New India Assurance - Property Insurance Quote Request Form

Name of Insured*

Name of Person Requesting Quote

Address

Mobile Number*

Fixed Line Number*

E-mail Address*

Property Construction Type*

Age of Property in Years*

Location of Property*

Proximity to Waterway*

Proximity to Other Buildings & Type

Any claims done in the past*

Claims History If Yes above

Topography of Land*

If Other answered above Please Indicate

True Market Value of Property*

Due date of Insurance