SBI General Insurance Company Limited

First Floor, No.3/1, Rukmini Towers, Platform Road, Sheshadripuram, Bengaluru 560 020
Servicing Branch GSTIN Number. : 29AAMCS8857L1Z8 , PAN No. : AAMCS8857L
IRDA Regn. No. : 144

PROPOSAL DETAILS
PROPOSAL NUMBER AND DATE PERIOD OF OWN DAMAGE(OD) COVER PREIOD OF LIABILITY(TP) COVER
P21913664 & 22-Sep-2023 28-Oct-2023 To 27-Oct-2024 To
PREVIOUS POLICY DETAILS
TP POLICY
OD POLICY INSURER OD POLICY NUMBER PERIOD OF OD POLICY TP POLICY INSURER PERIOD OF TP POLICY
NUMBER
SBIGI TSB/30533727 28-Oct-2022 To 27-Oct-2023 SBIGI TSB/30533727 28-Oct-2022 To 27-Oct-2025

INSURED DETAILS Individual

NAME GSTIN PANCARD NUMBER UIN PAY AS YOU DRIVE / USE
Mr. R VINOD KUMAR CUFPR6363G 0 0 KM
ADDRESS DATE OF BIRTH
#9 ACHHU NILAYA 2ND B CROSS GOKUL EXTN VIVEKANADHA ARSHAN ROAD DEVASANDRA K R PURAM NEW LOCATION
04-May-1997
BANGALORE KARNATAKA 560036
NOMINEE
NOMINEE NAME NOMINEE AGE MOBILE NUMBER EMAIL ID
RELATIONSHIP
Mrs. SARASAMMA 41 MOTHER 9491588112 VINODREDDYREBEL9491@GMAIL.COM

VEHICLE DETAILS
VARIANT MAKE / MODEL CHASSIS NUMBER ENGINE NUMBER YEAR OF MANUFACTURE
TOYOTA GLANZA V PETROL MT. Toyota / GLANZA MBHJWC13SNK281483 K12NP7152639 2022
SEATING
HYPOTHECATION / LEASE INVOICE DATE CC/KW/GVW FUEL TYPE
CAPACITY
KOTAK MAHINDRA PRIME LIMITED / BANGALORE 28-Oct-2022 1197 5 PETROL
REGISTRATION
GEOGRAPHICAL AREA EXTN. GEOGRAPHICAL AREA RTO CITY VEHICLE USAGE
NUMBER
NA India KORAMANGALA KA-01-MY-2679 Private

INSURED DECLARED VALUE (Rs.)

NON ELECTRICAL ELECTRICAL
VEHICLE BODY CNG / LPG TOTAL
ACCESSORIES ACCESSORIES
813106 0 600 0 0 813706

PREMIUM CALCULATION
A. OWN DAMAGE (OD) SECTION Amount (Rs.) B. LIABILITY (TP) SECTION Amount (Rs.)
BASIC PREMIUM BASIC PREMIUM
VEHICLE 8009 THIRD PARTY LIABILITY ( INCLUDING TPPD ) 0
NON ELECTRICAL ACCESSORIES 20 GEOGRAPHICAL AREA EXT. ( IMT-1 ) 0
ELECTRICAL ACCESSORIES (IMT-24) 0 BI FUEL KIT 0
BI FUEL KIT (IMT-25) 0 SUB TOTAL (THIRD PARTY LIABILITY) 0
BODY PREMIUM 0
SUB TOTAL (BASIC PREMIUM) 8029 PERSONAL ACCIDENT (PA) COVER
COMPULSORY PA COVER FOR OWNER DRIVER (IMT-15) Rs.
GEOGRAPHICAL AREA EXT (IMT-1) 0 0
15 LAC
IMT 23 0 PA COVER FOR PAID DRIVER (IMT-17) Rs. 2 LAC 0
SUB TOTAL 8029 PA COVER (0 FOR 5 UNNAMED PERSONS) (IMT-16) 0
DISCOUNTS SUB TOTAL (PA COVER) 0
VOLUNTARY DEDUCTIBLE (IMT-22A) 0 LEGAL LIABILITY
ANTI THEFT DEVICE (IMT-10) 0 PAID DRIVER (IMT-28) 0
AA MEMBERSHIP (IMT-8) 0 EMPLOYEE (FOR 0 PERSON) (IMT-29) 0
HANDICAPPED DISCOUNT (IMT-12) 0 NON-FARE PAYING 0 PASSENGER (IMT-37) 0
UNNAMED 0 PASSENGER ON AMBULANCE/HEARSES (IMT-
NCB (20%) 1606 0
46)
SUB TOTAL (DISCOUNTS) 1606 SUB TOTAL (LEGAL LIABILITY) 0
NET LIABILITY PREMIUM (B) 0
ADD-ONS 5290 TOTAL PREMIUM (A+B) 11713
THEFT AND CONVERSION RISK (IMT-43) 0 CGST (9%) 1054
INDEMNITY TO HIRER (IMT-44) 0 SGST (9%) 1054
PAY AS YOU DRIVE / USE DISCOUNT 0
NET OWN DAMAGE PREMIUM (A) 11713 GROSS PREMIUM PAID 13821

ADD-ON COVERS OPTED IN THE PROPOSAL

CONSUMABLES NIL DEPRECIATION -
- - -
- - -
- -

Proposal Validty:This proposal is valid for only 7 days from the date of generation.
Declaration: I/ we hereby declare and state that the above statements made by me/ us are true and complete. No part of it is false. I/ we desire to effect an insurance as describe herein with SBI General
Insurance Company Limited and I/ we agree that this proposal and declarations shall be the basis of contract between me/ us and the SBI General Insurance Company Limited and I/ we agree to accept
the policy subject to the condition specified by the Insurance Company.
I/we hold a valid and effective PUC and/or fitness certificate, as applicable, for the vehicle mentioned herein and undertake to renew the same during the policy period. I/ we agree to receive the policy
document (without enclosing the terms and conditions of policy) from the company and authorise the company to display Terms and Conditions of the policy on its website that enables access by me.

Date: 22-Sep-2023 Proposer Signature

NO CLAIM BONUS DECLARATION: