“An Insurance Agent who assists an applicant to complete application or proposal form for insurance shall be deemed to have done so as the agent of the applicant – Section 54 (2) Insurance Act, 2003”.
1. Proof of Ownership:
2. Vehicle License:
3. Means of ID:
4. Pictures of Vehicle:
5. Evidence of Payment:
6. Upload Excel Sheet of Vehicle Fleet:
Do you have an existing policy on this type of cover(*)?
If Yes, please give name of Insurance Company:
Have you in the last 3 years suffered a loss or refused a claim(*)?
If Yes, give details of loss:
Name of Insurance Company with which the claim was made:
Do you or your spouse or members of your organization belong to any political or pressure group?(*)
If Yes, please give details:
I/We, hereby declare that the above particulars and answers are true and complete in every respect and that no information has been
suppressed or withheld.