IRDAI Regn No - 137

Signature Not Verified

This Document is Digitally Signed
Signer : RANJAN KUMAR SAHOO
Date : 12/10/2019 6:08:34 PM
CERTIFICATE CUM POLICY SCHEDULE Reason:Signing Policy For SGI
PRIVATE CAR PACKAGE POLICY - ZONE B

MOTOR PRIVATE CAR (PACKAGE POLICY) - UIN NO. IRDAN137RP0016V01200809 - SAC Code. 997134
CIN No. U66010RJ2006PLC029979

Issue Office: 10003 - Address:- E - 8, RIICO INDUSTRIAL AREA SITA PURA -JAIPUR RAJASTHAN 302022 Tel
Policy No : 10003/31/20/357366 Prev Policy No - Geographical Area : INDIA
Insured's Code/ Name: 119568209 FURKAN
Address: S/O
: MEHARDEEN FAIZABAD . SAHARANPUR SAHARANPUR- UTTAR PRADESH
247121 Tel - Fax PANSAO710260003
Executive: NA0000005863 Agent Details :BG0000000003 M/S.STFC LTD - CA0197 / / Contact No:
Period of Insurance : From 00:00 on 24/10/2019 To Midnight of 23/10/2020 Prop No. - Issue date
Gross Premium: 25,745 S Tax: 0 GST:4634 Cess : 0 Total: 30,379

Registration Engine No Make - Model Type of Body / Cubic Capacity / Date of Seat Cap
Year of Manf Regn / Delivery
Mark & Place Chassis No Fuel Type (Incl Driver)
HP 17 D 6338 SJG4A11829 MAHINDRA & SUV/MUV 2179 01-07-16 6+1
PAUNTA SAHIB MA1TA2SJXG2A14262 MAHINDRA-SCORPIO DIESEL 2016
S10 2WD

IDV For the IDV For Non Electrical Electrical SI for Named CNG/LPG KIT SI Total Value
Vehicle Trailers Accessories Accessories Persons
8,17,494 0 8,17,494

A. OWN DAMAGE SCHEDULE OF PREMIUM B. LIABILITY

OD TOTAL 17,490.00 BASIC TP COVER 7,890.00
TOTAL PREMIUM 25,745.00 ADD :GR36A-PA FOR OWNER DRIVER 315.00
ADD :IGST 18 % 4,634.00 ADD :LL TO EMPLOYEES-IMT-29 50.00
FINAL PREMIUM 30,379.00 TP TOTAL 8,255.00
* NCB discount - 20 % Previous Policy : 10003/31/19/379211 - Previous Insurer : SHRIRAM GENERAL INSURANCE COMPANY
LTD Nominee for PA Owner/Driver : NA- Age : NA - Relationship : NA - Appointee Name : NA - Appointee Relationship : NA
ADD-ONS :-

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)
Deductibles under Section-I : COMPULSORY DEDUCTIBLE Rs.2000
Subject to IMT Endorsement Printed herein/attached to : IMT-15,IMT-22,IMT-29,IMT-7
Hypothecation Agreement with: SHRIRAM TRANSPORT FINANCE CO. LTD.

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. 750000
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 1500000
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
The Policy covers use of the vehicle for any purpose other than a) Hire or Reward b) Carriage of goods (other than samples or personal luggage) c) Organized racing d) Pace making
e) Speed testing f) Reliability Trials g) 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 - 3

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 is recoverable 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.

Broker POS Details : Name : - ID No : 2

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.comor 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 14/03/2

All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be Authorised Signatory
considered as delayed intimation. ***DIGITALLY SIGNED
GSTIN No. - 08AAKCS2509K1Z3
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