Auto Secure Private Car Package Policy

RENEWPOLICY-TrackOn-1-17472403
Date : 05/11/2022

Name : MR SUDHIR KUMAR Your Policy Details

Policy Number : 0159009475 04 00
Address : S/O SH INDRA PAL SINGH
Own Damage Policy Period : From 06/11/2022 to. Midnight of
R/O GALI NO 20 KRISHNA NAGAR
05/11/2023
SALEMPUR RAJPUTANA
ROORKEE
HARIDWAR Liability Policy Period : From 06/11/2022 to. Midnight of
UTTARAKHAND 05/11/2023
247667
PA Cover to Owner Driver Policy Period : From 06/11/2022 to.
Midnight of 05/11/2023

Phone : 9997059744 Premium Paid : `6,537.00

Dear MR SUDHIR KUMAR ,

We thank you for reposing your faith in us by renewing your vehicle

insurance policy. Your policy has been renewed as per youradvice
and incorporates changes (if any) requested by you.

We are enclosing policy schedule cum certificate of insurance of

your vehicle. You can access policy wordings, on our website
www.tataaig.com. You may also reach us at our 24*7 helpline1800
266 7780 in case you desire to have a printed copy of policy
wording.

As our valued customer, you will continue to enjoy a host of value

added benefits and give the extra protection that your vehicle needs.

We assure you of our best services at all times. Happy driving!

Sincerely ,
For TATA AIG General Insurance Company Limited

Authorized Signature

Tata AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001 Page 1 of 6
 Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent Name : NEHA AGARWAL
Agent License Code : 9838095 Agent Contact No : 9837713388
Policy Type: Auto Secure Private Car Package Policy
Policy No: 0159009475 04 00
Cover Note No: Cover Note Issuance Date:
Policy Code : 00/04/3184/02 Period of Insurance
Name & Address of Insured
(Section - I Own Damage) From 00:00
Name : MR SUDHIR KUMAR Hours on 06/11/2022 To Midnight of 05/11/2023 .
Address : S/O SH INDRA PAL SINGH,R/O GALI NO 20 KRISHNA
NAGAR,SALEMPUR RAJPUTANA, (Section - II Liability) From 00:00
,ROORKEE,HARIDWAR Hours on 06/11/2022 To Midnight of 05/11/2023 .
UTTARAKHAND 247667
Contact Number : 9997059744 (Section - III CPA Cover For Owner Driver) From 06/11/2022 To
Customer Id : 6031383470 Midnight of 05/11/2023
GSTIN :
Place of Supply : UTTARAKHAND ZONE : B
Supply Code : 05
Hire Purchase / Hypothecation / Lease With :
RTO LOCATION : ROORKEE
Geographical Area : India Lessor GSTIN :

Contract/Loan/Reference No:

Licensed
Registration Make / Model / Body Trailer Registration No. carrying
Engine Number Chassis Number Mfg. Year CC
Number Type / Chassis No. Capacity
including driver
MARUTI/VITARA
UK 17 C 9779 5290595 G134490 2016 1248 5
BREZZA ZDI/SUV
Insured Declared Value (IDV) `
Electrical / Elec
Non Electrical Bifuel / CNG /
Year IDV Of Vehicle tronic Accesso Trailer Side car Total IDV
Accessories LPG Kit
ries
1 307031 0 0 0 0 307031
SCHEDULE OF PREMIUM
Section - I OWN DAMAGE (A) Section - II LIABILITY (B)

Own Damage Premium on Vehicle & Third Party Premium

Accessories Basic TP premium ` 3,416.00

Basic OD Premium ` 3,086.58 PA Benefits

1 Year(s) Compulsory PA cover for Owner Driver ` 375.00
Discount Under Own Damage Section
Less: No claim bonus (45) ` 1,388.96 Legal Liability
Add: Legal liability to paid driver (IMT 28) Number of
TOTAL OWN DAMAGE PREMIUM (A) ` 1,697.62 ` 50.00
persons: 1
TOTAL ADD ON PREMIUM (C) ` 0.00 TOTAL LIABILITY PREMIUM (B) ` 3,841.38
COMPREHENSIVE PREMIUM (A+B+C) ) ` 5,539.00
NET PREMIUM ` 5,539.00
CGST @9% ` 499.00
SGST/UGST @9% ` 499.00
TOTAL POLICY PREMIUM ` 6,537.00

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 2 of 6
Drivers Clause: Persons or classes of persons entitled to drive: 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 other than for the purpose of driving tuitions 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

LIMITS OF LIABILITY
Under Such amount as Under ` 7,50,000.00 Under Section III Number of claims covered
Section II - 1 is necessary to Section II - :1 ` 15,00,000.00 under Depreciation
(i) of policy meet the 1 Year(s) Reimbursement Cover: 0
(Death of or requirements of (ii) of policy Compulsory PA Basis of claim settlement
bodily injury) the Motor (Third Party Cover for for Tyre Secure cover :
Property OwnerDriver
Vehicles Act,
Damage)
1988.

Deductible Compulsory Deductible : ` 1,000.00 UIN Numbers: , IRDAN108RP0002V01200001/A0005V01200910(TA 08)

Under Section Voluntary Deductible : ` 0.00
I
Imposed Excess: ` 0.00
Franchisee: ` 0.00

Subject to: A) IMT Endorsement Number : 22 , 28

B) TATA AIG Auto Secure Endorsement Number (TA): 08

NOMINATION DETAILS
Name of the Nominee Relationship with insured Name of Appointee (If nominee is minor) Relationship with Nominee
MRS MEENAKSHI Wife NA NA
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 TATA AIG General Insurance Company LTD.
In witness whereof this Policy has been signed at MUMBAI on 05/11/2022

Receipt No.(s): 101051038235791 05/11/2022

The stamp duty of Rs0.25 paid in cash or demand draft or by pay order,vide
Receipt/Challan no:LOA-NO.CSD/434/2022/3588 dated the 18/08/2022
GSTIN :05AABCT3518Q1Z2 UTTARAKHANDService Account Code: 997134 Authorized Signatory

Policy Servicing Office : UNIT NO. F3, 1ST FLOOR, 24-A,, NCR PLAZA, NEW CANTT ROAD,DEHRADUN, ,UTTARAKHAND, DEHRADUN, UTTARAKHAND,
248001

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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed 'AVOIDANCE OF
CERTAIN TERMS AND RIGHT OF RECOVERY'. This policy does not cover pre existing damages as per Inspection photographs and Report

Note :This Schedule, Policy terms and conditions available on company website and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been
attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any amendments/modifications/alterations made on this system generated policy document is not
valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is
made to the Company and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company. You are advised to go
through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim Bonus or any other material
information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. You may visit company
website at www.tataaig.com for detailed benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of
policy wording. Our grievance redressal procedure and details about ombudsman is also available in our policy wording. Please note that any misrepresentation, non disclosure or withholding of material facts will
lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any. We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we
receive confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own damage section of the policy.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 3 of 6
For Policy wordings, please scan the below QR code :

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 4 of 6
 RECEIPT

Receipt No. 101051038235791 Receipt Date: 05/11/2022

Policy No: 0159009475

Received with thanks from MR SUDHIR KUMAR a sum of 6535 ( Rupees Six Thousand Five Hundred Thirty-Five And Paise Zero Only ) vid
e Credit / Debit Card No 9999XXXXXXXX dated 05/11/2022 Name as in credit/debit card - drawn on PAYABLE AT PAR branch towards

Sl.No. Policy Number Total Premium ` Utilized from the receipt for policy ` Balance `

1 0159009475 6,537.00 6,535.00 0.00

Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.

GSTIN: 05AABCT3518Q1Z2 UTTARAKHAND Service Accounting Code: 997134

Revenue (Consolidated) Stamp Duty paid vide challan No. LOA_NO.CSD/270/2022/727 date 10/02/2022 for applicable cases

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 5 of 6
 Auto Secure Private Car Package Policy

1 Name (Registered Owner of the Motor Vehicle)* : MR SUDHIR KUMAR

2 Address For Communication* : S/O SH INDRA PAL SINGH,R/O GALI NO 20 KRISHNA NAGAR,SALEMPUR RAJPUTANA,,ROORKEE,
HARIDWAR,UTTARAKHAND,247667.

3 Vehicle Details : Please refer policy schedule cum certificate

4 Fuel Type : DIESEL
5 Insured’s Declared Value - Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number : 0159009475
Date of inception of TP portion : 06/11/2021
Date of Expiry of TP portion : 05/11/2022
Type of Cover : Package
Name of the Insurer : TATAAIG

7 Own Damage period of insurance desired from* : 06/11/2022 to midnight of 05/11/2023

8 Liability period of insurance desired from* : 06/11/2022 to midnight of 05/11/2023
9 Compulsory PA cover forowner driver period of insurance desired from : 06/11/2022 to midnight of 05/11/2023
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Unnamed Persons Personal Accident Cover for seating capacity, including driver CSI :

Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) :

Compulsory PA Cover for Owner Driver : ` 15,00,000.00 Term : 1 Years

Name of the Nominee : MRS MEENAKSHI Age : 40 RelationShip : Wife

Name of Appointee (if Nominee is Minor) :NA Relationship to the Nominee : NA
12 Restriction of Cover/Discounts/Concessions/Extended Covers
Automobile association membership opted : No Third Party Property Damage Cover restricted to 6,000/ only : No
Is Voluntary Deductible opted : No Amount of Deductible opted : 0
Vehicle is fitted with Anti Theft Device approved by ARAI : N/A

13 Add on covers : N/A.

14 Bank Details (Required for Refund / Claims)

Name of the Account Holder : Name of Bank & Branch :

Account Number : IFSC Code of Bank :

15 Declaration for No Claim Bonus : N/A .

16 I hereby give my consent toreceive one page insurance policy.

17 AML Guidelines:
1. I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of
proceeds of crime related to any of the offence listed in Prevention of MoneyLaundering Act, 2002.

2. I understand that the Company has the right to call for documents to establish sources of funds.

3. The insurance company has right to cancel the insurance contract in case I am/have been found guilty by any competent court of law under
any of the statutes, directly or indirectly governing the prevention of money laundering in India.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001 Page 6 of 6