MAGMA HOUSE, 24 Park Street , Kolkata -700016

(www.magma-hdi.co.in)
IRDA REG NO. 149 DATED 22nd MAY,2012 CIN:
U66000WB2009PLC136327

Date : 02/12/2019

To,
Mr. BASHA SHAIK
S/O,MAHABOOB PEERA
2/30,MAIN ROAD
BESTAVARIPETA
PRAKASAM
ANDHRA PRADESH

Agent/ Intermediary Name and Code:

Sub: Risk Assumption Letter

Dear Sir /Madam,

Thank you for choosing Magma- HDI General Insurance Company Limited as your preferred General Insurance Company. Please find
enclosed Policy No. P0018300021/4102/100623, which has been issued based on the details furnished to us as below:
Insured & Vehicle Details

Name of Insured Mr. BASHA SHAIK

Period of Insurance 03/12/2019 TO 02/12/2020

Vehicle Make/Model HERO/ GLAMOUR DRUM SELF CAST
RTO PRAKASAM
Vehicle Registration No. AP27AK5619
Vehicle Registration Date 24/08/2011
Engine No. JA06EFBGG10984
Chassis No. MBLJA06EUBGG10222

The information provided above is based on the information received from you and accordingly, the proposal has been processed. Coverage of
risk is subject to realisation of the full premium post which, insurance coverage under the policy would commence. In case the premium is not
received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab- initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at
customercare@magma- hdi.co.in or calling our toll free helpline on 1800- 300 2- 3202. Absence of any communication from you in this regard
within a period of 20 days of date of this letter, would mean that the issued policy is in order and as per your proposal.The Risk Assumption
Letter is to be read in conjunction with the policy and shall be considered as null and void without the same.
Thanking You,
Regards

For Magma HDI General Insurance Co Ltd.

Authorised Signatory
 MAGMA HOUSE, 24 Park Street , Kolkata -700016
TWO WHEELER PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office 2ND FLOOR, SURVEY NO. 134/3, PLOT NO. 16 ,TEACHERS'' COLONY, GURUNANAK ROAD,PATAMATA ,KRISHNA -520008 ,ANDHRA
PRADESH , PH: 30003976
Policy No P0018300021/4102/100625
Insured Mr. BASHA SHAIK
Period Of Insurance 00:00 Hrs of 03/12/2019
Address S/O,MAHABOOB PEERA,
To Midnight of 02/12/2020
2/30,MAIN ROAD
Agent No.:
BESTAVARIPETA
Agent Contact No.:
PRAKASAM
ANDHRA PRADESH
Hypothecation with
Contact Number
Email ID:
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & No. & Year of
Engine No. Chassis No. Make/Model/Type of CUBIC CAPACITY SEATING CAPACITY
RTA Location Manufacture
Body
AP27AK5619 /
2011 JA06EFBGG10984 MBLJA06EUBGG10222 HERO/GLAMOUR 124 2
PRAKASAM
DRUM
IDV (INSURED'S DECLARED VALUE)
Electrical/electronic
IDV of Vehicle Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
22000 0 0 0 /0 0 22,000.00
OWN DAMAGE(A) LIABILITY(B)
Basic OD 429.59 Basic TP 720.00
Sub Total 429.59 PA Owner Driver -SI Rs.100000 50.00
Total Own Damage Premium(A) 430.00 LL to Paid Driver IMT 28 50.00
Sub Total 820.00
Less:
TPPD Discount 50.00
Sub-Total Deductions 50.00
Total Liability Premium(B) 770.00
Premium Computation
Total Package Premium(A+B) 1,200.00
CGST @ 9% 108.00
SGST @ 9% 108.00

TOTAL 1,416.00
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 tes ting f) Reliability Trials g)Use in connection with Motor Trade
Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from ho lding or obtaining such a
Driver
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
Clause :
Rule 3 of the Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY
Under Excess in respect of each and every claim under Under In respect of any Under Damage to Third Party Property Under PA Owner – Driveras
Section Sec I of motor policy Section one accident -- As Section Rs. 6000/- in respect of any one Section per premium
I Compulsory : Rs. 100/- Voluntary : Rs. 0/- II-I (i) per Motor Vehicle II-I (ii) claim or series of claims arising III: computation table
Imposed : Rs. 0/- Total : Rs. 100/- Act out of one event.
Subject to I.M.T Endorsement Nos. IMT 7,IMT 20,IMT 22,IMT 28
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Percentage
MAHABOOB PEERA 50 100
Date of Signature of proposal 02/12/2019
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 Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 - 3002 - 3202

Date of Issue : 02/12/2019

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 92 8-F.T,
dated 05/02/2018
GST Number of MHDI - 37AAGCM1685C1ZI
GST Invoice Number - POL3707180001197
Accounting Code for Service - 997134, Motor vehicle insurance services Authorised Signatory

Place of Supply:ANDHRA PRADESH ( 37 )

Whether Tax is payable on Reverse Charge - No

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.