Relationship Manager Name *Relationship Manager Name

Name of WealthBuddy *

WealthBuddy (POS) Code *

Coverage Type *Coverage TypePackageTP OnlyOD Only

Product Type *Product TypeGCVPrivate CarTwo WheelerMSI DOther Commercial

Policy Issue ID *

Business Type *Business TypeNew/FreshRenewRollover

Name of Proposer *

Mobile No. of Proposer *

Email Id of Proposer *

KYC Of Proposer (Front) *

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KYC Of Proposer (Back) *

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Name of Insurance Company & Branch *

Net Premium (excl GST) *

Vehicle RC (Front) *

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Vehicle RC (Back) *

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New Policy *

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Comments (If any) *

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