of the section shall be punishable with fine, which may extend to ten lakh rupees.