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HDFC ERGO General Insurance Company Limited

REQUEST FOR TRANSFER OF INSURANCE


(All fields are mandatory and fill in CAPITALS only)

Policy No.

CUSTOMER INFORMATION (New Proposer)


Proposer Name
(New Owner)*
(First Name) (Middle Name) (Last Name)

Mobile No. Email *

Corr. Add: Building Name/


Block No.*

Street Name* Locality*

City* Pin Code* State*

Aadhar Card* PAN No.*

*Name of Nominee
(First Name) (Middle Name) (Last Name)

VEHICLE DETAILS

Registration No.

I, the undersigned Mr./ Ms./ M/s ___________________________________________________________________________________________________________________________


have purchased a vehicle insured with HDFC ERGO General Insurance Company Ltd and wish to transfer the said vehicle in my name, as per the details mentioned above.

I am attaching the below mentioned documents and premium amount cheque (as applicable) in support of my request for the transfer of insurance:

RC has been transferred in my name RC has not been transferred in my name

1. Form 29 and 30 duly filled or RTO Transfer fee receipt


Transferred Registration Certificate (RC) copy 2. No Objection Certificate (NOC) from previous insured for transfer of policy
(Not applicable for Liability Only Policy)

Date of Transfer as per RC D D M M Y Y Y Y


2. Additional Premium:
¡ Additional Premium Would be required from New Owner (Purchaser) in case the previous insured as per current policy was enjoying discounts on account on No Claim
Bonus.

3. Additional Documents:
¡ Death certificate would be required in addition to be above mentioned documents for Transfer of insurance on account of demise of Insured.
¡ In case Transfer of Vehicle from Employer (Company) to Employee (Insured Person), No Objection Certificate (NOC) on Company's Letterhead with below 2 details ;
1. No objection to transfer No Claim Bonus (NCB)
2. No objection to transfer policy

Yours Sincerely,

(Name and Signature of New Owner)

Self Help Branch Courier


Where to
Submit

Visit nearest branch with the documents. Manager - CEM


Visit our customer support section on
For nearest branch visit our website D-301, 3rd Floor, Eastern Business District
www.hdfcergo.com and place your request
www.hdfcergo.com (Magnet Mall), LBS Marg, Bhandup (West),
for Transfer of Insurance.
Mumbai - 400 078.

HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept, 14, 2016 and L&T General Insurance Company Limited upto Sept, 13, 2016). CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400020. Customer Service Address: D-301, 3rd Floor, Eastern Business District (Magnet Mall),
LBS Marg, Bhandup (West), Mumbai - 400 078. Toll-free: 1800 2 700 700 (Accessible from India only) | Fax: 91 22 66383699 | care@hdfcergo.com | www.hdfcergo.com. IRDAI Reg. No. 146. 1

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