insurance Policy

Registration Number*

RC Holder Name*

Phone*

Email*

Vehicle Date of Registration*

Previous Policy Start Date(Policy Date)

Model — Month*

Model — Year*

Previous Policy Type

Previous Policy Expiry Date

Upload RC Photo (PDF/JPG/PNG, max 5MB)*

Aadhaar Card Photo (PDF/JPG/PNG, max 5MB)*

Applicant Photo (PDF/JPG/PNG, max 5MB)*

Aadhaar Number*

Have you made any claim before?

Yes

Previous Claim Details (if any)

Additional Notes

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