Anda di halaman 1dari 2

Date : 27/05/2013 INDOFIL ORGANICS INDUSTRIES LT D-3 IND AREA PHASE 1 MOHALI MOHALI-160014 Dear INDOFIL ORGANICS INDUSTRIES

LT INVITATION TO RENEW YOUR MOTOR POLICY NO.I0975163 Thank you for insuring your motor vehicle with Bharti AXA General Insurance Co. Ltd. We thank you for your patronage and hope that you will continue to remain our customer. We wish to inform you that your SMART Motor Private Car Policy no. I0975163 is due to expire on 27/07/2013 . The premium due on renewal is INR 4692 (incl of S.tax). The renewal premium mentioned above is valid only if there is no change in any of the current information before the expiry of the policy. Payment Mode Kindly issue cheque/DD in favor of "Bharti AXA General Insurance Co.Ltd."

The premium amount is computed based on the criteria mentioned below: 1) The premium quote is based on the claim experience under the current policy as on date of generation of this renewal Notice. 2) If any claim is reported subsequently, No-Claim-Bonus benefit will not be applicable and premium is subject to change. 3) In case, the renewal instruction is received by us later than 27/07/2013 , acceptance of the vehicle would be subject to satisfactory inspection and underwriting guidelines effective on the date of receipt of instruction. 4) Kindly check your vehicle details and policy details before signing the document/s and return the document/s to our representative along with the premium payment. 5) Kindly issue the cheque/DD in favour of "Bharti AXA General Insurance Co. Ltd." If you have any further enquiry or need any details on our other products please call our Toll free No. 1800 103 2292 Your's Truly, For Bharti AXA General Insurance Co. Ltd. This is a computer generated letter.No signature is required. a) IMD Code: 91000114 b) Vehicle Details: 1) Make and Model: HYUNDAI SANTRO 2) Year of Manf: 2008 3) CC/Tonnage: 1086 / 0 4) Seating Capacity: 5 5) Coverage: COMPREHENSIVE 6) Vehicle /Non Elec.Acc.IDV: INR 180000 7) Registration no: PB65G8465 8) Chassis no: 304145 9) Engine no: 841405 10) Financing Institution: If any of the above mentioned details are found incorrect, kindly provide us with the correct details in the sheet submitted to our representative. Insurance is the subject matter of the solicitation.

Reference no: Policy Expiry Date: 27/07/2013 To: Client Number: 02928759 INDOFIL ORGANICS INDUSTRIES LT

Date : 27/05/2013 Communication Address: D-3 IND AREA PHASE 1 MOHALI MOHALI-160014 Intermediary Code: 91000114 Proposed Correction/ Changes on Renewal

Make and Model Year of Manf CC/Tonnage Seating Capacity/LCC Coverage Vehicle /Non Elec.Acc.IDV

HYUNDAI SANTRO 2008 1086 / 0 5 COMPREHENSIVE INR 180000

Registration No Regn Location/Zone Chassis No Engine No Financing Institution IDV Trailer/Side Car

PB65G8465 PB65 / B 304145 841405 INR 0

Electrical Accessories IDV INR 0 Bi Fuel Kit IDV INR 0 Kindly submit RC Book copy for changes to be made in the above mentioned Vehicle details. And letter from Financier in case of any change in the Financing Institution Proposed Correction/ Changes on Renewal Depreciated IDV Basic Premium Electrical Accessories Premium Bi Fuel Kit Premium(CNG/LPG) Geographical Extn Premium Fibre Glass Premium Trailer OD Premium Own Premises Premium IMT-23 Premium AAI Discount Premium Overturning Premium Voluntary excess Premium Anti Theft Discount Handicapped Discount NCB Percentage NCB Amount INR 180000 INR 6031 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 50% INR 3015 Premium Payable INR 4692 Basic TP Premium Comp PA to Owner Driver PA to Passengers Legal Liability to Paid Driver Liability for bi fuel Kit Geographical Extn Premium Trailer/Side car TP Premium Restricted TPPD LL to NonFare Bi Fuel Kit TP Premium Legal Liability to Others Total Liability Premium Total:- OD and TP Premium Service Tax INR 1110 INR 0 INR 0 INR 50 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 0 INR 1160 INR 4176 INR 516

Total OD Premium INR 3016 Proposed insurance period (In case of break in insurance) From:time _________ am/pm Date ____________ to midnight on_________________. Additions (if any) I/We wish to include the below mentioned Accessories/Coverage to my renewal policy. All the accessories stated by me are already installed by me/us in the vehicle Description Details Sum Insured Premium

Changed Communication Address: Residence Telephone no: Mobile no: Payment Details Cheque/DD no. : Name of the Bank : Date : Branch : I/We acknowledge receipt of the renewal notice in respect of my Motor Policy and agree to renew the said policy for one calender Year as per the details provided herein. I/We hereby declare that the information provided above is true and correct.
CC : 0 CA: INR 0

Office Telephone no: Email ID:

Date: Place:

Signature of the Insured.