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HDFC ERGO Long Term Fire Insurance Form

S.N Document Type Document Description Piramal Capital & Housing
Finance Limited_HDFC_
LTF_15%_Jan 18
Quote is valid till 30 days from quotation date
Quotation cum Proposal Form - Standard Fire & Special
Perils Policy

Name of the Client Ranjeet Kapil Sharma
Communication Address 204-A Sai Sharnam Society,
Near J.B. Nagar, Andheri-W,
Mumbai : 400706
Hypothecation Detail PCHF
Name of the Underwriter Pre-Underwritten
Transaction Type New
Method of Long term policy Method A
Terrorism No
Earthquake Yes
TAC Code 1001
Type of City (Metro -Mumbai, Chennai, Kolkata, Delhi, B’lore) Metro
(Non Metro - Other than Metro Cities)
Rate Per SQFT 3250
Carpet Area in SQFT 788
Sum Insured - Building 25,61,000
Sum Insured - Contents (Max 40% of Bldg. SI)
Total Sum Insured 25,61,000
Policy Period in Years 5
Policy start date 27-Sep-17
Type of Property/ Occupancy Dwellings (Indi. Flats/Bung)
Premium details
Fire Premium 4,482
STFI Premium 960
EQ Premium 640
Net premium 6,082
GST @ 18% 1,095
Total Premium Payable 7,177
(Premium Including GST)

Proposer Signature
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