Add Group Account Insurance

Group Account Details

Group Account

Codes

Agency

Vehicle Details

Vehicle Number

Vehicle Make / Model (Legacy)

GVW

Chassis Number (Legacy)

Make / Model (Legacy)

Motor Insurance Fields (Required for Renewal)

Select Vehicle Type *

Vehicle Class *

Vehicle GMV (New) *

Engine Number *

Chassis Number (New) *

PUC Date *

Insurance Details

Existing / Previous Policy Number *

Previous Insurance Company *

Previous Insured Name *

Legacy Policy Number

Legacy Company

Policy Type

Legacy Start Date

Legacy End Date

OD Premium

TP Premium

Total Premium

Renewal Period & NCB

New Insurance From Date *

New Insurance To Date *

Owner Transferred *

Claims Lodged *

No Claim Bonus *

Customer Details

Customer Name

Gender

Customer Phone

Address (Legacy)

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 *

Correspondence Address (Motor)

Same as Permanent Address