v8333378 Schedule
v8333378 Schedule
It will always be our endeavour to constantly better your experience by innovating and evolving our basket of conveniences. We strive to
deliver service which is personalized and is totally transparent. It is our aim to be with you in your time of need.
The policy has been issued on the basis of the information provided by you. The extract of the information has been enclosed for
your reference. We would request you to peruse the policy and satisfy yourself that it meets with your requirement fully.
Please note : Transfer of benefits under this insurance policy is not automatic on the sale of the vehicle. The transferee must apply
within 14 days from the date of transfer of vehicle in writing to the insurance company with full details in a duly signed fresh proposal
form alongwith evidence of sale and transfer fees of ₹. 50/- + Goods and Service Tax.
We would like to assure you that the electronic copy of your policy is as authentic and valid as the physical copy and it can be used as a
proof of insurance wherever required.
Once again, thank you for choosing to insure your vehicle with Future Generali and we look forward to being of service to you.
Assuring you of our best services at all times.
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Tax Invoice
INSURED DETAILS
Policy Number : V8333378 Address of Service Provider : Off Code-46,Future Generali India Insurance Co
Ltd, 8th Floor, Block C, Apeejay House, 15 Park
Street, Kolkata, West Bengal, Pincode - 700016
Invoice Number : 202019PNT0076573
Received with thanks from a sum of ₹ 53,075.00 towards Premium on the above mentioned policy.
NOTE :
1. In case of payment by cheque, in the event of dishonour of cheque for any reason whatsoever,insurance cover provided under this receipt automatically stands
cancelled from the inception irrespective of whether a seperate communication is sent or not.
2. Excess amount, if any, will be adjusted against subsequent policies, or will be refunded on demand.
(Authorised Signatory)
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Future Secure Motor Insurance
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989
Policy Servicing : Off Code-46,Future Generali India Insurance Co Ltd, 8th Floor, Block C, Apeejay House, 15 Park Street,
Office Kolkata, West Bengal, Pincode- 700016., Tel_No: -
Policy No. : V8333378 Period of Insurance : From 00:00 hrs of 24/03/2021 To
Insured : Mr. HIMANSHU M SHAH Midnight of 23/03/2022.
Address : MUKUNDRAY Covernote No : - Dated: Zone: B
SHAH,NERULNAVI, D-141 TTC Intermediary Name/Code : PAPIA ROY / 60060623
INDL AREA,, MIDC VILLAGE Telephone(Mob,Hom) : 9830890520/9830890520
SHIRWA, THANE, Email ID : [email protected]
MAHARASHTRA, 400706 Previous Policy No : V7094205-01
GSTIN Number : - FGI GSTIN Number : 19AABCF0191R1Z6
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No., Make/Model of Vehicle Engine No. Chassis No.
RTA Location
MH43AN9906 MERCEDES-BENZE CLASS E 27492030095742 WDD2120346L037786
VASHI 200
Year of Manufacture Cubic Capacity Type of Body Seating Premium
Capacity
2014 1991 Sedan 5 53,075.00
DRIVERS 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 - As per Motor Vehicle Rules, 1989 :- 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.
Geographical Area : INDIA
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 Motor Vehicle Act, 1988
is recoverable from the Insured. See the clause headed “AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY”.
For legal interpretation English version will be good.
For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this
schedule.
IMPORTANT - 1) All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2) In case of payment by
cheque, in the event of dishonor of cheque for any reason whatsoever, insurance cover provided under this document
automatically stands cancelled from the inception irrespective of whether a seperate communication is sent or not.
Warranted that the *Vehicle insured herewith has a valid Pollution Under Control (PUC) Certificate as on the inception date
of the policy.(*Not applicable for Electric Vehicles and New Non- Electric Vehicles).
LIMITS OF LIABILITY
Under Section II-I (i) : Death of or bodily injury - Such amount Under Section II-I (ii) : Damage to Third Party Property- ₹
as is necessary to meet the requirements of Motor Vehicles Act, 750000 /- in respect of any one claim or series of claims arising
1988 out of one event.
Under Section III : PA Owner – Driver as per premium Compulsory DeductibleUnder Sec I - ₹ 2,000.00
computation table
Hypothecation Agreement with:- NIL
SPECIAL CONDITIONS – NIL
ADDITIONAL EXCESS – NIL
The nominee for Compulsory PA to owner driver cover is 01) LEGAL HEIR, aged :21 Years, Relationship : Legal Executor,
Nomination % : 100%
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Policy No : V8333378 Period Of Insurance : From 00:00 hrs of 24/03/2021 To Midnight of 23/03/2022
INSURED'S DECLARED VALUE
For Vehicle -₹ For Non Elec For Side Car-₹ For Elec Accessories- For Bi-Fuel Kit Total Value-₹
Accessories - ₹ ₹ (CNG/LPG) - ₹
2,060,245 - - - - 2,060,245
SCHEDULE OF PREMIUM
PARTICULARS ₹ ₹
A-OWN DAMAGE
Basic Premium on Vehicle 21,694.38
Less : No Claim Discount 50% 10,847.19
Add : Add-on Premium 25,862.26
Total Own Damage Premium (A) (rounded off) 36,709.00
B-LIABILITY
Basic Premium including Premium for TPPD 7,890.00
Add : Compulsory PA to Owner-Driver Rs. 15 lacs 330.00
Add : Legal Liability to Paid Driver/Cleaner/Employees (No. of persons 1) 50.00
Total Liability Premium (B) 8,270.00
Total Annual Premium (A+B) 44,979.00
Total Premium for the Policy Period 44,979.00
Goods and Service Tax 8,096.22
Total Premium (rounded off) 53,075.00
Class of Vehicle: Private Car Subject to Endorsement Nos. 22 ,28 ,15 ,
I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in
accordance with the provisions of chapter X and chapter XI of M .V. Act, 1988.
For FUTURE GENERALI INDIA INSURANCE CO. LTD.
Receipt No : Y0645299
Date of Issue : 19/03/2021
Place of Issuance : Mumbai*
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 19/03/2021
For registration of your Motor Claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable)
The stamp duty of Rs. 0.25/- paid by Letter Of Authorisation No. CSD/227/2021/301/21, Dated 25/01/2021. Mudrank -
2017/C.R.97/M-1,dated 09/01/2018.
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Annexure
Forming part of policy number:- V8333378
Motor Add-on Cover
Serial Add-on Description UIN No. Premium
No. Amount -₹.
1 Road Side Assistance IRDAN132P0001V03201213 250.00
2 Zero Depreciation Cap IRDAN132P0001V02200910 16,774.84
3 Theft Or Loss Of Keys 3,594.61
4 Loss Of Personal Belongings - Maximum payable amount 3,594.61
Laptop:Rs. 50,000 ;Maximum payable amount Mobile: Rs. 25,000
5 Consumables IRDAN132A0039V01201718 1,648.20
Please refer the attached detailed policy wordings for the above mentioned coverages.
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Dear HIMANSHU M SHAH,
We wish to inform you that the Insurance policy number V8333378 has been issued on the basis of the information and
declaration given by you, the transcript whereof is mentioned below. In case of any disagreement or objection or any changes
with respect to information mentioned below, we request you to please revert back within a period of 15 days from date of your
receipt of this transcript or the policy start date whichever is earlier, failing which it will be deemed that you are satisfied with
the correctness of the details mentioned below. Please be informed that this Policy shall be construed to be void ab initio/invalid
in the event we find that you have not disclosed material or correct information required for the purpose of providing the below
insurance cover and in case of any claim arising under the policy in such a scenario, we shall be under no obligation whatsoever
to settle such claim to you and the premium paid by you under this policy shall stand fully forfeited.
Future Secure Motor Insurance - TRANSCRIPT/DECLARATION
Sr No Insured Details
1 Insured Name HIMANSHU M SHAH
2 Registration address of the Insured MUKUNDRAY SHAH,NERULNAVI, D-141 TTC INDL
AREA,, MIDC VILLAGE SHIRWA, THANE,
MAHARASHTRA, 400706
3 Communication address of the Insured MUKUNDRAY SHAH,NERULNAVI, D-141 TTC INDL
AREA,, MIDC VILLAGE SHIRWA, THANE,
MAHARASHTRA, Pincode :- 400706
4 Residence Telephone no
5 Mobile no
6 Email id
Policy Details
7 Policy Number V8333378
8 Risk start time and date 24/03/2021/00:00
9 Risk end date 23/03/2022
10 Renewal NCB % 50%
Vehicle Details
11 Make and Model of vehicle insured MERCEDES-BENZE CLASS E 200
12 Registration No MH43AN9906
13 Engine No 27492030095742
14 Chassis No WDD2120346L037786
15 Cubic Capacity 1991
16 Year of Manufacturing 2014
17 RTO where vehicle is/will be registered VASHI
18 Seating Capacity 5
19 Date of Registration / Purchase 05/04/2017
20 Usage of the vehicle PV
21 Fuel Type Diesel
22 Hypothecation/Lease/Hire Purchase
23 Bank Name
24 Vehicle * being insured has valid Pollution Under Yes
Control (PUC) Certificate as on inception date of
policy.(*Not applicable for New Vehicle)
Previous Insurance Details
25 Previous Insurer Name Future Generali India Insurance Co. Ltd.
26 Expiring Policy No V7094205
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Third Party Coverages Opted
35 Basic Premium including Premium for TPPD Opted
36 Add:-Trailers Not Opted
37 Less : Limit of Liability under sec II-1(ii)-₹. 6000 Not Opted
38 Add : Bi-Fuel Kit (CNG/LPG) Not Opted
39 Add : Geographical Area Extn Not Opted
40 Add : Compulsory PA to Owner-Driver ₹. 15 lacs Opted
41 Add : PA to persons other than Owner/Driver (No. of Not Opted
persons 0)PA Limit ₹.0 per person.
42 Add : PA to Drivers/Cleaner/Conductors (No. of Not Opted
persons 0) PA Limit ₹ 0 per person.
43 PA to Named Persons other than Owner Driver As per Not Opted
Annexure attached
44 Add : Legal Liability to Paid Opted
Driver/Cleaner/Employees (No. of persons 1)
45 Add : Legal Liability to (No. of persons 0) Not Opted
46 Add : Increased Limit of Liability under sec II-1(ii)-₹. Not Opted
7.5lacs
Own Damage Coverages Opted
47 Basic Premium on Vehicle Opted
48 Add : Non-Electrical Accessories Not Opted
49 Add : Electrical/Electronic Accessories Not Opted
50 Add : Bi-Fuel Kit (CNG/LPG) Not Opted
51 Add : Trailers Not Opted
52 Add : Geographical Area Extn Not Opted
53 Add : Embassy Loading Not Opted
54 Add : Fibre Glass Tanks Not Opted
55 Add : Driving Tutions Not Opted
56 Add : Rallies Not Opted
57 Less : Anti Theft Not Opted
58 Less : Vehicles Specially Designed/Modified For Not Opted
Handicapped Persons
59 Less : Use confined to own premises Not Opted
60 Less : Automobile Association Membership Not Opted
61 Less : Vintage Car Not Opted
62 Less : Voluntary Deductible-₹. 0 Not Opted
63 Add : Add-on Premium Opted
Nominee Details
64 Nominee Name LEGAL HEIR
65 Nominee Relationship with Insured Legal Executor
66 Nominee Age in Y or M 21Y
67 Nominee % 100
68 Appointee Name -
69 Relationship of Appointee with Nominee -
On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.
Any modification(s) in the policy resulting in additional premium, will be applicable from the inception of the policy and this has
to be paid by you immediately to keep the policy coverage intact.
In case of Disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please
contact our Help Line numbers & register your objections/changes/disagreement to the contents of this transcript or you may also
send us email or written correspondence at the below address within a period of 15 days from date of receipt of this transcript or
the policy start date whichever is earlier.
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
ENDORSEMENTS
(Attached to and forming part of policy)
IMT.15. PERSONAL ACCIDENT COVER TO THE INSURED Endorsement in respect of personal injury to any paid driver and/or conductor
OR ANY NAMED PERSON OTHER THAN PAID and/or cleaner whilst engaged in the service of the Insured in such occupation in
DRIVER OR CLEANER connectionwith the vehicle insured herein and will in addition be responsiblefor all
costs and expenses incurred with its written consent.
(Applicable to private cars Including three wheelers rated as private cars Provided always that:
and motorized two wheelers with or without side car [not for hire or reward]) (1). this Endorsement does not indemnify the insured in respect of any liability in
In consideration of the payment of an additional premium It rs hereby agreed and cases where the insured holds or subsequently effects with any insurer or group of
understood that the Company undertakes to pay compensation on the scale insurers a Policy of Insurance in respect of liability as herein defined for insured's
provided below for bodily Injury as hereinafter defined sustained by the insured general employees;
person in direct connection with the vehicle insured or whilst mounting and (2). the insured shall take reasonable precautions to prevent accidents and shall
dismounting from or traveling in vehicle Insured and caused by violent accidental comply with all statutory obligations;
external and visible means which independentlyof any other cause shall within six * (3) the Insured shall keep record of the name of each paid driver conductor
calendar months of the occurrence of such Injury result In:- cleaner or persons employed in loading and/or unloading and the amount of wages
Details of Injury Scale of Compensation
and salaries and other earnings paid to such employees and shall at all times allow
i) Death 100% the Company to inspect such records on demand.
ii) Loss of two limbs or sight of two eyes or one 100% (4) in the event of the Policy being cancelled at the request of the Insured no refund
limb and sight of one eye of the premium paid in respect of this Endorsement will be allowed.
iii) Loss of one limb or sight of one eye 50% Subject otherwise to the terms conditions limitations and exceptions of the Policy
iv) Permanent Total Disablement from 100% except so far as necessary to meet the requirements of the Motor Vehicles Act,
injuries other than named above 1988.
Provided always that :- *In case of Private cars/ motorised two wheelers(not used for hire or reward) delete
(1) compensationshall be payable under only one of the items (i) to (iv) above In this para.
respect of any such person arising out of any one occurrence and total liability of
the insurer shall not in the aggregate exceed the sum of Rs.........*during any one
period of insurance in respect of any such person.
(2) no compensation shall be payable in respect of death or Injury directly or
indirectly wholly or in part arising or resulting from or traceable to (a) Intentional
self Injury suicide or attempted suicide physical defect or infirmity or (b) an
accident happening whilst such person Is under the influence of Intoxicating liquor
or drugs.
(3) Such compensation shall be payable only with the approval of the insured
named in the policy and directly to the injured person or his/her legal
representative(s) whose receipt shall be a full dischargeIn respect of the Injury
of such person.
Subject otherwise to the terms exceptions conditions and limitations of this policy.
*The capital Sum Insured (CSI) per passenger is to be inserted.
IMT.22. COMPULSORY DEDUCTIBLE
(Applicable to Private Cars, three wheelers rated as private cars,all
motorized two wheelers, taxis, private car type vehicle plying for public /
private hire, private type taxi let out on private hire)
Notwithstanding anything to the contrary contained in the policy it is hereby
understood and agreed that the insured shall bear under Section 1 of the policy in
respect of each and every event (including event giving rise to a total
loss/constructivetotal loss) the first Rs……* (or any less expenditurewhich may be
incurred) of any expenditure for which provision has been made under this policy
and/or of any expenditure by the insurer in the exercise of his discretion under
Condition no ….** of this policy.
If the expenditure incurred by the insurer shall include any amount for which the
insured is responsiblehereunder such amount shall be repaid by the insured to the
insurer forthwith.
For the purpose of this Endorsementthe expression“event” shall mean an event or
series of events arising out of one cause in connection with the vehicle insured in
respect of which indemnity is provided under this policy.
Subject otherwise to the terms conditions limitations and exceptions of this Policy.
* (i) to insert amount as appropriate to the class of vehicle insured as per GR. 40
of the tariff.
(ii) in respect of a vehicle rated under the Tariff for Private Car and in respect of a
motorised two wheeler not carrying passengersfor hire or reward, if any deductible
in addition to the compulsorydeductibleprovided in this endorsementis voluntarily
borne by the insured, the sum representingthe aggregate of the compulsory and the
voluntary deductibles is to be inserted.
** to insert Condition no 3 in respect of a vehicle rated under Tariff for Private Car
/ Two wheelers or Condition no 4 in respect of a vehicle rated under the Tariff for
Commercial Vehicles.
IMT. 28. LEGAL LIABILITY TO PAID DRIVER AND/ OR
CONDUCTOR AND / OR CLEANER EMPLOYED
IN CONNECTION WITH THE OPERATION
OF INSURED VEHICLE
(For all Classes of vehicles)
In consideration of an additional premium of Rs. 50/-notwithstanding anything to
the contrary contained in the Policy it is hereby understood and agreed that the
insurer shall indemnify the insured against the insured’s legal liability under the
Workmen's Compensation Act, 1923 , the Fatal Accidents Act, 1855 or at
Common Law and subsequent amendments of these Acts prior to the date of this
Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287