Motor Insurance Filing Form – Wealth Health TRACKER

Full name

First

Middle

Last

Your full name

Email

Your email ID

Policy number

The unique identifier for the insurance policy

date insurance issuance

Type of motor insurance

Date and time of policy issuance

Date

Time

The date and time the policy was issued

Any add-on

If any additional coverage taken for an extra cost

Enter the details of the add-on you purchased

Add-ons

Date of availing add-ons

The date the add-on has been effective from

Add-on expiry date

The date till which the add-on is valid

Benefit in detail

Optionally, elaborate the benefit of this add-on

Coverage

Eventualities in-scope of coverage and their respective coverage amount

Does not cover

Eventualities out-of-scope of coverage (separate the points with a comma)

Additional benefits

Any other benefit

Policy expiry date

The date till which the policy is valid

Agent contact number

The person to call in case of an eventuality

Motor insurance policy documents

Click or drag a file to this area to upload.

Upload key motor insurance policy docs