Add Group Account Insurance

Group Account Details

Group Account

Codes

Agency

Vehicle Details

Vehicle Number

Vehicle Make / Model

GVW

Chassis Number

Make / Model

Select Vehicle Type *

Vehicle Class *

Vehicle GMV *

Engine Number *

Chassis Number (Motor) *

PUC Date *

Insurance Details

Existing / Previous Policy Number *

Previous Insurance Company Name *

Previous Insured Name *

Policy Number

Company

Policy Type

Start Date

End Date

OD Premium

TP Premium

Net Amount

Total Premium

Insurance From Date *

Insurance To Date *

Owner Transferred *

Claims Lodged During the Preceding Years *

No Claim Bonus *

Customer Details

Customer Name

Gender

Customer Phone

Address Line 1

Address Line 2

Insurer Profile (Motor Fields)

Title *

Owner Name *

Date of Birth *

Marital Status *

Nominee *

Nominee Relation Status *

Permanent / Residential Address (Motor)

House Number *

House Name *

Landmark Name *

City/District *

State *

Pincode *

Telephone *

Mobile *

Email *

Aadhaar *

PAN Number *

GST *

Corporate PAN Number *

Corporate TAN *

Corporate GST *

Correspondence Address (Motor)

Same as Permanent Address