IRDAI Regn No - 137

Signature Not Verified

This Document is Digitally Signed
Signer : RANJAN KUMAR SAHOO
Date : 8/18/2021 11:58:13 AM
CERTIFICATE CUM POLICY SCHEDULE Reason:Signing Policy For SGI
PRIVATE CAR PACKAGE POLICY - ZONE A

MOTOR PRIVATE CAR (PACKAGE POLICY) - UIN NO. IRDAN137P0016V01200809 - SAC Code.
CIN No. U66010RJ2006PLC029979

Issue Office: 10064 - Address:- E - 8, RIICO INDUSTRIAL AREA SITAPURA -JAIPUR RAJASTHAN 302022 Tel
Policy No : 10064/31/22/000575 Prev Policy No - Geographical Area : INDIA
Insured's Code/ Name: 6711640 Mrs.Test Test
Address: Test
: Test Test-NEW DELHI NEW DELHI 110025
Executive: NA0000000128 Broker Details / W.A. :LC0000000011 M/S.MADHAV INSURANCE BROKERS PVT. LTD. / / Contact No:
9489364526
Period of Insurance : From 00:00 on 20/08/2021 To Midnight of 19/08/2022 Prop No. - Issue date
Gross Premium: 4,803 S Tax: 0 GST:865 Cess : 0 Total: 5,668

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)
DL 1 RE 5544 6734787356876876767 MARUTI SUZUKI-ZEN HATCHBACK 998 01-08-16 4+1
North Delhi 767687 ESTILO LXI BS-IV PETROL 2016
8767676767676767676
776767

IDV For the IDV For Non Electrical Electrical SI for Named CNG/LPG KIT SI Total Value
Vehicle Trailers Accessories Accessories Persons
3,08,312 0 3,08,312

A. OWN DAMAGE SCHEDULE OF PREMIUM B. LIABILITY

OD TOTAL 2,066.00 BASIC TP COVER 2,072.00
TOTAL PREMIUM 4,803.00 ADD :PA-UN-NAMED-GR36B2 PERSON(s) : 250.00
ADD :IGST 18 % 865.00 5 - SI PER PERSON : Rs.100000
FINAL PREMIUM 5,668.00 ADD :PA-PAID DRIVER, 50.00
CONDUCTOR,CLEANER-GR36B3
ADD :GR36A-PA FOR OWNER DRIVER 315.00
ADD :LL-PAID DRIVER, 50.00
CONDUCTOR,CLEANER-IMT-28
TP TOTAL 2,737.00
* NCB discount - 50 % Previous Policy : 56713546876 - Previous Insurer : Bajaj Allianz General Insurance Company Limited
Nominee for PA Owner/Driver : Test- Age : 18 - Relationship : Brother - Appointee Name : NA - Appointee Relationship : NA
ADD-ONS :- (IRDAN137RP0016V01200809/A0001V01201920) Road Side Assistance,

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.1000
Subject to IMT Endorsement Printed herein/attached to : IMT-15,IMT-16,IMT-22,IMT-7
Hypothecation Agreement with: SBI SMECCC, Delhi

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-XLXIV

"Warranted that the Assured named here in /owner of the vehicle insured holds a valid Pollution Under Control (PUC) Certificate on the date of commencement of the Policy. If the PUC is not
found valid on the date of accident (Except Electric vehicles), the Company reserves its right to repudiate the Own Damage claim made under the Policy"

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.
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]

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. -
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 IRDAI Regn No - 137

Attached to and forming part of policy number 10064/31/22/000575

Preinspection Report: Not Applicable

Broker POS Details : Name : - ID No :
CIN No. U66010RJ2006PLC029979

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]

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. -
Page 2 of 2