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§Goods carrying vehicle liability policy

Schedule cum Certificate of Insurance de:

Name of Insured: MR.BANSILAL MODAJI PRAJAPATI Business or Occupation: DIRECT



Tel. No.: Res.: Office:

Effective date of commencement of insurance of the purpose of Act:09/06/2010Time:

Date of Expiry of the Insurance: 08/06/2011

Particulars of vehicle Insured: Policy No.: 1102782349001925 Certificate No.:

Registration Mark, Engine Seating Net IDV (Insured’s

Make/Model Type 0f C.C Year of
No., Place of No Capacity Premium Declared Value
& Variant Body GVW Manufacture
Registration Chassis Including (Rs.)
No driver
MH04CP5403 TATA407 G/T 5700 2006 1+1 6595/- LIABILITY
Name of Registration
Authority: MUMBAI Geographical Area: MAHARASTRA

Limitations As To Use Persons or Classes of Persons entitled to drive:

The Policy covers use for any purpose other than:
a. Hire or Reward Any person including the Insured provided that a person driving
b. Carriage of goods (other than samples or personal luggage) an effective driving license at the time of the accident and is not
c. Organised racing disqualified from holding or obtaining such a license.
d. Pacemaking
e. Speed testing Provided also that the person holding an effective Learner’s License
f. Reliability trials may also drive the vehicle and that such a person satisfies the
g. Any purpose in connection with Motor Trade requirements of Rules 3 of the Central Motor Vehicles Rules, 1989.

Limits of Liability:
As per requirements of Motor Vehicle Act, 1988
a. Under Section II-1 ( i ) of the Policy –Death of or bodily injury such amount as is necessary to meet there requirements of the Motor Vehicle Act, 1988
b. Under Section II (1 ) (ii ) of the Policy-Damage of Third Party Property Rs. 100,000.00 /-
Deductible under Section-I Rs. 50.00 /-
Voluntary Deductible under Section-I: Rs. /- (IMT-22A)
PA Cover for owner-driver under section 3 CSI Rs. 100,000.00/-.
Additional Excess 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 Chapter XI of M.V.Act, 1988.
*Service Tax Reg. No. GIS/Mumbai – I/1528/2001

The policy wording with detailed terms, condition and exclusions are available on our website
“The stamp duty of Re. 25,00,000/- paid in by pay order, vide Receipt No 184147 dated 22.3.2007.”**
** Not Applicable for Jammu & Kashmir State.
For claims please contact us on 30338282 or email us at or visit our website
Note: If Premium is paid through cheque, the policy is void ab-initio in case of dishonour of cheque.

“It is hereby declared and agreed that all pre-exisitng damages to the vehicle having occurred prior to the commencement of cover are excluded from
the scope of the policy.

For Reliance General Insurance Company Limited

Duly Constituted Attorney (s)

Registered Office: 19,Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai – 400 038, India
Address Of Servicing Branch Office:
Reliance General Insurance Co. Ltd,
Avirahi 2nd Floor, S.V Road, Borivali (W) Mumbai, ,
Reliance PRIVATE VECHAIL Policy No. 1104782349001925
Insured’s Declared Value
For the Vehicle For Side Car Non Electrical Accessories Electrical/Electronic Value of CNG/LPG Kit Total Value
0 0
Schedule Of Premium
A. Own Damage Rs. B. Liability Rs.
Basic Premium on Vehicle 00.00 Basic Premium Including Premium for TPPD Vehicle 5580.00
Non Electrical Accessories 0.00 Less: Restricted Third Party Property Damage to Rs.6000/- 00.00
Electrical & Electronic @ 4% (Endt. IMT – 24) 0.00 Liability Premium for Trailers (Endt. IMT – 30)
Bi-Fuel Kit (CNG/LPG) @ 4% (Endt. IMT – 25) 0.00 CNG / LPG Bi-fuel Kit (Endt. IMT – 25) 0.00
Loss Of Accessories 0.00 Total 0
Total Net Basic Own Damage Premium 0 PA Benefits
Geographical Area Extn. (Endt. IMT – 1) 0.00 Compulsory PA Covers for Owner – Driver (Endt. IMT – 15) 100.00
30% for Imported Vehicles without custom duty PA for Named Passenger (Endt. IMT – 15)
(Endt. IMT – 19) Sr. No. Name of Passenger CSI 0.00
Fibre Glass Fuel Tanks 0.00
PA for Unnamed Passenger (Endt. IMT – 16)
60% on OD Premium for Driving Tuition (Endt. IMT – 61) 0.00 00.00
No. 0f Passengers: 1 CSI Per Person: 50,000.00
PA benefits to paid drivers, cleaners and conductors
Extension of Rally Cover as per number of days 0.00 50.00
No. of People: & Driver
Extension for Racing, Speed Tests, Dexterity Trails, Hill 0.00 Legal Liability
Additional Towing Cover 0.00 Liability Premium for Geographical Extension 0.00
Legal Liability to paid drivers, cleaners and conductors (Endt. IMT –
28) 0.00
Total Schedule OD Premium 00.00
No. of People: 0 250.00

Legal Liability to Employee (Endt. IMT – 29)

Less 0.00
No. of Employees:

Voluntary Excess 0.00 Liability extension for Rally Cover as per no. of days 0.00
Discount for Anti-theft Devices (Endt. IMT – 10) 0.00 Liability Extension for Racing, Speed Tests, Dexterity Trails, Hill 0.00
Automobile Association Discount (Endt. IMT – 8) 0.00 Climbs
50% Discount for Vehicles specially designed / modified
for Blind, Handicapped and mentally challenged 0.00 PACKAGE PREIMUM (Total ODP + Total Liability Premium)
persons (Endt. IMT – 12)
Vintage Car Discount Add: Service Tax 10.30 % 616.00
Used of Vehicle within Insured’s premises 0.00
Side Car Discount 0.00 FINAL PREMIUM (Rounded Off) 6595.00
Deduct 0.00% for NCB
Sub Total (deductions) 0.00
Add30% loading for adverse history / break in 0
Electrical Accessories Non Electrical Accessories
Serial Number of Serial Number of
Sl. No. Make and Model Net Premium Sl. No. Description Net Premium
Accessory Accessory

ubject to I.M.T.Endt.Nos. & Memorandum printed/herein/attached hereto. IMT22,16,15

Lease Agreement within Witness whereof this Policy has been signed at Mumbai on 05/in lieu of Cover Note No. 2618327 dated 09/06/2010
In case of hypothecation/hire purchase/lease
Name of Financier: (None) Location: Type of Financial Arrangement: (None)

For Reliance General Insurance Company Limited

Duly Constituted Attorney (s)

Registered Office: 19,Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai – 400 038, India