Proposal form / Information form [প্রস্তাবনা/তথ্য ফর্ম]

General Information (Mandatory) [সাধারণ তথ্যাবলী (বাধ্যতামূলক)]

General Information (Optional) [সাধারণ তথ্যাবলী (ঐচ্ছিক):]

Other Information [অন্যান্য তথ্যাবলী:]

Period of Insurance [বীমার মেয়াদকাল:]
Same as Registration [রেজিষ্ট্রেশনের মত একই:]
Other Address [অন্যান্য ঠিকানা:]

** By providing information in this form will be treated as client proposal form to get insurance coverage. Client's mobile number / email address will be considered as the digital signature of the client. You must fillup personal information & particulars of the Vehicle section. Unless mandatory information your form will not be submitted. **
Dear ,
Your vehicle ID is:

You will be charged as below:

Basic Premium:
Total Driver / Helper / Conductor Fee: ( * ) =
Total Passenger Fee: ( * ) =
NCB
Net Premium
Vat(15%)
Total Premium
Online payment charge
Total with online charge