Date : 09/11/2019

Policy No : FCV/S25100073/A2/10/004093

Client ID : 42561014

MR. CHINNAVENKATESWARLU BHUPANI

S/O NADIPI RANGAIAH
SATYAVOLU,RACHARLA
RACHARLA
PRAKASAM
ANDHRA PRADESH
Contact Number : 9852147895
Email Id :
KOTI SANGAM256@GMAIL.COM

Dear MR. CHINNAVENKATESWARLU BHUPANI

Welcome to Bharti AXA General Insurance Co. Ltd

Congratulations! You have made the right choice by selecting the Bharti AXA SMART Motor Commercial Policy. Your Policy No ( FCV/S25100073/A2/10/004093) will be your
9friend in need. Bharti AXA, with its world-class service, will reach out to you with a range of benefits, including a fast, fair and friendly claims-settlement experience. We will
be at your side, providing quality solutions and convenience at every step. By going in for this policy, you have bought yourself peace of mind!

The policy guidelines and the details of your insurance coverage are available in the enclosed policy document. Should you have any questions, please contact your Bharti
AXA insurance advisor or call our toll free number 1 800 103 2292. You can also e-mail us at customer.service@bharti-axagi.co.in or register your query in the support
section at www.bharti-axagi.co.in. We are there to help you.

We thank you for reposing faith in Bharti AXA General Insurance Co. Ltd and look forward to adding value to our relationship by providing more services and benefits in the
years to come.

Warm regards,

G. Rajagopal
Head-Operations and Claims

Bharti AXA GENERAL INSURANCE COMPANY LTD

1st Floor, Ferns Icon , Survey No.28 , Doddanakundi , Bangalore 560037. INDIA. IRDA Regn.No.139
Tel: 91 80 40260100 Fax: 80 40260101 Email: Customer.service@bharti-axagi.co.in
 SMART Motor Commercial, CERTIFICATE OF INSURANCE AND SCHEDULE, NEW BUSINESS,
Bharti AXA General Insurance Company Limited, 4th Floor opp Datapro, Flat no A1, MG Road
ORIGINAL
Form 51 of the Central Motor Vehicle Rules ,1989
Certificate / Policy No : FCV/S25100073/A2/10//004093 Account Number : A2000558
Policy type : Commercial Vehicle - Passenger- LAIBILITI ONLY INSURANCE POLICY
Period of Insurance : From 10:00 Hours on 10/11/2019 To Midnight on 09/11/2020
Premium Paid (incl. S. Tax) : INR 7520.00
: MR. CHINNAVENKATESWARLU BHUPANI
Policy holder's Name
:
Address : S/O NADIPI RANGAIAH
: SATYAVOLU
: RACHARLA
: PRAKASAM
: ANDHRA PRADESH
Under Hire purchase/Hypothecation/Lease with : Agent Details
Geographical Area : INDIA Agent Name : BHARTI AXA DIRECT A/C-SM1N
Tel No - Mobile No: ,
Regn.No : AP27TV0343 Place of Regn : PRAKASAM
: TATA ACE MAGIC HT
Make / Model 7SEATER BSII
Year of Manufacture : 2009 Body Type :
Seating Cap. (Incl.Driver) :7 Engine C.C : 447
Public / private Carrier :
Chassis No. : MAT4451219VG18648 Engine No. : 275IDI05GQZS67230
IDV of the Vehicle : INR 0
Bi-Fuel(CNG/LPG) :
Total Insured Declared Value of the Vehicle : INR 0
Schedule of Premium
A)Own Damage Premium B) Liability premium
Premium for (Vehicle and non Electrical
: INR .0 Basic : INR 6220.0
Accessories)
CNG/LPG Kit (IMT 25) : INR 0 Restricted TPPD : INR 0
Comp. PA : INR 100
Geographical Area : INR 0
Fibre Glass Tank : INR 0 No. of Passengers :
IMT – 23 : INR 0
Add: legal Liability to paid Driver as per Endt. : INR 50
Own Premises : INR 0
IMT 28
NCB 0 % : INR 0 CNG / LPG(IMT 25) : INR 0
Load /Discount : INR .0 LL others : INR 0
LL Non-Fare : INR 0
A. Total Own Damage premium : INR 0 B. Total Liability Premium : INR 6370.0
Net Annual
: INR 6373.0
Premium (A+B)
ADD service Tax (Annual) : INR 1147
Total Annual Premium : INR 7520.00
Driver's clause: Persons or Classes of person entitled to drive
Any person including the insured : 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 the vehicle when not used for transport of passengers at the time of accident and that such a person satisfies the
requirements of Rule 3 of the central Motor Vehicle Rules , 1989
Limitation As to Use
The Policy covers use only for carriage of passengers in accordance with the permits(contract carriage or stage carriage) issued within the meaning of Motor Vehicles Act.Policy does not cover:
1)Use for Organised racing ,pace making,reliability trial or speed testing. 2)Use whilst drawing a trailer,except towing(other than for reward)of any one disabled mechanically propelled vehicle.
Limits of Liability
Under Section II-1 (i) of the policy (Death or bodily injury) : such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988.
Under Section II-1 (ii) of the policy
(Damage to third party Property) : INR 6000
P.A Cover for Owner - Driver Under Section
III: CSI : INR 200000
Compulsory Deductible Seating Capacity not exceeding 17 Passengers : INR 500.00
Seating Capacity not exceeding 17 but not 36 Passengers : INR 1000.00
Seating Capacity not exceeding 36 Passengers : INR 1500.00
Taxis and Three Wheelers rated as Commercial Vehicles
(Cubic Capacity not exceeding 1500 CC) : INR 500.00
Taxis and Three Wheelers rated as Commercial Vehicles
(Cubic Capacity exceeding 1500 CC) : INR 1000.00
Name of Nominee : NADIPI RANGAIAH Age of Nominee : 50
Driver Nominee Relationship : FATHER Name of Appointee :
Appointee Nominee Relationship :
Subject to Indian Motor Tariff Endorsement (nos)
IMT20-
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 Vehicle Act, 1988.
In witness of this policy has been signed at _______________ on _______________ in lieu of covernote no. dated
Receipt No. : 1417880
Service Tax Registration no. : AADCB2008DST001
BHARTI AXA GENERAL INSURANCE COMPANY LTD.

Authorized Signature
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's Act , 1988 is recoverable from the insured. See the clause headed "AV OIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY"
The 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 m ade to the company and Company accepts the requested amendments/
modifications/alterations and records the same through separate endorsement to be issued by the Company.
Issued By – On 09/11/2019

This motor policy is generated and issued online therefore the stamp duty payable on this policy is paid separately.
Bharti AXA GENERAL INSURANCE COMPANY LTD
1st Floor, Ferns Icon , Survey No.28 , Doddanakundi , Bangalore 560037. INDIA. IRDA Regn.No.139
Tel: 91 80 40260100 Fax: 80 40260101 Email: Customer.service@bharti-axagi.co.in