HDFC ERGO General Insurance Company Limited

Proposal Form cum Transcript Letter For Private Car Policy - Bundled

Proposal No. PMTB012521702710(LOS#: 159388147)

Vehicle Details Proposal Details
Make HYUNDAI Proposal No. 202501280085578
Model GRAND I10 NIOS-CORPORATE Period of From 28 Jan, 2025 16:54 hrs
1.2 KAPPA Insurance
Registration No NEW To 27 Jan, 2028 23:59
PMTB012521702710 RTO TINSUKIA Issuance Date
MR PANKAJ KUMAR RAY Chassis No. MALB251CLRM596973 Invoice No. 012521702710
TINSUKIA 167 TINSUKIA TINSUKIA - Cubic Capacity 1197 Seats 5 Customer Id 101301756734
786192 ASSAM - Tel. 98XXXXXXX3
Year of Manufacture 2024 Body Type HATCHBACK
Engine No. G4LARM124001
Email ID : [email protected]
Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Year 1 From 28/01/2025 To 719537 0 0 0 0 719537
27/01/2026
Own Damage Policy Period Liability Policy Period
From Date & Time 28/01/2025 16:54 To Date & Time 27/01/2026 From Date & Time 28/01/2025 16:54 hrs To Date & Time 27/01/2028
hrs Midnight Midnight
Premium Details (`)
Own Damage Premium(a) (`) Liability Premium(b) (`)
Basic Own Damage 7987 Basic Third Party Liability 10640
Total Basic Premium 7987 LL to Paid Driver (IMT-28) 150
Less: others 3587 PA Cover for Owner Driver of 1500000 ( CPA Cover Policy Period From Date 28/01/2025 853
To Date 27/01/2028 )
Total - Less 3587 PA Cover for Paid Driver of 10000 (IMT-17) 15
Add on Coverages Net Liability Premium (b) 11658
Zero Depreciation (IRDAN146RPMT0041V01202425/A0048V01202425) 2159 Total Package Premium (a+b) 20016
Engine and Gear box Protection (IRDAN146RPMT0041V01202425/A0044V01202425) 1079 GST 18% : Central Tax 9% ( `1801.5 ) + State Tax 9% ( `1801.5) 3603
Cost of Consumables (IRDAN146RPMT0001V01202425/A0005V01202425) 720
Total - Add on 3958
Net Own Damage Premium (a) 8358 Total Premium 23619
Geographical Area India Compulsory Deductible (IMT-22) 0 Voluntary Deductible (IMT-22A) 0
Nominee for Owner driver Ravindra Ray, Father Appointee
Hypothecated(IMT-7) with:HDFC BANK LTD,Hdfc Bank Ltd
Agent Name : HDFC BANK LTD Agent Code : 201587086428 Tel No. : 91-22-61606161
Anti rebate clause
Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended) : 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: provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall
not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed conditions
establishing that he is a bona fide insurance agent employed by 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..
Terms and Conditions
I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C:
1) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the
contract between me/us and HDFC ERGO General Insurance Company Limited.
2) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately.
3) I/We also shall endeavor to procure the renewal notice and pass on the same to HDFC ERGO General Insurance immediately upon the receipt of such renewal notice.
4) Any person who, knowingly and with intent to defraud the Insurance Company or other persons, files a proposal for insurance containing any false information, or conceals for the
purpose of misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a
denial of insurance benefits.
GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details
provided during policy issuance. For any subsequent changes or addition (i.e. if GSTIN not entered at the time of policy issuance ) on policy schedule, changes shall be carried out through
fresh policy issuance with prospective effect.
5) I understand the Proposal No. 202501280085578 is issued to me basis on above information.
6) IT has been declared by you that you are not a Politically Exposed Person and the source of funds to purchase this policy are from salary/business income.
Transcript Declaration : In case disagreement or objection or any other changes with respect to information and contents mentioned herein above,please contact our toll free number and
register your objections / changes / disagreement to the conte nt of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days
from date of your receipt of this transcript along.

Disclaimer : Proposal Form and Policy Schedule have been generated basis details entered by proposer / insured on Online Platform (either on HDFCERGO.com or its affiliated Online
Channels (IRDAI Licensed Intermediaries). For any modification, kindly visit URL https://www.hdfcergo.com/customer-care/customer-support.html and register your service request or write to us
at [email protected]
Customer Name: PANKAJ KUMAR RAY PAN No. :
DHNPR7734D UIN :IRDAN146RPMT0001V01202425
HDFC ERGO General Insurance Company Limited
Frequently Asked Question’s (FAQ’s) - Motor Insurance

WHAT ARE THE MAJOR COVERS UNDER THE POLICY? HOW DO I FILE A CLAIM?
Loss or Damage to the Insured Vehicle caused due to: For Accidental damage to the insured vehicle (Own Damage Claims):
a. Fire, explosion, self ignition or lightning. ◾ Visit the 'Help' section by clicking https://selfhelp.hdfcergo.com
b Burglary, housebreaking or theft ◾ Send us a "Hi" on our WhatsApp number 8169 500 500
c All act of God perils like earthquake, flood, cyclone etc ◾ Call us on our Customer Service No.: 022-62346234/ 0120-
d Accidental external means, terrorism, riot and strike 62346234 Please keep the following details handy while intimating a
Liability to Third Parties: Provides claim:
cover for any legal liability arising out of the use of the vehicle a. Policy number
for b. Registration details/RC copy
a Accidental death / injury to any third party c. Driver's details at the time of accident including driving license number
b Any damage to property owned by third party d. FIR on a case-to-case basis
Personal Accident Cover: The e. Repair estimate
policy provides for a mandatory Personal Accident cover for owner driver and optional
cover for passengers covering accidental death and permanent total disability WHAT IS THE CLAIM PROCESS?
1. If your vehicle can be driven, take it to the nearest dealer / garage.
WHAT ARE THE MAJOR EXCLUSIONS OF THE POLICY? 2. Get a repair estimate, fill up the claim form and attach a copy of the registration
a. General aging, wear & tear, mechanical or electrical breakdown, failure, certificate and driving license of the person driving at the time of the accident.
depreciation, any consequential loss 3. If the garage is within our network, you could avail of cashless claim facility. Pay for
b. Damage by a person driving without a valid license non accident
c. Damage by a person driving under the influence of liquor or drugs related repairs, depreciation and deductible. We would settle the rest.
d. Loss/damage attributable to war, mutiny, nuclear risks 4. If the garage is outside our network, you would have to get the claim reimbursed
e. Damage to tyres and tubes, unless damaged during an accident subsequently.
f. Usage on hire & reward (applicable for all classes except public commercial vehicles) 5. The insured should not initiate any repairs or dismantle the vehicle before the survey is
g. Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes, completed.
headlights, paint work (applicable for all commercial vehicles; unless opted CLAIMS DOCUMENTS -
additionally) For ACCIDENTAL DAMAGE TO INSURED
h. Loss or damage resulting from overturning arising out of operation as a tool VEHICLE
(applicable for mobile cranes, drilling rigs, mobile plants, navvies, shovels, grabs, a. Duly filled and signed claim form & satisfaction voucher
rippers unless opted for additionally) b. Registration Certificate (RC)
i. Loss of or damage to accessories by burglary housebreaking or theft unless the c. Driving license of the person driving at the time of the accident
vehicle is stolen at the same time (applicable to all commercial vehicles & two d. Policy copy , original repair estimate, repair invoice
wheelers) e. Payment receipt for non-cashless claims
f. Original repair invoice for cashless claims
TRANSFER OF INSURANCE (INCASE VEHICLE IS SOLD) g. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence
proof)
a. No objection letter from the previous insured h. Form 35 & original NOC from financer incase of total loss where payment is made to
b. Form 29/30, Sale Deed OR transferred RC copy. In case of smart card, RTO insured
transfer fee paid receipt. i. Acopy of police FIR/panchnama is required for TP injury / death / property damage
c. Differential Premium if any (NCB recovery, PAto Owner - Driver etc)
d. NOC from Financier, if applicable. Additional documents required for commercial vehicles:
e. Pre-inspection is must if transfer request date is >14 days from the endorsed RC copy a. Spot survey b. Load challan c. Fitness certificate d. Route permit
date
CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT
f. Break-in loading >45 days ( if applicable)
a. Duly filled and signed claim form & discharge voucher ( after loss settlement )
Additional Documents b. Original Registration Certificate (RC)
a. Incase of death of Insured - a. Death Certificate b. Legal heir certificate c. Original policy copy
b. Incase of Employer to Employee transfer - a. Letter from Employer d. Copy of FIR lodged at the nearest police station
e. All original keys & vehicle invoice copy
WHAT CHANGES CAN BE DONE IN MY POLICY ENDORSEMENT f. No trace report confirming that the stolen vehicle is not traceable
g. Original NOC from financer incase of hypothecation / HPA
For Changes related to registration of vehicle or vehicle details like h. Intimation to RTO for theft of vehicle
a. Correction in registration number/ location / address i. Duly signed RTO transfer papers (Form 26, 28,29,30,35)
b. Correction in vehicle make & model/ cubic capacity/ seating capacity/ engine j. RC extract with stolen remark from the concerned RTO after the loss
& chassis number/manufacture year k. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence proof)
l. Deed of subrogation cum indemnity on judicial stamp paper
To make above changes, you need following documents: Disclaimer: Where it is brought to the notice of the Company, that vehicle insured which is not a new vehicle but
a. Request letter for the change shown as a new vehicle with a malafide intention, claims for total loss of such vehicle would not be admissible, if
there is a gap of more than 10 days from date of invoice of vehicle and the proposal date.
b. Policy copy
c. Registration Certificate copy /Invoice Copy for change in vehicle details WHAT IS NCB?
d. Cheque for additional premium if applicable NO CLAIM BONUS (NCB):
NCB is provided for every claim free year basis the slab as provided by Tariff.
For addition of electrical and non electrical accessories, CNG & LPG Kit: How can I get No Claim Bonus Reserving Letter? NCB
a. Request letter for the change Reserving letter can be provided only on Sale of vehicle evidenced by transferred RC copy
b. Policy copy OR Sale Deed and Form 29 & 30. The OD section of the policy needs to be transferred to
c. Invoice copy (mandatory where value of accessory exceeds ₹ 20,000/-) the new owner or cancelled.
d. Endorsed Registration Certificate Copy (For CNG/LPG kit)
e. Cheque for additional premium HOW DO I RENEW MY POLICY?
You can renew your policy via any of the below options:
E-mail or Call us for additional premium details & send relevant documents copy to our a. RENEW ONLINE: Visit "Instant Renewal" section on our website
customer service office www.hdfcergo.com to renew instantly
b. Call on 022 - 62346234 / 0120 - 62346234 and renew instantly
For Change of financier details (Hypothecation/Lease/Hire-Purchase) c. Courier the Cheque / Demand Draft in favor of "HDFC ERGO General Insurance
a. Request letter for the change Company Ltd' to our Customer service office
b. Policy copy d. Email to [email protected]
c. Endorsed Registration Certificate copy
d. NOC from financier OR form 35 duly signed and stamped by financier HOW TO CONTACT US?
Customer Service No :022 - 6234 6234 / 0120 - 6234
6234 E-Mail :[email protected]
For any endorsments on your policy you can simply place your request on HELP Section Write to us at :HDFC ERGO General Insurance Company Limited
of our (Customer service office) D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS
website www.hdfcergo.com Marg, Bhandup (West). Mumbai - 400078. Maharashtra.
 Convenience at your fingertips
On the HELP section of our website, you can:

APR2023
Get Policy Make Track Update

Ver.
₹ 80D
Copy/ Tax Changes on Claim Contact
Certificate Policy Status Details
This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.