3103.

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To authenticate your policy: 30-
1. visit https://scan.me/download Digitally signed by
2. Download the QR code scanning app Mr.Mukul Kishore
3. Scan the QR code on this policy and be Date: 2016.03.30
assured that you have an original policy

AJIT
Reliance Motor Private Car Certificate cum Policy Schedule - Package Policy BI
http://rgiclser 0

Policy Number: 9202252311404482 Proposal/Covernote No: R30031600887

633101

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2311 Insured Name : FIN Period of Insurance:
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Mr. Ajit Kumar . From 00:01 Hrs on 27-Apr-2016 to 23:59 Hrs of 26-Apr-2017
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542082
Communication Address : Policy issuing branch: UP-65-
S/o Late Ram Narayan Singh N 6/2-b-132 Indira Nagar Colony Chi Assi Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway,

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Varanasi Uttar Pradesh India 221005 Santacruz (east), Mumbai,Mumbai,Mumbai,Maharashtra,400055

30-Mar-
Mobile No : 9450534846 Email-ID ajitkumar132in@gmail.com

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27-Apr-
109461.0
26-Apr-
Hypothecation/ NA Insured Blood Group:
Lease :
3103.00
Insured Vehicle Details

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Registration No. UP-65-AA-9960 Mfg. Month & Year APR-2005
HYUNDAI / SANTRO / XP

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Make / Model & Variant CC / HP 1086

Engine No. / Chassis No. 542082 / 633101 Seating Capacity Including Driver 5
Type of Body NA LCC Excluding Driver 4

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UTTAR PRADESH - Varanasi
RTO Location Total Premium ` 3103.00

Insured Declared Value (IDV)

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Vehicle IDV ` 109461.00 CNG / LPG Kit ` 0.00
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Electrical / Electronic Accessories ` 0.00 Trailer / Side Car ` 0.00
Non Electrical Accessories ` 0.00 Total IDV ` 109461.00
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Premium Summary
Own Damage - Section I Amount (`) Liability - Section II Amount (`)
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Ins

Basic OD 0 2628.16 Basic Liability (TPPD 1) 0 1598.00

Total Basic Own Damage Premium 1 2628.16 Total Basic Liability Premium 1 1598.00
Less 1 PA Benefits - Section III 1
Voluntary Deductible - (IMT - 22A) 0 -788.45 Compulsory PA cover to Owner Driver (IMT-15) 0 100.00
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Deduct 45 % for NCB 0 -827.87 Total PA Premium 1 100.00

Sub Total of Deductions 1 -1616.32 TOTAL LIABILITY PREMIUM 1 1698.00
ANYWHERE ASSIST SERVICES 1 0.00 TOTAL PACKAGE PREMIUM (Sec I + II + III) 1 2710.00
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TOTAL OWN DAMAGE PREMIUM 1 1011.84 Add: Service Tax (Including Swachh Bharat Cess) 0 392.95
TOTAL PREMIUM PAYABLE (`) 3103.00
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Subject to I.M.T.Endt.Nos. IMT 22A,15,22

PA-Nominee Details Name Age Relation

1 Ajay Singh 43 Son
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Deductible under Section-I : (i) Compulsory deductible ` 1000.0/- (ii) Additional compulsory deductible ` 0/- (iii) Voluntary deductible ` 7500.0/-
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Consolidated Stamp duty Paid vide GRAS GRN No. MH003135880201516E dated 25 August 2015** ** Not Applicable for the State of Jammu & Kashmir
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"The shortfall/excess in the TP Premium will be collected/refunded after the release of the IRDA OF INDIA circular which shall be effective from 1st April, 2015"
Direct / Direct
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Intermediary Code/Name Intermediary Contact No. Intermediary E-mail ID

Special Conditions : NA

Limits of liability : Under Section III of the policy - PA cover for owner driver CSI ` 200000.0/-
(a) Under Section II (1)(i) of the Policy-Death of or bodily injury to any person so far as it is necessary to meet the
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requirements of the Motor Vehicle Act, 1988. (b) Under Section II (1)(ii) of the Policy-Damage to property other than property
belonging to the insured or held in trust or in the custody of control of the insured up to the limits specified- (TPPD 1 Sum
Insured - ` 7,50,000/- , TPPD 2 Sum Insured - ` 6,000/-).
BID03
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 3103.00
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Limitations as to use : The Policy covers use 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) Any purpose in connection with
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Persons/Classes of persons : Any person including the Insured:
entitled to drive Provided that a person driving holds a valid driving license at the time of the accident and is not disqualified from holding of

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such a license. Provided that the person holding a valid Learner's License may drive the vehicle and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
*No Claim Bonus is subject to no claim on the previous policy. Benefits under the policy stands forfeited if claim is/was made in previous policy. 45.00

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"It is hereby declared and agreed that any damages pre-existing, any losses occurred & any Liability having been incurred, prior to the commencement of cover
under this policy are excluded from the scope of this policy."
"This policy provides you with a host of roadside assistance services at no extra cost*. Services include assistance for Towing, Battery Jumpstart, Minor Repairs,

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Tyre Punctures, Emergency Fuel, Delivering Back up key , Organizing a taxi, Organizing Hotel Accommodation and Sending Outgoing Messages."
The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in.
I/We hereby certify that the Policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of Chapter X and
Chapter XI of M.V. Act, 1988.

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Note: In the event of dishonor of cheque, this policy document automatically stands cancelled from inception irrespective of whether a separate communication is
sent or not. No Claim Bonus will be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy.
Updating Registration Number of vehicles within 15 days of policy inception is MANDATORY as per IRDA. Kindly provide the same to your Agent/Our Call

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centre/Policy issuing Branch (Applicable for policies booked without Registration No of vehicles).
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 hold good.

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Note: This policy has been issued based on the information provided by you and the policy is not valid if any of the information provided is incorrect. In case you find
anyvariations against your proposal or any discrepancy in the policy, kindly contact us immediately. Subject otherwise to the terms, conditions and exclusions of the
Reliance Motor Private Car Package Policy.
In witness whereof this Policy has been signed at Mumbai on policy start date in lieu of Proposal/Covernote No. as mentioned in the policy.
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In the unfortunate event of a claim, please call quoting your Policy No. on 1800 3009 (toll free) and register your claim immediately within 7days from the
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date of loss. You can also reach us at rgicl.services@relianceada.com.
For Reliance General Insurance
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Authorised Signatory
Ins
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Reliance General Insurance Co.Ltd.IRDA of India Registration No. 103. An ISO 9001:2008 Certified Company
Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.
Corporate Office: Reliance Centre, 4 Floor, South Wing, Near Prabhat Colony, Santacruz (East), Mumbai - 400 055.
Insurance is a subject matter of solicitation. Corporate Identity No.U66603MH2000PLC128300.
Service Tax Registration No. AABCR6747BST001 Category-General Insurance Business : Service 00440005
RGI/MCOM/MOT-02/POLICY-SCHEDULE/Ver. 1.0/200115
Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.

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Risk Assumption Letter

Dear Mr. Ajit Kumar .
Thank you for choosing Reliance General Insurance. 0
Please find enclosed policy no.: 9202252311404482 which has been issued based on the details declared by the applicant.
Ajit

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Mr. Insured Vehicle Details

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Registration No. UP-65-AA-9960 Mfg. Month & Year APR-2005

0 HYUNDAI / SANTRO / XP
Make / Model & Variant 27-Apr- Date of Registration 27-Apr-2005

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Engine No. / Chassis No. 542082 / 633101 Seating Capacity Including Driver 5
Type of Body NA CC / HP 1086

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UTTAR PRADESH - Varanasi
RTO Location LCC Excluding Driver 4

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Insured's Declared Value (IDV)

Vehicle IDV ` 109461.00 CNG / LPG Kit ` 0.00

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Electrical / Electronic Accessories ` 0.00 Trailer / Side ` 0.00
Non Electrical Accessories ` 0.00 Total IDV ` 109461.00

Previous Policy Details

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Previous Year Policy No. Period of Insurance Previous Policy-Claim Status
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9202252311002378 From : 2015-04-27 00:00:00.0 To : 26-Apr-2016 midnight Yes No BI
YOU HAVE OPTED FOR THE FOLLOWING COVERS e
Standard Cover Vehicle Own Damage + Third Party Coverage
Electrical/electronic accessories
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NO
NO Non-electrical accessories
NO Bi-fuel kits comprising LPG/CNG systems
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Add-on Covers
Nil Depreciation Cover NO No deduction for depreciation on vehicle parts other than tyres and tubes with respect to approved partial loss claims.
Motor Secure Plus NO No deduction for depreciation, consumable on vehicle parts and covers the engine other than tyres and tubes in respect to
Ins

approved partial loss claims.

Motor Secure Premium NO No deduction for depreciation, consumable on vehicle parts and covers the engine, loss of key other than tyres and tubes in
respect to approved partial loss claims (Loss of Key Sum Insured - ` 0.0 /-)
9202252311404482
NCB Retention Cover NO
No-Claim Bonus % is retained even after a claim, which would have become 0% without this cover.
NO
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Total Cover NO
NO Provides cover for registration charges, road tax and insurance premium (Total Cover Sum Insured -` 0.0 /-)
NO
Key protect cover Provides cover for car keys, locks or locksets including the locksmith’s charges against theft, burglary, loss or damage to
the key
NO NO
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Consumables cover Provides cover for consumable items like nuts and bolts, ac gas, fuel, etc. against specific perils on approved partial loss
claims
Engine protect Cover Covers for repair or replacement of damaged engine parts, differential parts and gear box parts caused as a result of
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lubricating oil leakage or submergence in water

NO NO
EMI Protect Pays for car EMIs for the time period during which the car is in one of our network garages for repair.

Daily Allowance Benefit

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NO NO
Daily Allowance Benefit Plus
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NO
Motor Extended Wattenty
This policy provides you with a host of roadside assistance services at no extra cost. For more details visit www.reliancegeneral.co.in
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Please take a moment to carefully check your policy details mentioned above and in the policy schedule. Kindly confirm that the same are in order. In case of
discrepancies, please let us know immediately. You can write to us at services.rgicl@relianceada.co.in or call us on 1800 3009 (toll free) for necessary
changes/rectification. In the absence of any communication from you within a period of 15 days of receipt of this letter, we will consider that the issued policy is in
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order and as per your proposal. Non disclosure and/or misrepresentation of claims in the previous policy period can lead to cancellation of your policy or rejection

For Reliance General Insurance Co. Ltd.

92022523114

Authorised Signatory

Reliance General Insurance Co.Ltd. IRDA of India Registration No. 103. An ISO 9001:2008 Certified Company
Registered Office Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,Mumbai - 400 001
Corporate Office Reliance Centre, 4 Floor, South Wing, Near Prabhat Colony, Santacruz (East), Mumbai - 400 055.
Insurance is the subject matter of Solicitation. Corporate Identity Number U66603MH2000PLC128300.
RGI/MCOM/MOT-02/RISK ASSUMPTION/Ver.1.0/200115

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Remember to carefully go through the Risk Assumption Letter and confirm your personal as well as your vehicle details.
In case of any discrepancy in the policy details, kindly revert within 15 days from the policy start date on 1800 3009 (toll free) or visit any of our branches.

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Kindly refer to the Key Feature Document and Policy Wording at www.reliancegeneral.co.in to understand your policy better and learn more about the policy

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coverages, add-on covers and Policy Exclusion. This document is a statement of the specific provisions that form the Terms and Conditions of this Policy.

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1. Changes in vehicle make & model/cubic capacity/seating capacity/engine & chassis no./year of manufacture/registration no./ location/address
Documents required : Letter for change, policy copy and registration certificate copy along with additional premium cheque, if applicable.

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2. Changes in electrical and non electrical accessories/CNG/LPG kit
Documents required : Letter for addition, policy copy, invoice copy of accessories, endorsed registration certificate copy (for CNG/LPG kit) and cheque for
additional premium.
3. Changes in financier details (Hypothecation/Lease/Hire purchase)
Documents required : Letter for change, policy copy, endorsed registration certificate copy and no objection certificate from financier (not mandatory for

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deletion, if registration certificate copy is endorsed).

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Ins
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1.Claim form duly filled and signed (company stamp in case of company registered vehicles)
2.Registration copy
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3.Driving License of the driver at the time of loss

4.Policy copy

Note: 1. As soon as a claim occurs, please intimate immediately at our call centre 1800 3009 (toll free). Delay in intimation would result in the violation of policy
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Trade Logo above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.

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9450534846

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http://rgiclservic
9450534846
front

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LiveSmart

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Name Ajit Kumar .

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Policy No. 9202252311404482
Policy Period 27-Apr-2016 to 26-Apr-2017

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Chasis No 633101
Vehicle No UP-65-AA-9960
Emergency Contact No

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Blood Group Scan the QR
code for details

1800 3009

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For breakdown or claims call

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9450534846
back
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- All insurance contracts are based on the information provided by the insured
in the proposal form.
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- Intimate claim immediately at our Toll Free No. 1800 3009 and provide:
1.Policy No. as mentioned on the card.
2.Place,Date & Time of Loss.
3.Name of the Driver Driving the vehicle at the time of Loss.
4.The damages suffered by the vehicle.
Ins

5.Injuries to passengers/driver/third parties if any.

6.Place when the vehicle is currently available for inspection.
IRDA of India Registration No. 103.
Reliance General Insurance Company Limited. Insurance is a subject matter of solicitation.
Corporate Office: Reliance Centre, 4 Floor, South Wing, Near Prabhat Colony, Santacruz
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(East), Mumbai - 400 055.Corporate Identity No.U66603MH2000PLC128300.

RGI/MCOM/MOT-02/MOTOR CARD/Ver. 1.0/200115

Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and
used by Reliance General Insurance Company Limited under License.
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