Filmsure Portal

Location, Brand & Roll Number

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Roll Number

Box Photos

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Customer Information

First Name

Last Name

Email Address

Phone Number (Primary)

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Phone Number (Alternative)

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Address Line 1

Address Line 2

Vehicle Information

Registration Number

Chassis Number

Vehicle Company Name

Vehicle Model

Date of Application

Vehicle Photos (Front, Side, Back — 4 photos)

Billing Information

Filmsure Protection

Choose Your Shield

Panel replacement cover for your PPF investment. Pick the tier that matches your risk.

Essential Shield 5% of invoice value Basic cover, lowest cost Replacement1 panel, 1 time LabourNot covered DocumentsRepair invoice from dealer Select Plan

Most Popular Premier Guard 15% of invoice value Balanced cover for regular drivers Replacement1 panel, up to 2 times LabourCovered DocumentsRepair invoice from a place authorized by insurance Select Plan

Elite Armour 25% of invoice value Maximum cover, minimum paperwork Replacement1 panel, up to 3 times LabourCovered DocumentsNo documents required Select Plan

GST Invoice Copy (photo)

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Invoice Value

₹

Coverage Amount (10% of invoice) ₹0.00

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Application Centre

Detailing Centre Name

Center Email

Contact Number (Primary)

+91

Contact Number (Secondary)

+91

Contact Person Name

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Brand Name

Roll Number

Customer Name

Customer Email Address

Customer Phone No. (Primary)

Customer Phone No. (Secondary)

Customer Address

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Detailing Centre Name

Contact Person Name

Detailing Centre Email

Detailing Centre Contact Number (Primary)

Detailing Centre Contact Number (Secondary)

Total Amount

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