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Car Insurance Form
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Insurance Co. Details
Insurance Company Name
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Plan Name
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Sub Plan Name
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Personal Details
Name
DOB
Gender
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Male
Female
Others
Aadhaar No
Is Pan Card available ?
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Yes
No
PAN NO
Email
Mobile No
Alternate Mobile No
Permanent Address
Same as Permanent Address
Communication Address
Vehicle Details
Make / Model
Engine No
Chassis No
CC / HP
Seating Capacity Of Side Car (If Any) Including Driver
Have you registered your vehicle ?
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Yes
No
Vehicle No / Registration No
RTO Location
Year of Manufacture
Package Category
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Standlone OD
Standlone TP
1 + 3 (Bundled)
1 + 1 (Comprehensive Package)
Car Fuel Type
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Diesel
Non-Diesel
Attachments
Add Attchment
Pan / Form 60
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Pan / Form 60
File
Remarks
Aadhaar Front Side
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Aadhaar Front Side
File
Remarks
Aadhaar Back Side
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Aadhaar Back Side
File
Remarks
Recent Photo
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Recent Photo
File
Remarks
Remarks
Add Remarks
Remarks
Remarks Filled by
Submit
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