Reliance Two Wheeler Vehicle Certificate cum Package Policy Schedule

Name of Insured : Mr. ROHIT MOHAN Policy/Certificate No. :1203422312017775

Address : SAMSUNG INDIA SOFTWARE OPERATIONS Proposal/Covernote No. : NA
BLOCK- B,BAGMANE LAKEVIEW66/1, BAGMANE Period of Insurance : From 15:22 Hrs on 23/08/2012 to 22/08/2013 Hrs
TECH PARK, BYRASANDRA,C.V RAMAN NAGAR on 23:59:00
Bangalore-560093, KARNATAKA NCB Retention : No
Contact Details : Business / Occupation : NA
Mob.No.: 9999999999 Hypothecated with: NA Location : NA
Email ID : NA Zone : A Geographical Area : India
Particulars of vehicle Insured:
Make / Model / Engine / Type of Cubic Year of Seating capacity of side car (If Net Premium IDV (Insured Declared
Reg. No. & Place
Variant Chassis No. body Capacity MFG any Including driver) Rs. Value) Rs.
DL-5S- T-8950 & BAJAJ /
02411 / 01418 - 150 2005 2 677.00 19975.00
Delhi Rohini PULSAR / 150
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 Motor Trade
Persons or Classes of Persons 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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limits of Liability :
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 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 Rs. 6000/-.
Deductible under Section-I :
(i) Compulsory deductible Rs.100/- (ii) Additional compulsory deductible Rs. 0.00/, (iii) Voluntary deductible Rs. 0.00/, (iv) PA Cover for owner-driver under Section-III CSI - Rs.1,00,000/-
Special Conditions : NA
It is hereby declared and agreed that all pre-existing damages to the vehicle having occurred prior to the commencement of cover are excluded from the scope of the policy. The NCB provided is on Basic OD Premium excluding Add on
where applicable. The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in
Consolidated stamp duty paid vide Receipt No. 9451 dated 15/06/2012. Not applicable for the State of Jammu and Kashmir.
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. 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 only be allowed, provided the policy is renewed within 90 days of the expiry of the
previous policy.

Insured's Declared Value

For the Vehicle (Rs) For Trailers (Rs) Elec./Electronic Accessories (Rs) Non Elec. Accessories (Rs) Value of CNG/LPG Kit (Rs) Total IDV (Rs)
19975.00 0 0 0 0 19975.00
Electrical Accessories Non Electrical Accessories
Sl No. Make and Model Serial Number of Accessory Sum Insured Sl No. Make and Model/Description Serial Number of Accessory Sum Insured
PREMIUM SCHEDULE
OWN DAMAGE LIABILITY
Basic OD (Including Additional Covers if any) 322.33 Basic Liability 355.00
Basic Own Damage Premium 322.33 Less: Restricted Third Party Property Damage to Rs.6,000/- (IMT-20) - 50.00
Basic Liability Premium 305.00
Total Own Damage Premium 322.00 PA Benefits
Compulsory PA covers for owner-Driver of CSI 1,00,000 (IMT-15) 50.00
***All Premium Figures are in Rupees Total PA Premium 50.00
Legal Liablitiy
Total Legal Liablitiy Premium 0.00
Total Liability Premium 355.00
Package Premium 677.00
Add: Service Tax (12% of Net Premium) 81.24
Add: Education Cess (2%of Service Tax) 1.62
Add: Secondary & Higher Education Cess (1% of Service Tax) 0.81
FINAL PREMIUM 761.00
Service Tax Reg. No. AABCR6747BST001
Subject to I.M.T.Endt.Nos. & Memorandum printed/herein/attached hereto.15,16,22,25,20
Category-General Insurance Business Service 00440005
Subject to Reliance GI Add on endrosements printed herein/ attached hereto
The 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. Subject otherwise to the terms, conditions and exclusions of the Reliance Motorised Two
Wheeler Package Policy. In Witness whereof this Policy has been signed at Mumbai on 23/08/2012 in lieu of Cover Note No. NA dated NA
In the unfortunate event of a claim, Please call along with your Policy No. on 1800 103 1999 (toll free) or 022 41112600 (Standard STD Rates Apply) and register your claim immediately
within 7 days from the date of loss. For Customer service, Please call along with your Policy No. on 1800 3002 8282 (toll free) or 022 39898282 (local charges apply)|www.reliancegeneral.co.in
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 For Reliance General Insurance Co. Ltd.
Company by reason of wider terms appealing 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. NOTE: Kindly acknowledge receipt of this
policy.
In case you find any variations against your proposal or any discrepancy in the policy, kindly contact us immediately
Reliance General Insurance Co. Ltd.
Registered Office: Reliance Centre, 19, Walchand Hirachand Marg, Ballard Estate, Mumbai - 400 001
Policy Issuing Office: 570, Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai - 400 031
Branch Issuance Office: Rai's Tower Plot No.2054,2nd Avenue,2nd Floor,Next to Senthil Nursing Home, Annanagar,Chennai,Tamil Nadu -600040

Duly Constituted Attorney(s)

An ISO 9001:2008 Certified Company
Intermediary Code/Name: 12BRG287 / ICM Insurance Brokers Private Limited
Intermediary Contact No:
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