MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

GCCV - PUBLIC CARRIERSOTHER THAN THREE WHEELERS

PACKAGE POLICY – ZONE C
Policy No : 4810239/31/2020/2554 Prev Policy No :

Cover Note No : 4600090714 Cover Note Dt :

Insured’s Code : 73455541 Issue Office Code : 462503

Insured’s Name : Mr. DURGU NAIDU MATSA Issue Office Name : CBO-II KAKINADA

ADDRESS : S/O RAMU,8-91,T ARJAPURAM Address : CITY BRANCH OFFICE - 2

RAVIKAMATHAM 67-15-29, UPSTAIRS OF ANDHRA BANK
NAGAMALLITHOTA JUNCTION
VISAKHAPATNAM,ANDHRA PRADESH KAKINADA ANDHRA PRADESH 533003

Tel /Fax /Email : / / NA Tel /Fax /Email : 0884-2555006: 0884 – 2661967 /

/ 462503@orientalinsurance.co.in
Agent/Broker Details
Dev.Off.Code : NZ0000000169 AGENCY MANAGER DO-KAKINADA
Agent/Broker : BA0000129603 K RATNAKAR RAO
Address : 2-46-25/1, OPP PRAGATI JUNIOR COLLEGE, KAKATIYA
NAGAR,KAKINADA-533003, EAST GODAVARI DISTRICT,
ANDHRA PRADESH 533003
Tel /Fax /Email : /9848162165//kanna.ratnakararao@gmail.com

Period of Insurance : FROM 09:14 ON 30/09/2020 TO MIDNIGHT OF 29/09/2021

Collection No & Dt : CSH 9561002567 –29/09/2020
Gross Premium : 15,200 Service Tax : 2,812 Stamp Duty : .5 Total: 18,012
Geographical Area : INDIA Area Extension :

Particulars of Insured Vehicle:

Registration Engine No. Year of Type Of Body Seating Capacity Cubic

Mark & Place Chassis No. Make – Model Manufacture (including Driver) G.V.W Capacity

AP 31 TC 1564 275IDI06GXYSE1608 TATA ACE 2012 OPEN 1+1 1550 702

MAT445056CZG61888 HT BSIII

Limitations as to use:
The Policy covers use only under a permit within the meaning of the Motor Vehicles Act 1988 or such a carriage falling under Sub-section 3 of
Section 66 of the Motor Vehicles Act 1988.
Use only for social, domestic and pleasure purposes and for the insured’s business of profession. The Policy does not Cover use for
1 hire or reward, tuition, racing, pace making, reliability trial, speed testing, carriage of goods (other than Samples of personal luggage) in
connection with any trade or business or use for any purpose in connection with Motor Trade.

Driver:
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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limit of Liability:
Under Section II-1 (i) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-1 (ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000
P.A Cover under Section III for Registered Owner Cum Driver (CSI) : Rs. 200000
Insured’s Declared Value

For the Vehicle For the Side Car Non Electrical Electrical
Accessories Accessories Value of LPG/CNG Total Value

4,00,000 0 0 0 0 4,00,000

Place : KAKINADA For and on behalf of

Date : 30/09/2020 The Oriental Insurance Company Limited
IRDA-REGNO-586 Validity unknown
Digitally signed by
BALWANT SINGH
Date: 2020 09 30 09:14:59 IST
Reason Approved
Located NOIDA
In case of any query regarding the Policy please call Toll Authorised Signatory
Free No. 1800 11 8485 and 011 33208485.
All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 2
Now you can buy and renew selected policies online at https://www.orientalinsurance.org.in/
Regd. Office Oriental House, A-25/27, P.B. No.7037, Asaf Ali Road, New Delhi – 110 002.
 Attached to and forming part of policy number 4810239/31/2020/2554

SCHEDULE OF PREMIUM

A.OWN DAMAGE B.LIABILITY

BASIC OD COVER 1820.00 ADD :BASIC TP COVER 15,050.00

LESS:BO UNDERWRITER DISCOUNT 246.00 BASIC TP TOTAL 15,050.00
BASIC OD TOTOAL 1574.00 ADD :PA FOR OWNER DRIVER-GR36A 100.00
OD TOTAL 1574.00 ADD :LL-PAID DRIVER,CONDUCTOR,CLEANER-IMT-40 50.00
MOTOR TOTAL OD 1574.00 TP TOTAL 15,200.00
TOTAL PREMIUM 15,200.00
ADD :SGST 1,368.00
ADD :OGST 1,368.00
STAMP DUTY 0.50
ADD :Swachh Bharat Cess 38.00
ADD :Krishi Kalyan Cess 38.00
TOTAL AMOUNT 18,012.00

Deductibles under Section-I

Subject to IMT Endorsement Printed herein/attached to : IMT-20 , IMT-29

(Details of IMT Endorsements and GR also available on internet TAC website www.tac.org.in)

Hypothecation Agreement with: -

Hire Purchase/Lessor Agreement with: -

In the event of a claim under the policy exceeding Rs.1 lac or a claim for refund of premium exceeding Rs 1lac, the insured will comply with the
provisions of the AML policy of the Company. The AML policy is available in all our operating Offices as well as company’s website

The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC endorsements mentioned
Herein above which are available on company’s website: www.orientalinsurance.org.in or on demand from the policy issuing office

Warranted that in case of dishonor of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void abinitio
(from inception).
Claim is not admissible if Driving Licence is found fake or is not valid whether of not in the knowledge of the insured.
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 Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorized by and on behalf of the company has/have herein to set his/her hands at KAKINADA
On 30-SEP-20
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 MVAct, 1988 is Recoverable from the Insured. See the
Clause headed “AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY”.

For and on behalf of

The Oriental Insurance Company Limited
Validity unknown
Digitally signed by
BALWANT SINGH
Date: 2020 09 30 09:14:59 IST
Reason Approved
Located NOIDA
Authorised Signatory
Entered By : P.H.SHARMA

Examined By : P.H.SHARMA

In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GO1007158 All the Amounts mentioned in this policy are I Indian Rupees
IRDA Regn. No. 556 – Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Place : KAKINADA
Date : 30/09/2020
IRDA-REGNO-586 Page 2 of 2