Trips Incliding USA/Canada :
 

Please select "Yes", if your travel itinerary includes USA and/or Canada.

This would help us suggest the right plan.

Our plans incorporate the various medical expenses that might be incurred in these countries.

Select "No", if you are not visiting USA and/or Canada in your entire travel itinerary.


 
     
Special Asian Countries Plan :
 

We have a special plan for Asian Countries.

The following table shows the Sum Insured and coverage details.

Please note that if you are visiting Japan this plan is not applicable

ONLY FOR ASIAN COUNTRIES EXCLUDING JAPAN

COVERAGE - $15000
A.   Maximum period of insurance 30 days
B.   Medical expenses and repatriation up to US$ 15000
C.   Deductible US$ 50 per event (including for dental services for immediate relief of dental pain)
D.   Personal accident US$ 7500
E.   Other benefits such as loss of checked baggage, delay of checked baggage, loss of passport & personal liability not covered


Countries eligible for Asian Plan

Afghanistan Iraq Myanmar Sri Lanka
Bahrain Israel Nepal Syria
Bangladesh Jordan North Korea Taiwan
Bhutan KazakhStan Oman Tajikistan
Brunei Kuwait Pakistan Thailand
Cambodia Kyrgyzstan Papua NewGuinea Turkmenistan
China Laos Philippines U.A.E
Georgia Lebanon Qatar Uzbekistan
India Malaysia Saudi Arabia Vietnam
Indonesia Maldives Singapore Yemen
Iran Mongolia South Korea



 
     
Policy Plan :
 


Our plans

Plan Category Territory Coverage
A-1 Business & Holiday World wide-excluding USA/Canada US$ 50,000
A-2 Business & Holiday World wide-excluding USA/Canada US$ 250,000
B-1 Business & Holiday World wide-including USA/Canada US$ 100,000
B-2 Business & Holiday World wide-including USA/Canada US$ 500,000



 
     
Purpose of Visit :
 

Please select whether your purpose of visit.

As of now we are only considering Business and Holiday only.

If you are going abroad on any other purpose ( Education, Sports etc)

Please contact our nearest office for a suitable plan.


 
     
Countries to be visited and the duration of stay :
 

Kindly mention the countries visited and the approximate number of days in each country in the following format Country-1(Number of Days), Country-2(Number of Days).

For example, if you are visiting Germany and UK , please write it as

Germany (6 days), UK(4 days)


 
     
Diseases suffered/suffering from :
 


  • Neurological/Mental Related
  • Slipped Disc
  • Spinal Disorder
  • Hypertension
  • Disease of Uterus/Ovaries/Breast
  • Fistula
  • Piles
  • Arthritis
  • Rheumatic Diseases
  • Cataract
  • Cancer
  • Diabetes
  • Tuberculosis
  • AIDS/HIV Related disorder
  • Any Congenital diseases or Any other complaint requiring specialist’s consultation or surgical or hospital treatment or investigations.
    •


Please note that any sickness/accident arising out the above mentioned diseases will not be covered under the policy


 
     
Winter- sports and Mountaineering :
 


Please mention whether you will participating in adventure activities like winter sports and mountaineering.

Please note that any sickness/accident arising out the above mentioned activities will not be covered under the policy


 
     
Name and Address your Family Physician :
 


Kindly enter the name and address of your family physician for reference and faster claim processing


 
     
Beneficiary Details :
 

Kindly enter the name and relationship of the beneficiary Please note that the assignee you mention will be eligible for the receipt of the benefits in case of death.


 
     
Branch Office :
 


Oriental Insurance has several branches across cities and they are responsible for handling your queries during the insurance period. Kindly select a branch office nearest to your place of residence to facilitate verification procedures and claim processing.

Also note that all your queries such as claims, endorsements, grievances etc will be directed to this office.


 
     
Date of First Registration of Vehicle :
 
Please see date of first registration of your vehicle from your RC book and it must be same or newer than date of purchase of vehicle.
 
     
Sum Insured or IDV:
 

The Insured's Declared Value (IDV) of the vehicle is the 'SUM INSURED' for the purpose of this Policy and is fixed at the commencement of each Period of Insurance. The IDV of the vehicle is fixed on the basis of manufacturer's listed selling price of the brand and model of the vehicle proposed for insurance. A percentage of the listed selling price is deducted to calculate the Insured Declared Value for the Current Vehicle
The IDV of the side car(s) and / or accessories, if any, fitted to the vehicle but not included in the manufacturer's listed selling price of the vehicle is likewise to be fixed in the same manner.

Please contact the nearest OICL office if this value is not acceptable to you.

This value is suggestive only.
 
     
Do you wish to opt for higher deductible over and above the compulsory:
 

You may opt for a higher voluntary deductible over and above the compulsory deductible, which will entitle you for discount in the premium. By choosing higher deductible amount, you are willing to bear the amount declared in the event of a claim. For instance, if you have declared a higher deductible of Rs 7,500 for your vehicle and if your claim amount is Rs 20,000, then you will bear the first Rs 7,500 and the company will bear the remaining.
You can choose the Higher Deductible from the drop down provided. Higher the deductible, higher the discount

 
     
Is vehicle fitted with anti theft device:
 

If your vehicle is fitted with any of these devices to protect from theft. Vehicles fitted with anti-theft devices approved by Automobile Research Association of India (ARAI), Pune and whose installation is certified by any of the Automobile Associations are eligible for a discount.
Please provide brief description and enter the Value of these items (If more than one, then total Sum of all items put together).
a.    Ignition Shield, Fuel Cut-Out Switch,
b.    Car Alarms,
c.    Sirens,
d.    Ultrasonic Motion Sensor,
e.    Glass Etching (Vehicle Identity Number) on Motor Vehicle,
f.     Glass Break Detector,
g.    High powered electronic noise maker and standby power unit,
h.    Battery Isolator,
i.     Steering Wheel Lock,
j.     Hand Brake Lock,
k.    Gear Transmission Lock,
l.     Wheel Lock etc

 
     
Have you registered the CNG/LPG kit with RTO:
 

It is important to register your CNG/LPG kit with RTO if it is not company fitted. An unregistered kit will not be eligible for claim.
 
     
Details of Accessories:
 

Please enter the details of Electrical, Non-electrical and CNG/LPG kit items you want to propose for Insurance
Electrical
Any electronic / electrical items like Stereo, A.C etc. which were not fitted by the manufacturer and were installed after the car was purchased can be covered under Electrical / Electronic Accessories
Non-Electrical
Any non electronic / non electrical items like Alloy wheel, Leather seat covers etc. which was not fitted by the manufacturer and installed after purchased of car to be consider as non electronic accessories. This would not be part of Car IDV.
CNG/LPG Kit
The details of CNG/LPG kit and Total Cost Incurred on setting up the entire kit

 
     
End Date:
 
The portal allows you to buy only 1 year policy. Hence the end date will always be one year after start date.
 
     
Select OICL Office:
 
Oriental Insurance has several branches across the city and responsible for handling your queries during the insurance period. Kindly select a branch office nearest to your place of residence to facilitate verification procedures and claim processing. All your queries such as claims, endorsements, Grievances etc will be directed to this office.
 
     
Were there any claims in expiring policy:
 
If there were any claims in your expiring policy you are not eligible for no claim bonus. If there were no claims in the expiring policy you are required to enter the no claim bonus discount you were enjoying in your expiring policy.
 
     
RTO Zone details :
 
For Private Car/ Two Wheelers/ Commercial Vehicles ratable under Section 4.C.1 and C.4 :
Zone A - New Delhi, Mumbai, Kolkata, Chennai, Pune, Ahmedabad, Hyderabad, Bangalore
Zone B - Rest of India

For Commercial Vehicles excluding vehicles ratable under Section 4. C.1 and C.4 :
Zone A - New Delhi, Mumbai, Kolkata, Chennai
Zone B - Hyderabad, Itanagar, Dispur/Guwahati, Patna, Raipur, Panaji, Gandhinagar, Chandigarh, Shimla, Srinagar, Ranchi, Bangalore, Thiruvananthapuram, Bhopal, Imphal, Shillong, Aizawl, Kohima, Bhubaneswar, Jaipur, Gangtok, Agartala, Lucknow, Dehradun
Zone C - Rest of India
 
     
Vehicle Registration Number :
 
If your car is brand new, You don’t need to enter registration number. If it is an old car, the registration number is mandatory.
 
     
Vehicle Chassis Number :
 
Please enter 17 digit chassis number” for all new/non oicl renewal vehicles(2 wheelers/private car).
 
     
Do you own the building premises under insurance?:
 

Answer the question with Yes if you own the premises/house which is under insurance.
If you are the owner, Section 1(A) is compulsory along with section 1(B).







 
     
Section 1A - Building:
 

Enter the sum you want to insure for the items listed.
Please note that Total Sum Insured should not be more than 2 Crores for this section.
Cost of land should not be included in estimating the total cost of the building.







 
     
Section 1B - Contents:
 

THIS IS A COMPULSORY SECTION.Enter the Values of Sum Insured for each of items listed.
Please note that Total Sum Insured should not be more than 2 Crores for this section.

Stock in Trade : Enter the Value of the stock that is kept in the shop premises.

Fixtures & Fittings : Enter the sum you want to insure for Fixtures and Fitting in the shop premises.

Goods held in trust : Enter the value of goods held in trust in the shop premises.

All other contents : Value of all other contents in the shop.





 
     
Section 2 - Burglary and Housebreaking:
 

Please Select Housebreaking, if you want to Insure all your contents (as per Section 1(B)) for larceny and theft.
Please note that for Housebreaking all the items for Insurance are directly taken from section 1(B).
You are not allowed to change any details. If you want to change details, Please change in Section 1(B) itself.




 
     
Section 3 - Money in Transit:
 

Money in Transit Value :Money which is lost by accident or misfortune while the Insured's money is in his hands or in the hands of his authorized employees in transit between any two places within a radius of 25 kilometers from the Insured premises.
Kindly enter the money (Value of Money carried in Rs) which is in transit.




 
     
Section 4 - Pedal Cycle:
 

You can insure Pedal Cycles belonging to the Insured or any member of the Insured's family by against Fire, Lightning or External Explosion, Riot, Strike, Malicious Act, Housebreaking and/or Theft, Accidental External Means, Flood, Cyclone, Storm, Tempest and other similar convulsions of nature and atmospheric disturbance Earthquake (Fire and/or Shock).

Make & Name of the Manufacturer : Please enter the Make and the Name of Manufacture of the Pedal Cycle Under insurance.

Year of Manufacture :Enter the Year of Manufacture of the Pedal Cycle.

Frame Number : Enter the Frame Number/Identification Number of the Pedal Cycle.

Value : Enter the Value of the Pedal Cycle as Sum Insured.


 
     
Section 5- Plate Glass:
 

You can Insure against loss or damage to fixed plate glass in the Insured premises by accidental breakage.

Description : Enter a brief description of the Fixed glass.

Dimension : Enter the dimension of the Plane fixed glass in Standard terms.

Total Value : Enter the total value of the Fixed plate glass as the Sum Insured.





 
     
Section 6 - Neon Signs:
 


Description : Enter a brief description of the Neon signs under insurance.

Description Position :Give a brief description of the position of the Neon Signs.

Year of Manufacture : Enter the year of Manufacture of the Neon signs.

Location : Give a brief description of the location of the Neon signs in the shop.

Total Value : Enter the total value of the Neon glass as the Sum Insured.



 
     
Section 7 - Baggage:
 

With Baggage Insurance you can insure Baggage related to the Insured and/or such members of his/her family as are permanently residing with him/her and accompanying the Insured or his/her family members belonging to him/her or for which he/she is responsible whilst traveling anywhere in India whilst on tour or holidays LOST, DESTROYED or DAMAGED by ACCIDENT or MIS-FORTUNE.

Sum Insured : Enter the Sum want to Insure for the Baggage.

Description : Enter a brief description of the Baggage under Insurance.



 
     
Section 8- Personal Accident:
Benefit Description Amount Payable(Rs) Table No
Premium / Rs 1 Lakh Sum Insured
Normal Risk(Rs) Heavy Risk(Rs)
1 Death Only(100% of Capital Sum Insured) Death and Total Permanent Disablement 1 Lakh Table 1 Benefit 1 Only 45/- 70/-
2 Loss of two limbs, loss of sight of two eyes or loss of one limb and loss of sight of one eye (100% of Capital Sum Insured) 1 Lakh Table 1-A Benefit 1&4 Only 80/- 120/-
3 Loss of One limb or loss of sight of one eye (50% of Capital Sum Insured) 50,000      
4 Permanent Total Disablement from injuries other than named above (100% of Capital Sum Insured) 1 Lakh      
5 Permanent Partial Disablement   Table II Benefit 1 to 5 100/- 150/-

Note:
Only Table II�benefits are available for Insurance as a package policy. If you want to avail full and comprehensive benefits of Personal Accident, please take�a� separate Personal Accident Policy(Also available Online). �

You may also note that, Table II includes the benefits of Table 1 &�Table 1A as described above.
Section 9 - Fidelity Gurantee:
 

If the Insured shall sustain direct pecuniary loss caused by act of fraud or dishonesty committed by a salaried person employed by the Insured in the insured premises, the Company will indemnify the Insured in respect of such loss provided that:

Name of the Employee : Enter the name of the Employee under the fidelity guarantee section.

Designation :Enter the designation of the employee.

Monthly Salary: Enter the monthly salary of the employee under fidelity guarantee.

Amount of Guarantee : Enter amount of guarantee of the employee.



 
     
Section 10A - Liabilities:
 

The Company shall indemnify the Insured in respect of sums which the insured shall become legally liable to pay as private shopkeeper occupying the premises specified in the schedule (subject to the sum set in the schedule).

AOA : Any One Accident

AOY : Any One Year.

Public Liability(AOA/AOY) : The Indian Workmens Compensation Act 1923 provides for the payment of compensation by the employer to his employees (for their dependents in the event of fatal accidents) if personal injury is caused to them by accidents arising out of and in the course of their employment. The Workmens Compensation policy covers the liability of an employer for employment injury (including death) sustained by any employee who is a WORKMAN as defined under Workmen Compensation Act.

 
     
Section 10B - Workmen Compensation:
 

The Company will indemnity the Insured against all sums which the Insured shall become legally liable to pay as compensation to his employees mentioned in the Schedule engaged in the Insured's shop premises under Fatal Accident Act, 1855, Workmen's Compensation Act 1923 or any amendment thereto prior to the date of issue of this Policy.

Number of employees : Enter the number of employees under proposal.

Nature of Work : Select the Nature of Work.

Annual Earnings : Enter the Annual earnings of the Individual in Rupees.

Wage Type : Select wage type. It is the monthly earnings of the workmen. Select whether the monthly salary of the workmen is greater or less than Rs 4000.



 
     
Section 11 - Business Interruption:
 

This section will cover losses arising out of Business Interruption of the Insured as a direct result of operation of perils covered under Section I-Building & Contents (Excluding Money & Valuables) of the policy and is subject to admissibility of claim under Section I.

Gross Income : Enter the Gross of the Shop over the period.

Accountants Charge :Enter the amount paid to the accountant as a fee.

Indemnity Period :Enter the Indemnity Period in days.

Pan No : Enter the Pan Number of the proposer.

Sales Tax No : Provide the sales tax number of the shop under insurance.

Sum Insured : Enter the Sum Insured under this section.






 
     
State Of OICL Office:
 

Oriental Insurance has several branches across cities and they are responsible for handling your queries during the insurance period.
Kindly select a branch office nearest to your place of residence to facilitate verification procedures and claim processing.
Also note that All your queries such as claims, endorsements, grievances etc will be directed to this office.

State : Select the state in which you reside.

City : Select your city/town.

Branch : Select OICL branch which is accessible to you. This is important as all your queries and claim processing will be directed to this office.




 
     
Do you own the building premises under insurance?:
 

Answer the question with Yes if you own the premises/house which is under insurance.
If you are the owner, Section 1(A) is compulsory along with section 1(B).







 
     
Section 1A - Building:
 

Enter the sum you want to insure for the items listed.
Please note that total cost of the building should not be more than 2 Crores for this section.
Cost of land should not be included in estimating the total cost of the building.







 
     
Section 1B - Contents:
 

THIS IS A COMPULSORY SECTION.Enter the Values of Sum Insured for each of items listed.
Please note that total cost of the building should not be more than 2 Crores for this section.

Furnishings, Safes, Machinery, Additonal Fixtures and Fittings, Stationery : Enter the Value of items listed as a whole /Single sum Insured for all the items

Clothings : Enter the Sum you want to insure for all the clothing and related material that are present in the house.

Kitchen Appliances : Enter the Sum you want to insure for all the Kitchen Appliances that are present in the house.

Miscellaneous : Any other Miscellaneous items.

Electrical and Mechanical Appliances: Please enter the requisite details in case you want to insure Electrical equipment against Fire and Allied perils.
Also note that, electrical items older than 5 years (Year of Manufacture more than 5 years from today) are not considered for insurance.





 
     
Section 2- House Breaking:
 

Please Select Housebreaking, if you want to Insure all your contents (as per Section 1(B)) for Larceny and theft.
Please note that for Housebreaking all the items for Insurance are directly taken from section 1(B).
You are not allowed to change any details. If you want to change details, Please change in Section 1(B) itself.







 
     
Section 3- Jewellery & Valuables:
 

Under Jewellery and Valuables, you can cover all your Jewellery and Valuables in house against any damage caused by Accident or Misfortune.

Description : Please enter a brief description of the Jewellery item or Valuable under Insurance.

Weight : Specify the weight of the Jewellery item in Standard terms.

Valuation Certificate Number : Please enter Valuation Certificate Number concerned with the Jewellery item.

Value : Enter the total value of Jewellery Piece or Valuable under Insurance.





 
     
Section 4- Plate Glass:
 

You can Insure against loss or damage to fixed plate glass in the Insured premises by accidental breakage.

Plane Square : Enter the Value of the Plane Square in Rupees.

Letter or Screening : Enter the Value of the Letter or Screening on the Plate Glass in Rupees.

Framework : Enter the Value of the Framework on which the glass is supported in Rupees.

Description : Enter a brief description of the Fixed glass.

Dimension : Enter the dimension of the Plane fixed glass in Standard terms.

Total Value : Enter the total value of the Fixed plate glass as the Sum Insured.





 
     
Section 5- Breakdown of Electrical Equipments:
 

Under this section, you can Insure all your Electrical Appliances in the house against sudden physical damage caused by and/or solely due to mechanical and/or electrical breakdown of domestic, electronic (except for computers and its accessories) or mechanical appliances, apparatuses or gadgets (including television and its accessories) specified in the schedule.
Please note that the details are automatically updated from section 1(B). You cannot edit /delete any of the items. If you want to change, Please change in Section 1(B) itself.





 
     
Section 7- Pedal Cycle:
 

You can insure Pedal Cycles belonging to the Insured or any member of the Insured's family by against Fire, Lightning or External Explosion. Riot, Strike or Malicious Act. Housebreaking and/or Theft. Accidental External Means. Flood, Cyclone, Storm, Tempest and other similar convulsions of nature and atmospheric disturbance Earthquake (Fire and/or Shock).

Make & Name of the Manufacturer : Please enter the Make and the Name of Manufacture of the Pedal Cycle Under insurance.

Year of Manufacture : Enter the Year of Manufacture of the Pedal Cycle.

Frame Number : Enter the Frame Number/Identification Number of the PedalCycle.

Value : Enter the Value of the Pedal Cycle as Sum Insured.





 
     
Section 8 - Baggage:
 

With Baggage Insurance you can insure Baggage related to the Insured and/or such members of his/her family as are permanently residing with him/her and accompanying the Insured or his/her family members belonging to him/her or for which he/she is responsible whilst traveling anywhere in India whilst on tour or holidays LOST, DESTROYED or DAMAGED by ACCIDENT or MIS-FORTUNE.

Sum Insured :Enter the Sum want to Insure for the Baggage.

Description : Enter a brief description of the make and type of Baggage under Insurance.





 
     
Section 8- Personal Accident:
Benefit Description Amount Payable(Rs) Table No
Premium / Rs 1 Lakh Sum Insured
Normal Risk(Rs) Heavy Risk(Rs)
1 Death Only(100% of Capital Sum Insured) Death and Total Permanent Disablement 1 Lakh Table 1 Benefit 1 Only 45/- 70/-
2 Loss of two limbs, loss of sight of two eyes or loss of one limb and loss of sight of one eye (100% of Capital Sum Insured) 1 Lakh Table 1-A Benefit 1&4 Only 80/- 120/-
3 Loss of One limb or loss of sight of one eye (50% of Capital Sum Insured) 50,000      
4 Permanent Total Disablement from injuries other than named above (100% of Capital Sum Insured) 1 Lakh      
5 Permanent Partial Disablement   Table II Benefit 1 to 5 100/- 150/-

Note:
Only Table II�benefits are available for Insurance as a package policy. If you want to avail full and comprehensive benefits of Personal Accident, please take�a� separate Personal Accident Policy(Also available Online). �

You may also note that, Table II includes the benefits of Table 1 &�Table 1A as described above.
Section 10 - Liabilities:
 

The Company shall indemnify the Insured in respect of sum which the insured shall become legally liable to pay as private householder occupying the premises specified in the schedule (subject to the sum set in the schedule).



 
     
Section 10B - Workmen Compensation:
 

The Indian Workmen's Compensation Act 1923 provides for the payment of compensation by the employer to his employees (for their dependents in the event of fatal accidents) if personal injury is caused to them by accidents arising out of and in the course of their employment.
The Workmen's Compensation policy covers the liability of an employer for employment injury (including death) sustained by any employee who is a WORKMAN as defined under Workmen Compensation Act.

Name of Employee : Enter the Full name of the employee under proposal.

Nature of Work : Select the Nature of Work of the Employee.

Annual Earnings : Enter the Annual earnings of the Individual in Rupees.

Wage Type : Select wage type. It is the monthly earnings of the workmen. Select whether the monthly salary of the workmen is greater or less than Rs 4000.

Sum Insured : Enter the Sum Insured for the Workmen under Insurance in Rupees.





 
     
Select OICL Office:
 

Oriental Insurance has several branches across cities and they are responsible for handling your queries during the insurance period.
Kindly select a branch office nearest to your place of residence to facilitate verification procedures and claim processing.
Also note that all your queries such as claims, endorsements, Grievances etc will be directed to this office.

State : Select the state in which you reside.

City : Select your city/town.

Branch : Select OICL branch which is accessible to you. This is important as all your queries and claim processing will be directed to this office.





 
     
Select OICL Office:
 

In case appliances are more than 5 years old.Please contact underwriting office





 
     
Select OICL Office:
 

In case you wants this cover it can be issued only by any of our u/w offices.





 
     
Help for digital signature validation
 

Please click the following link to download the help document for signature validation corresponding to your PDF viewer version.


Download document for Acrobat Reader 7.0
Download document for Acrobat Reader 8.0
Download document for Acrobat Reader 9.0
 
     

Please note, digital signature will work only in Adobe Acrobat reader 7.0 and above. Other versions will show invalid signature.
Name and Address your Family Physician :
 


Kindly enter the name and address of your family physician for reference and faster claim processing


 
     
Branch Office :
 


Oriental Insurance has several branches across cities and they are responsible for handling your queries during the insurance period. Kindly select a branch office nearest to your place of residence to facilitate verification procedures and claim processing.

Also note that all your queries such as claims, endorsements, grievances etc will be directed to this office.


 
     
Personal Accident cover for Children :
 

Personal Accident Sum Insured for child, less than 18 years, can be a maximum of 50% of the Primary Insured Person. For a child, above 18 years, the Personal Accident Sum Insured value can be upto a maximum of 100% of the Primary Insured Person.

Illustration -

Child Less than 18 years:

For Silver Plan , if Personal Accident covered for Primary Insured is 300000(Silver Plan), Valid Personal Accident Sum Insured values will be 150000, 100000 and 50000
For Gold Plan, if Personal Accident covered for Primary Insured is 600000(Gold Plan) Valid Personal Accident Sum Insured values will be 300000, 200000 and 100000


Child above 18 years:

For Silver Plan , if Personal Accident covered for Primary Insured is 300000(Silver Plan), Valid Personal Accident Sum Insured values will be 300000, 200000 and 100000
For Gold Plan, if Personal Accident covered for Primary Insured is 600000(Gold Plan) Valid Personal Accident Sum Insured values will be 600000, 400000 and 200000

 
     
Risk type:
 

There are two types of Risks in Personal Accident in order to categorize individuals into Accident Prone (RISKY) and Non-Accident Prone (NORMAL).
Working with Mines, Explosives, Magazines, Installation of High Tension Electrical Supply lines.
Jockeys, Circus Personnel, racing on wheels, Horseback racing, big game hunting, Mountaineering, winter sports (Skiing, Ice hockey etc), ballooning, Polo or persons engaged in Occupation of Similar Hazard.
 If the Individual under insurance involves himself or herself in above activities, Please select HIGH RISK under Risk type otherwise select NORMAL RISK.

Please select the options as instructed. Failing which claims will not be approved if a normal risk person is injured/died in a high risk activity.
 
     
Medical Extension:
 

The policy may be extended to include payment of medical expenses (due to accident) with an option of  10% or 25% of  the Capital Sum Insured
With a valid claim amount whichever is lower by charging an additional premium at the rate of 10% or 25% of basic cover. The medical benefits are in addition to the benefits provided in the policy.

Please select the required percentage (10% or 25%) from the drop down provided. In case you don’t need an extension cover, select No.
 
     
Diseases suffered from:
 
If the Individual under insurance has suffered or Suffering from the following diseases or defects. Please specify.
  • Any Physical defect or Infirmity

  • Gout

  • Arthritis

  • Diabetes

  • Paralysis

  • Fits of any kind
 
     
Monthly Income:
 

Please enter your monthly Income from gainful source of Employment in this box.
Enter only numerical values without any commas.
Make sure you are entering correct values, as this income will be used to calculate your and family members Maximum available sum insured.
The Maximum available Sum insured are as follows

  1. For Table 1 and 1-A, Maximum Sum Insured is 120 times Monthly Income
  2. For Table II, Maximum Sum Insured is 60 times monthly Income.
  3. For Table III, Maximum Sum Insured is 120 times Monthly Income or Rs 5 Lakh ( whichever is lower)
 
     
Table Of Cover :



            The following types of coverages are offered under a Personal Accident policy:-


Benefit

Description

Amount Payable

(Rs)

Table No

Premium

Normal Risk Rs

Heavy Risk Rs

1

Death Only (100% of Capital Sum Insured)

1 Lakh

Table 1 Benefit 1 Only

45/-

70/-

 

Death and Total Permanent Disablement

 

 

 

 

 

 

2

Loss of two limbs, loss of sight of two eyes or loss of one limb and loss of sight of one eye

1 Lakh

Table 1-A Benefit 1&4 Only

80/-

120/-

 

(100% of Capital Sum Insured)

 

 

 

 

 

 

 

 

 

3

Loss of One limb or loss of sight of one eye

50,000

 

 

 

 

(50% of Capital Sum Insured)

 

 

 

 

 

 

 

 

 

 

4

Permanent Total Disablement from injuries other than named above

1 Lakh

 

 

 

 

(100% of Capital Sum Insured)

 

 

 

 

 

 

 

 

 

 

5

Permanent Partial Disablement

 

Table II

Benefit 1 to 5

100/-

150/-

 

 

 

 

 

6

Temporary Total disablement@1% of Capital Sum Insured up to 104 Weeks

 

Table III

Benefit 1 to 6

150/-

225/-

 

(maximum weekly benefits not exceeding 5000)

 

 

 
 
     
Assignee Name:
 
Assignee is the Individual who will receive the amount payable in case of death of the Individual under Insurance.
Enter the name of the assignee in the text box provided.
 
     
Policies you can Renew online:


LIST OF POLICIES
ACCIDENT POLICY FOR POSTAL SAVINGS BANK ACCOUNT HOLDERS
AGREED VALUE-BURGLARY
ANIMAL DRIVEN CART INSURANCE
AQUA CULTURE INSURANCE
AVASHYA RIN BIMA KAVACH PACKAGE POLICY
AVASIYA RIN BIMA KAVACH SPECIAL POLICY
BAGGAGE CORPORATE
BAGGAGE CORPORATE UNNAMED
BAGGAGE INSURANCE
BANKER'S INDEMNITY
BHAGYASREE CHILD WELFARE INSURANCE
BHAVISHYA AROGYA
BHAVISHYA AROGYA - PNB
BLOOD STOCK
BURGLARY
BURGLARY DECLARATION
BURGLARY FLOATER
BURGLARY FLOATER DECLARATION
CARRIER LEGAL LIABILITY
CIVIL ENGINEERING COMPLETED RISKS INSURANCE
CONTACT LENS INSURANCE
CONTRACTORS PLANT AND MACHINERY
COURIERS LIABILITY INSURANCE
CYCLE RIKSHAW INSURANCE POLICY
ELECTRONIC EQUIPMENT INSURANCE
ERROR and OMISSION -MEDICAL ESTABLISHMENT
FIDELITY GUARANTEE
FLORICULTURE - ROSE INSURANCE
FLORICULTURE PACKAGE - ROSE INSURANCE
GCCV
GOOD HEALTH INSURANCE
GPA - Bangiya Gramin Vikash Bank (BGVB)
GPA - ORIENTAL BANK OF COMMERCE
GPA ORIENTAL SURAKSHA DRGB
GRAMIN PERSONAL ACCIDENT INSURANCE POLICY
GUN INSURANCE
HAPPY FAMILY FLOATER
HONEY BEE INSURANCE
HOPE - Health Of Privileged Elder
HORTICULTURE INSURANCE (FRUIT BEARING)
HOUSE HOLDERS PACKAGE POLICY
HUT INSURANCE
INDIVIDUAL MEDICLAIM
JAN AROGYA BIMA
JAN AROGYA BIMA - GROUP
JANATA PERSONAL ACCIDENT INSURANCE POLICY
JEWELLERS BLOCK
KHALIHAN INSURANCE
KISAN AGRICULTURAL PUMPSET INSURANCE
KISAN CREDIT CARD PA INSURANCE
KISAN PACKAGE INSURANCE
LIVESTOCK INSURANCE
LIVESTOCK MASTER POLICY
LPG DEALERS INSURANCE
MACHINERY BREAKDOWN INSURANCE
MICRO BHAGYASREE CHILD WELFARE INSURANCE
MICRO GRAMIN PERSONAL ACCIDENT INSURANCE POLICY
MICRO KISAN AGRICULTURAL PUMPSET INSURANCE
MICRO LIVESTOCK (CATTLE) INSURANCE
MICRO RAJ RAJESHWARI MAHILA KALYAN BIMA YOJANA
MICRO UNIVERSAL HEALTH INSURANCE
MICRO--JANATA PERSONAL ACCIDENT INSURANCE POLICY
MISCELANEOUS CLASS D VEHICLES
MOBILE INSURANCE
MONEY INSURANCE
MOTOR TRADE - INTERNAL RISK - CLASS G
MOTOR TRADE - ROAD RISK - CLASS F
MOTOR TRADE - ROAD TRANSIT RISK - CLASS E
MOTORISED-TWO WHEELERS
NAGRIKSURAKSHA - GROUP
NAGRIKSURAKSHA - INDIVIDUAL
NEON SIGN
OFFICE UMBRELLA
ORIENTAL HEALTH ROYAL - BANGIYA GRAMIN VIKASH BANK
ORIENTAL HEALTH ROYAL - DENA BANK
ORIENTAL HEALTH ROYAL - OBC
ORIENTAL SANJIVNI DRGB
PA FLIGHT COUPON
PA FLIGHT COUPON - OPEN POLICY
PA INDIVIDUAL
PAGER INSURANCE
PCCV
PEDAL CYCLE INSURANCE
PETROCHEMICAL RISKS INSURANCE POLICY
PLANTATION INSURANCE (NON FRUIT BEARING)
PLATE GLASS INSURANCE
PNB-ORIENTAL ROYAL MEDICLAIM POLICY
POULTRY INSURANCE
PRAVASI BHARTHIYA BIMA YOJANA
PRAVASI BHARTIYA BIMA YOJANA POLICY 2006
PRIVATE CAR
PROFFESSIONAL INDEMNITY -DOCTORS
PROFFESSIONAL INDEMNITY -OTHER THAN DOCTORS
RAJ RAJESHWARI MAHILA KALYAN BIMA YOJANA
RASHTRIYA SWASTHYA BIMA YOJNA
SERICULTURE INSURANCE
SHOPKEEPERS INSURANCE
SPORTS INSURANCE
STANDARD FIRE
STANDARD FIRE -- NEW TARIFF
STEVEDORE LIABILITY
STUDENT SAFETY TAILOR MADE POLICY
STUDENTS SAFETY
SUHANA SAFAR
SWASTHYA BIMA POLICY
SWEET HOME PACKAGE POLICY
THANE JANATHA SAHAKARI BANK
TRAILERS
TRIBAL PACKAGE POLICY
TV/VCR INSURANCE
UNIVERSAL HEALTH INSURANCE
LIVE STOCK(CATTLE) INSURANCE
End date of existing policy:
 
Please note that the end date of existing policy must be lesser than current date. If you want to renew a policy that has already expired, please contact the nearest OICL Office.
 
     
Date of First Registration of Vehicle :
 
If your car is brand new and don't have the registration number,
please enter "New" in Registration number field.
If it is an old car, the registration number is mandatory.
 
     
Hazardous Goods for Shop Code :
 
No Hazardous Item to be stored at the time of Sum Insured Entry for Stocks.