DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0002V02201213

Two Wheeler Policy- Bundled - 5 year Act only and 1 year Own Damage
Endorsed Certificate of Insurance cum Schedule /TAX INVOICE
Policy Servicing Office OFFICE NO. 516 AND 517, 5TH FLOOR, NEELKANTH CORPORATE PARK, ,PLOT NO. 240, 2401/1-8, KIROL ROAD,VIDYAVIHAR (WEST) ,MUMBAI -400086 ,MAHARASHTRA , PH: (1800) 2663202
Policy No P0021200029/4113/102785
Insured Mr DATTATRAYA PURSHOTTAM AKUBATTIN
Period of Insurance(Own Damage) 12:30 Hrs of 05/12/2020 To 23:59 Hrs of 04/12/2021
Address P NP -152 GANESH NAGAR DANJAY NAGAR SHIVAJI NAGAR ,KALYAN RD
Period of Insurance(Third Party Liability) 12:30 Hrs of 05/12/2020 To 23:59 Hrs of 04/12/2025
AHMEDNAGAR
Agent No.: BRC0000285
AHMEDNAGAR
Endt. No. EE01
MAHARASHTRA 414001
Endt. Effective Date 05/12/2021
Mobile:9834217066
Contact Number 9834217066
Hypothecation with SHRIRAM CITY UNION FINANCE LTD
Email ID:
GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & No. & RTA Location Year of Manufacture Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
NEW / HERO MOTOCORP LIMITED DESTINI 125 VX
2020 JF17ELLGL17488 MBLJFW244LGL10301 125 2
AHMEDNAGAR BSVI/SCOOTER
IDV (INSURED'S DECLARED VALUE)
IDV of Vehicle Non Electrical Accessories Electrical/electronic Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
67592 0 0 0/0 0 67592
OWN DAMAGE(A) LIABILITY(B)
Basic OD 1,121.51 Basic TP 3,285.00
Add On Cover Basic Plus- PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s) 750.00
270.37
( DEPRECIATION RE-IMBURSEMENT , )
Sub Total 4,035.00
Sub Total 1,391.88
Total Own Damage Premium(A) 1,392.00
Total Liability Premium(B) 4,035.00
Premium Computation
Total Package Premium(A+B) 5,427.00
CGST @ 0% 488.43
SGST @ 0% 488.43
TOTAL 6,404.00
Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :
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)Use in connection with Motor Trade
Driver 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
Clause : the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY
Under Excess in respect of each and every claim under Sec I of motor policy Under In respect of any one Under Damage to Third Party Property Rs. 100000/- in Under Section PA Owner – Driver as per
Section I Compulsory : Rs. 100/- Voluntary : Rs. 0/- Imposed : Rs. 0/- Total : Section II-I accident -- As per Motor Section II-I respect of any one claim or series of claims III: premium computation table
Rs. 100/- (i) Vehicle Act (ii) arising out of one event.
Subject to I.M.T Endorsement Nos. IMT 7,IMT 22

Date of Signature of proposal 05/12/2020

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.

Premium Amount in Word's ( ) :- Six Thousand Four Hundred Four Only

For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 266 3202

Date of Issue : 05/12/2021

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 658, dated 21/04/2022
GST Number of MHDI 27AAGCM1685C1ZJ
GST Invoice Number - POL2712210001979
Accounting Code for Service - 997134, Motor vehicle insurance services

Previous GST Invoice No. -POL2712210001979

Authorised Signatory
Place of Supply:MAHARASHTRA ( 27 )

Whether Tax is payable on Reverse Charge - No

UIN : IRDAN149P0002V02201213
This is a valid Tax invoice in terms of Sub-rule 2 of Rule 54 of CGST Rule 2017. Further, being an Insurer, issuing of e-invoice and QR Code are not applicable on
us in terms of Notification No 13 and 14 of 2020 dated 21st March 2020 issued from Central Board of Indirect Taxes and Customs.
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 Complete details of coverage , terms, conditions & exclusion please refer the standard policy wording attached with this schedule

IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
3) This document is digitally signed, hence counter signature / stamp is not required.