5/20/25, 12:03 PM about:blank
Future Generali India Insurance Co. Ltd.
India Bulls Finance Centre, Tower 3, 6th floor, Senapati Bapat Marg MUMBAI - 400013,MAHARASHTRA
IRDA Registration Number: 132
Broker Details
TMIBASL, 1ST FLOOR, AFL HOUSE, LOK BHARTI COMPLEX, MAROL MAROSHI ROAD, ANDHERI
CIN Number: U50300MH1997PLC149349
(EAST), MUMBAI - 400 059, 022–62379515
License Validity: 13-MAY-23 To 12-MAY-
Category: Composite Broker IRDAI Lic. No: 375
26
Proposal Details
Motor Liability Policy No
Own Damage Period 22- Motor Liability Period 22-
Proposal No. Proposal Date. Cover Type. 1 YEAR 3001/TMP-
May-2025 To 21-May- May-2024 To 21-May-
PPVBU22188176 20-May-2025 STANDALONE OD 100248950/00/000 (
2026 2027
ILG )
Proposer Details
Proposer Name Address of the Proposer
Proposer Type Vehicle Usage
Mr. VANABHAI HEMABHAI AT DEVPURA ( TALSARI) PO BIYOK TA VAV DI
Individual Private
PATEL BANASKANTHA THARAD GUJARAT 385575
Vehicle Details
Invoice Date Chassis No. Engine No. Make Model & Variant CC
22-May-2024 MAT627434RLC32905 1.5CR08CVXW06008 TATA NEXON NEXON CREATIVE + 1.5 1497
Place of Registration
Registration No. Invoice Value Year of Manufacture Seating Capacity
BANASKANTHA - GJ-
GJ-08-DG-5733 1319990 2024 5
08
Other Details
Branch/Office of HP/Lease/Hire
HP/Lease/Hire Pur. Agreement with Agreement Type Loan Account/Contract No
Purchaser
BANK OF BARODA Hypothecation FHDSTHRASAS
THARAD - THARAD
Insured Declared Value (IDV)
Vehicle Electrical Accessories Non-Electrical Accessories CNG/LPG Total IDV
1055992 0 0 0 1055992
Premium Calculation
A.Own Damage Premium
Basic Premium Amount (Rs.) Deductibles Amount (Rs.)
Vehicle 5055 Voluntary Discounts Rs. (0) 0
Non Electrical Accessories 0 Anti Theft Device 126
Electrical Accessories 0 AA Membership 0
Bi Fuel Kit 0 NCB (20%) 986
Sub Total (Basic Premium) 5055 Handicapped Discount (0%) 0
Geographical Area Extension 0 Sub Total (Discounts) 1112
IMT 23 Premium 0
Sub Total 5055
Add-Ons 4752 Net Own Damage Premium(A) 8694
Total Premium 8694
CGST Premium (9%) 782
SGST Premium (9%) 782
Total GST Premium (18%) 1564
Gross Premium 10259
Add-on: Nil Depreciation, Return To Invoice, Consumables
POSP Details
POSP Name: POSP Aadhaar Number: POSP PAN Number:
ZAMIR JOHAR SAIYED - BMNPS7497D
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 Future Generali India Insurance Co. Ltd.
and I/ we agree that this proposal and declarations shall be the basis of contract between me/ us and the Future
Generali India Insurance 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 hereby confirm that I have mandated to place my insurance cover and have read and agreed on the terms and
conditions and also give my unconditional consent for receiving a call from TMIBASL or its affiliated entities on my
number even if the number is enrolled under NDNC/DND registry
Date: 20-May-2025
Proposer Signature/ Thumb Impression
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 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 may be allowed in
accordance with the published prospectuses or tables of the insurer.
2.Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
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