PA cover is mandatory. you can opt out If the following one you do not have

1. The owner does not have driving license or
2. Owner already has PA cover of atleast 15 lacs.

Confirmation (Previous Policy Addons)

Does the previous policy have nil dep?

3 Proposer Detail Back to Quotation

Proposer Detail

Own Damage Period :
To

Liability Period :
To

Policy Tenure : 1 Year

Model Variant :

year of purchase :

Value (IDV) :

NCB : %

Premium :

Salutation*

Salutation required

First Name *

First Name required Please enter valid First Name

Last Name *

Last Name required Please enter valid Last Name

Gender *

Male Female

Gender is required

Date of Birth *

Date of Birth is required Please enter valid Date of Birth

Company Name *

Company Name required Please enter valid Company Name

Mobile No.*

Mobile No. is required Please enter valid Mobile No.

Email *

Email required Please enter valid Email

Proposer Communication Details

Contact Address *

Address is required Please enter valid Address

Occupation Type*

Select Occupation Type

Marital Status *

Select Marital Status

GSTIN

Note: State code of GSTIN should match with the communication state GSTIN required Please enter valid GSTIN

PAN No.

PAN No. required Please enter valid PAN No.

Nominee Details

Nominee Full Name *

Nominee Name required Please enter valid Nominee Name

Relationship *

Nominee Relation required

Marital Status is Single hence Nominee cannot be the selected option.

Age *

Nominee Age required Please enter valid Nominee Age

Gender *

Male Female Nominee Gender required

Appointee Full Name *

Appointee Name required Please enter valid Appointee Name

Appointee Relationship *

Appointee Relation required

Marital Status is Single hence Nominee cannot be the selected option.

Vehicle Details

Please keep bike registration certificate (RC) and expiring insurance policy document ready to fill this form.

Previous Insurance Company *

Previous Insurance Company required

Previous Policy No.*

Previous Policy No. required Please enter valid Previous Policy No.

Previous TP Insurance Company *

Previous TP Insurance Company required

Previous TP Policy No.*

Previous TP Policy No. required Please enter valid Previous Policy No.

Chassis No.*

Chassis No. required Please enter valid Chassis No. with minimum 6 characters.

Engine No.*

Engine No. required Please enter valid Engine No. with minimum 6 characters.

PUC NO.

PUC Expiry Date

RTO

Reg. No.* Reg No. required

Please enter valid Reg No. Vehicle registration number must be valid .

Year of Manufacturer*

Year of Manufacturer required Please select Year of Manufacturer.

Is Vehicle Financed ?

Agreement Type*

Agreement Type required

Finanacier*

Financier required Please enter valid Financier Name.

4 Preview & Payment Change Proposal Detail

Proposer Details

Company Name
Proposer Name
Date of Birth
Mobile No.
Email Id
State
City
Contact Address
Pincode
Nominee Name
Nominee Relationship
Nominee Age
Nominee Gender

Vehicle Details

Registration No.
Chassis No.
Engine No.
Model & Variant
Date of Registration
Previous Insurance Company
Previous Policy No.
Previous TP Insurance Company
Previous TP Policy No.

I hereby confirm that I have mandated Vedant Insurance Broking Private Limited. to place my insurance cover and have read and agreed on the Terms and Conditions. Please select Terms & Conditions

1 Basic Detail

Policy Tenure

Vehicle Details

Previous Policy Detail

Additional Covers

Add-ons

IDV

2 Quotation Change Basic Detail

No Plans Found.

3 Proposer Detail Back to Quotation

Proposer Detail

Proposer Communication Details

Nominee Details

Vehicle Details

4 Preview & Payment Change Proposal Detail

Proposer Details

Vehicle Details

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