IRDAI Regn No - 137

Signature Not Verified

This Document is Digitally Signed
Signer : RANJAN KUMAR SAHOO
Date : 8/14/2019 12:08:09 PM
CERTIFICATE CUM POLICY SCHEDULE Reason:Signing Policy For SGI
MOTORISED-TWO WHEELERS PACKAGE POLICY - ZONE B

MOTOR 2 WHEELER (PACKAGE POLICY) - UIN NO. IRDAN137RP0017V01200809 - SAC Code. 997134
CIN No. U66010RJ2006PLC029979

Issue Office: 10021 - Address:- E - 8, RIICO INDUSTRIAL AREA SITAPURA -JAIPUR RAJASTHAN 302022 Tel
Policy No : 10021/31/20/044707 Prev Policy No - Geographical Area INDIA
Insured's Code/ Name: 116907440 Mr.Kapil Verma
Address: 27,
: AGRASEN NAGAR, UDAIPOLE UD AIPUR UDAIPUR-UDAIPUR RAJASTHAN
313001
Executive: NA0000000100 Broker Details / W.A.: LW0000000008 M/S.POLICY BAZAAR INSURANCE WEB AGGREGATOR PVT. LTD. / /
Contact No: 18002088787
Period of Insurance : From 00:00 on 15/08/2019 To Midnight of 14/08/2020 Prop No. - Issue date
Gross Premium: 1,137 S Tax: 0 GST:204 Cess : 0 Total: 1,341

Registration Engine No Make - Model Type of Body / Cubic Capacity / Date Of Seat Cap
Regn / Delivery
Mark & Place Chassis No Fuel Type Year of Manf (Incl Driver)
RJ 27 BB 2718 JF50E83179717 HONDA-ACTIVA 3G SCOOTY 109 17-08-16 1+1
Udaipur ME4JF505GG8179629 PETROL 2016

IDV For the IDV For side Non Electrical Electrical SI for Named CNG/LPG KIT SI Total Value
Vehicle car Accessories Accessories Persons
43,918 0 43,918

A. OWN DAMAGE SCHEDULE OF PREMIUM B. LIABILITY

OD TOTAL 385.00 BASIC TP COVER 752.00
TOTAL PREMIUM 1,137.00 TP TOTAL 752.00
ADD :CGST 9 % 102.00
ADD :SGST 9 % 102.00
FINAL PREMIUM 1,341.00
* NCB discount - 35 % Previous Policy : 211200/31/2019/108142 - Previous Insurer : Oriental Insurance Company Limited
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association, Voluntary Excess, Anti-Theft, Handicap Person, Driver Tuition, Fibre Glass,
CNG/LPG Unit, Geographical Extn, Imported Vehicle etc wherever applicable). ADD-ON UIN No. IRDAN137A0002V01201415:- Nil Depreciation Cover.
Deductibles under Section-I : COMPULSORY DEDUCTIBLE Rs.100
Subject to IMT Endorsement Printed herein/attached to : IMT-22
Hypothecation Agreement with: -
Hire Purchase/Lease Agreement with:
-
Limit of Liability :
Under Section II-1(i) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-1(ii) in respect of any one claim or series of claims arising out of one event is Rs. 100000
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 0

Driver's Clause
Any person including the insured,Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified
from holding or obtaining such a license.,Provided also that the person holding an effective Learner's license may also drive the vehicle and that such
a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limitations as to Use
Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover use for hire or reward, tuition, racing, pace making, reliability
trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any trade or business or use for any purpose in connection with Motor Trade
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms attached.Warranted that in case of dishonour of premium cheque(s) the Company shall
not be liable under the policy and the policy shall be void abinitio (from inception). I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are
issued in accordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at HEAD OFFICE - 21

IMPORTANT NOTICE
The Insured is not Indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment made by the Company by reason of wider terms appearing in the
Certificate in order to comply with the MVAct, 1988 isrecoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION.
Preinspection Report: Not Applicable
Broker POS Details : Name : - ID No :
Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.

For instant renewal of your insurance policy, Log on to www.shriramgi.com or contact us at our Head office no. - 0141-3928400
In case of Claims/Grievance, Please contact us at: Toll Free No - 180030030000, 18001033009 Email id - [email protected]

For and on behalf of

SHRIRAM GENERAL INSURANCE COMPANY LTD

Place : JAIPUR
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the expiry date of
your policy. If you do not want us to contact you, kindly send an e-mail for the same on [email protected]
Consolidated Stamp Duty paid vide Inspector General Registration and Stamp Ajmer order No. F7(77)Gen/2017-18/4250 dated 14/03/2018 and order
All the Amounts mentioned in this policy are in Indian Rupees Authorised Signatory
Note :-Claim intimation after 48 hours will be
GSTIN No. - 08AAKCS2509K1Z3 considered as delayed intimation. ***DIGITALLY SIGNED
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