Policy Number : P0019000100/4102/771452

MAGMA HOUSE, 24 Park Street , Kolkata -700016

(www.magma-hdi.co.in)
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800-266-3202

Date : 24/03/2019

To,
ARUN GOKUL T
SUYASH PG,10TH MAIN,TULASI THE ATRE ROAD,MARATHAHALLI
BANGALORE
KARNATAKA - 560037
Mobile No: 8075705168

Agent/ Intermediary Name and Code: POLICYBAZAAR INSURANCE WEB AGGREGATOR PRIVATE LIMITED WAG0000001

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. . P 0 0 1 9 0 0 0 1 0 0 / 4 1 0 2 / 7 7 1 4 5 2 , w h i c h h a s b e e n i s s u e d b a s e d o n t h e d e t a i l s f u r n i s h e d t o u s a s b e l o w :

Insured & Vehicle Details

Name of Insured Arun Gokul T
Period of Insurance 27/03/2019 TO 26/03/2020
Vehicle Make/Model BAJAJ/DOMINAR 400 DISC ABS
RTO Bengaluru
Vehicle Registration No. KA03JK3326
Vehicle Registration Date 27/03/2017
Engine No. M09120
Chassis No. M09757
Previous Policy Details
Previous Policy No. 201250020117704705601000
Previous Policy Period 27/03/2018 TO 26/03/2019
Previous Year NCB% 20
Previous Insurer Name Liberty Videocon
Previous Policy Type Package

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 1800-266-3202. 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

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 Policy Number : P0019000100/4102/771452

MAGMA HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800-266-3202
TWO WHEELER PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office : No. 36, 2nd & 3rd Floor HMJC, J. C. Road, Bangalore-560002

Policy No P0019000100/4102/771452 Period Of 00:01 Hrs of 27/03/2019

Insured ARUN GOKUL T Insurance To Midnight of 26/03/2020
Address SUYASH PG,10TH MAIN,TULASI THE ATRE Agent No. : WAG0000001
ROAD,MARATHAHALLI Agent Contact : 1800-258-5970
BANGALORE PG/IR No.
KARNATAKA
560037
Contact Number 8075705168 Lease agreement
with
Email Address arungokul1990@gmail.com
GST Number Unregistered

INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION

Registration No. & Year of
Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
RTA Location Manufacture
KA03JK3326 /
2017 M09120 M09757 BAJAJ DOMINAR 400 DISC ABS 373 2
KA03

IDV (INSURED'S DECLARED VALUE)

IDV of Vehicle ₹ Non Electrical Accessories ₹ Electrical/electronic Accessories ₹ Bi-Fuel kit(LPG/CNG) ₹ Other accessories ₹ Total Value ₹
100800 0 0 0 0 100800
OWN DAMAGE(A) ₹ LIABILITY(B) ₹
Basic - OD 1136 Basic - TP 2323
Non Electrical Acessories 0 PA Owner Driver -SI Rs.0.00 0
Electrical or Electronic Accessories 0 Sub Total 2323
Sub Total 1136 Add:
Add Driving Tution TP 0
Zero Dep - OD 0 Geographical Extension TP 0
Sub-Total Addition 0 Sub-Total Addition 0
Less Less:
No claim bonus 25 % 284 TPPD Discount 0
Sub-Total Deductions 284 Sub-Total Deductions 0
Total Own Damage Premium(A) 852
Total Liability Premium(B) 2323

Premium Computation

Total Package Premium(A+B) 3175

IGST @ 18% 572.00
CGST @ 9% 0.00
SGST @ 9% 0.00
Total 3747

Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :I/2017/10029846768

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 testing 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 holding 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
Damage to Third Party
Excess in respect of each and every Property Rs. 100000/-
Under Under In respect of any one Under Under
claim under Sec I of motor policy in respect of any one PA Owner – Driver as per
Section Section accident -- As per Motor Section Section
Compulsory : Rs. 100/- Voluntary : Rs. claim or series of claims premium computation table
I II-I (i) Vehicle Act II-I (ii) III:
0/- Imposed : Rs. 0/- Total : Rs. 100/- arising out of one
event.
Subject to I.M.T Endorsement Nos. IMT 7,IMT 15,IMT 16,IMT 22,IMT 28

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 Policy Number : P0019000100/4102/771452

NOMINATION DETAILS

Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship With Insured Percentage
susaji mr 58 Mother 100

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.

Premium Amount in Word's ( ₹ ) :- Three Thousand Seven Hundred Fourty Seven only
In case of Claims, please contact us at 1800 - 266 - 3202 For Magma HDI General Insurance Co. Ltd.

Date of Issue :24/03/2019

Place : Kolkata

Authorised Signatory
Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 928-F.T, dated
01/06/2017
GST Number of MHDI - 29AAGCM1685C1ZF
GST Invoice Number - POL2903190004602
Accounting Code for Service - 997134, Motor vehicle insurance services

Place of Supply:KARNATAKA ( 29 )

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.

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