Date: 24/01/2013

Policy No.:

0152293778

Mr.JAVED SYED SAYED RASOOL

1 16 463/1 IRFAN NAGAR SIRPOOR KAGHAZNAGAR, ADILABAD, MANCHERIAL 504208, ADILABAD, ANDHRA PRADESH

Work Phone :

Client Id:
Dear

5004652619

Mr.JAVED SYED SAYED RASOOL

It is my pleasure to welcome you to the Tata AIG family.

Your Policy No. is 0152293778. The insurance coverage that you have opted for is Auto Secure Commercial Vehicle Liability Only. The details of your coverages and the other guidelines regarding your policy can be had from the policy document that is enclosed with this. Please do file these documents for future reference. I am sure that you will benefit from the best that we have to offer. You are offered security and convenience by us through a host of benefits under the policy that you have opted, security in the feeling that your assets are protected and convenience in accessing us as your insurer. The most striking feature of this accessibility being the 24 - hour help line for all our policy holders. Please do call us at this number in case you require any clarifications or services.

It is our promise to be there for you in your time of need.

We shall work on providing you with many more benefits that will stand by our commitment to provide you with nothing but the best.
We thank you for choosing us for your requirements and promise you a pleasant experience called insurance.

Sincerely yours,

*Conditions apply.

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 Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Email: customersupport@tata-aig.com Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780

Branch: MUMBAI
DE: amitkotp

ORIGINAL

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TIME STAMP: 11:03:24/01/13

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RECEIPT

Receipt No.: W002774768

Receipt Date: 24/01/2013

Received with thanks from Mr. JAVED SYED SAYED RASOOL (ID:5004652619) (Insured: Mr. JAVED SYED SAYED RASOOL (ID:5004652619)) a sum of Rs. 1,045.00 ( Rupees One Thousand Fourty Five and Paise 00 Only )
vide Cash towards

Sr. No. 1

Policy No. 0152293778

Total Premium (Rs.) Utilised from Receipt (Rs.) 1,045.00 1,045.00

Excess: 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. Amount 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 Service Tax Registration No : Insurance/Tata/Mumbai-I/1542/2001-02. Revenue ( consolidated ) Stamp duty duly paid vide Challan No. MH0002855752 dated 12/12/2012 , 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 Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780 Email: customersupport@tata-aig.com

RP01

Branch: MUMBAI
DE: amitkotp

ORIGINAL

Page 2 of 4

TIME STAMP:24/01/2013

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Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Agent/Broker Producer Name- AMIT KAMALKOTHARI Agent/Broker Contact NoAgent/Broker License Code 8568606
Certificate & Policy No.

0152293778 00

Policy Type
Trailers

Auto Secure Liability Only Policy

Effective time and date of commencement of Insurance From 11:10 Hours on 24/01/2013
Date of Expiry
INDIA

Midnight on 23/01/2014
ADILABAD

Premium (incl.S.Tax)

Place of Registration

Rs. 1,045.00 Insured's Business/Profession Self-employed Geographical Area

Name and address of the Insured

JAVED SYED SAYED RASOOL Name: Address : 1 16 463/1 IRFAN NAGAR SIRPOOR KAGHAZNAGAR ADILABAD
MANCHERIAL 504208 ANDHRA PRADESH

Under Hire Purchase/Hypothecation/Lease with

Registration No.

Make & Model

LOCAL TRAILER

Body Type
TRAILER

Mfg. Year

Public / Gross VehicleWeight Private

Cubic Capacity

Engine No.
NA

Chassis No.

AP01U9103
IDV of vehicle(Rs.)

2004
Bi-Fuel/CNG/LPG Kit(Rs.)

742003
Total Insured Declared Value (Rs.)

IDV of Trailer(Rs.)

IDV of non-built-in Accessories(Rs.) Electrical Non-Electrical

Max. Licensed Capacity Incl Driver, Cleaner

0
SCHEDULE OF PREMIUM
Own Damage Basic

0.00 0.00

Basic

930.00 930.00 930.00 930.00 114.95

1,045.00

A. TOTAL OWN DAMAGE PREMIUM (rounded off)

B. TOTAL LIABILITY PREMIUM

COMPREHENSIVE PREMIUM(A+B)

NET PREMIUM

Add : 12.36% Service Tax

TOTAL PREMIUM

Drivers Clause : Persons or classes of persons entitled to drive : Any person including insured:

Limitations as to use:

Use in connection with the insured's business The Policy does not cover:1) Use for racing, pace making, reliability trial or speed testing.

2) Use for the carriage of passengers for hire or reward.

3) Use whilst drawing a greater number of trailers in all then is permitted by law.

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 Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Website: www.tataaiginsurance.in 24x7 Tollfree Helpline :1800 266 7780 Email: customersupport@tata-aig.com

Branch: MUMBAI
DE: amitkotp

ORIGINAL TIME STAMP: 11:03:24/01/13

Page 3 of 4 FU: amitkotf

Drivers Clause : Persons or classes of persons entitled to drive : Any person including insured:

Limitations as to use:

The policy covers use only under a permit within the meaning of the Motor Vehicles Act 1988 or such a carriage falling under sub-section (3) of Section 66 of the Motor Vehicles Act, 1988.

"Warranted that not more than 1 trailer(s) shall be towed at any one time by the towing vehicles. It is further warranted that the insurer shall not be liable to indemnify the insured in connection with any vehicle or trailer if a greater number of trailers in all than is permitted by law are towed by Other Vehicles"

Limits of Liability: Under Section II-1 (i) of the policy (Death of or bodily injury) : Such amount as is necessary to meet the requirements of the Vehicles Act, 1988. Under Section II-1 (ii) of the policy (Damage to Third Party Property ) : Rs. 7,50,000.00/P.A. Cover for Owner - Driver under Section III: CSI : Rs. /Nominee for P.A. Cover : Age: Yrs Relationship :

Subject to (A) Indian Motor Tariff Endorsement No(s):

(B) TATA AIG Commercial Vehicle Endorsement No(s):

Deductible under Section - I

Compulsory Deductible Voluntary Deductible Imposed Excess

.

: Rs. /: Rs. /: Rs. /-

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 XI of Motor Vehicles Act, 1988.In witness whereof this Policy has been signed at MUMBAI on 24/01/2013.

For Tata AIG General Insurance Company Ltd.

Receipt(s): W002774768 Service Tax Registration No : Insurance/Tata/Mumbai-I/1542/2001-02.

The stamp duty of Rs. 0.50 /-(Rupees zero and Paise 50 Only) paid in cash or demand draft or by pay order, vide Receipt/Challan no MH0002855752 dated the 12/12/2012.

IN CASE OF AN ACCIDENT TO YOUR VEHICLE PLEASE INTIMATE US IMMEDIATELY FOR SPOT SURVEY FAILING WHICH CLAIM COULD BE PREJUDICED.
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 Schedule, the attached Policy 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.

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 Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Website: www.tataaiginsurance.in 24x7 Tollfree Helpline :1800 266 7780 Email: customersupport@tata-aig.com

Branch: MUMBAI
DE: amitkotp

ORIGINAL TIME STAMP: 11:03:24/01/13

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