(This is not a quotation and to be used only for Internal Purpose)
 PROPOSAL NO.  
 COVERNOTE NO.  
 PERIOD OF INSURANCE  From         Hours    To   Midnight of   
Value of
Chassis (Rs.)		 Value of
Body (Rs.)		 For Vehicle
(Rs.)		 For Trailer
(Rs.)		 Non-Electrical
Accessories (Rs.)		 Electrical /
Electronic Accessories (Rs.)
0.00 0.00 0.00 0.00 0.00 0.00
Value of CNG/LPG Kit (Rs.) Fiber Glass Fuel Tank Total Value (Rs.)
0.00 0.00

A.OWN DAMAGE No.Of Person SI IMT PREMIUM(RS.)
B.LIABILITY No.Of Person SI IMT PREMIUM(RS.)
 Total
 TOTAL TOTAL OWN DAMAGE PREMIUM (A) 0.00
 D.ADD-ON COVERS (BENEFITS) Benefit No. Option No.     
 ADD-ON COVERS PREMIUM 0.00
 TOTAL ADD-ON COVERS PREMIUM (D) 0.00
 E.OTHER SERVICE CHARGES(NON PREMIUM)
Chola value added services 0.00
 TOTAL-OTHER SERVICE CHARGES(NON  PREMIUM)(E) 0.00
 TOTAL LIABILITY PREMIUM (B) 0.00
 C.PERSONAL ACCIDENT COVER
 TOTAL (C) 0.00
  TOTAL PREMIUM (A+B+C+D+E) 0.00
 GST 0.00
 PREMIUM PAYABLE 0.00