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HR E L MPANY LtMI
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LOyfG TERM TWO WHEELER - NEW

BUNDLED I¥IOTOR 2 WHEELER POLICY - UIN NO.
4170t2 - Address:- DNO:80-23-21, I ST FLOOR JAYASRI GARDENS, 2nd-STREET JAWAHARLAL NEHRU RQAD,-
RAJAHMUNDRY ANDHRA PRADESH 533101 Tel 7412078353 / 7412078354
P llcy NO Pr¥ ' POIIC¥' Ho • Geographical Araa INDIA
j 41701Z/31/20/009116
Inaured’• Code/ Name• 118557172/Mr.CH JSV SWAMY
Address: S/O:NARAYANA MURTHY,D. NO:2-81/1 ROWTHULAPUDI,•EAST
GODAVARI ANDHRA PRADESH 533446
ExecU(ive: LIA0000005487 Agent Details: MISP00000178 KANTIPUDI ENGINEERIN COMPANY PRIVATE LlhtlTED //BD0000000160
Contact No:
Perfod of Insurance • OD: From 16:39 on 24/09/2019 To Midnighl of 23/09/2020 Prop No. - Issua date
TP: From 16:39 on 24/09/2019 TO midnight of 23/D9/2024 PA Owuer Diver CovarPerIod--2¥-SEP-19 TO Z3-SEP-20
Gross Premium: 4,730 S Tax: 0 GST:852 Cess : 0 7otal: 5,5g2

Rag1•tratton Engine No I\take - Model Type of Body / Cublc

Mark & P\ace Chassis No Fuel T pe Incl Orlver

AF2152B952B SUZUKI-ACCESS 125 SCOOTY T25 24-09-19 1+1

Kakinada MB8DP11AGK6 E1899 ORUM BRAKE p ¿ 2019
6

Hon Electrical Electrical Sf for Named CNG/LPG SI Total Value

Vohlcle Acceacories Accessories Persons
57,191 57.191

A. OWN DAMAGE SCHEDULE OF PREMIUM B. LIABILITY

3D TOTAL 1,130.00 BASIC TP COVER 3,285.00
TOTAL PREMIUM 4,730.00 ADD :GR36A-PA FOR OWNER DRIVER 315.00
ADD :CGST9 % 426.00 TP 7OTAL 3,60D.00
ADD :SGST 9 % 426.00
FINAL PREfi/IlUM 5,582.00
”NCB discount - Y+ Previous Policy : NA Nominee too PA Owner/Driver : G KRISHNA- Age : 32 - Relationship : Father-in-Law -
Appointee Name : NA - Appointee Relationship : NA
Handicap Pemon. Dñver Tuition. F›bra Giass,

Deductlbles under Sectlon•l : COMPULSORY OEDUCTIBLE Rs.100

Subject to IMT Endorsement Prlnted hereln/attached to : IMT-15,IMT-Z2
Hypothecatlon Agreement with: - .t ‘

Hire Purchase/Lease Agreement with-

Llmlt of Lleblllty :
Undar Sactlc•' !"!’!" ^ "^* accI1mI: ^ W Mata Vahlclea Act. t988.
Under Sectbn ”””"’ ”‘ “ “ 8 ^ ‘” series of clams •ñsing out of one evenl ie Rg. 750000
P.A. Cover undef 5 IU {0 O¥mef - DrfyBr { {) ; RR. $ @

DdvePs Clausa
9 • an elTectiva drlvlng Ilcensa at die Iim• of the eccidanl and k not disquglifiâd holding or obtainlng such a
RuJer, 1988. such a person satisfies In raguimments ol Rule 3 ol the central jgotot Vehiclas
LlmltatJons es to Use

P*' eItached.Werrantad that In casa

IMPORTANT NOTICE

My payrranl made by tha

headed "AVOIDANCE
PDLlcY is su8JEcT -r
UR AUTHuRtSED nc F'FtE TENTATIVE DURINC
THEIR INSPECTIOhI. •

Race : RAJAHMUNDRY Data : Z4/gg/ggj y