| Estimated Market Value of Your Vehicle * |
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| Region where car is normally used * |
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Value Of A.C. and additional electrical
accessories |
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| Value Of non-electrical accessories |
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Premium Amount |
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| Cubic Capacity (cc) * |
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(Approximate) |
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No Claim Bonus/Loading as given in
previous year's policy document |
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| Had an accident and claimed insurance this year? |
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| Personal Accident Cover (No.of Persons) |
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| Cover per Person (Rs.) |
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Rs.50 for Third Party Property Damage
(Unlimited Cover) |
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Rs.15 for covering your Driver under the
Workmen's Compensation Act |
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| Are you a member of WIAA/AAUI/AASI/AAEI |
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| Is your vehicle bought as hire purchase, lease agreement or on hypothecation |
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