DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149RP0006V02201213

COMMERCIAL VEHICLE PACKAGE MISCELLANEOUS GROUP OF VEHICLES POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office 2ND FLOOR, SURVEY NO. 134/3, PLOT NO. 16 ,TEACHERS'' COLONY, GURUNANAK ROAD,PATAMATA ,KRISHNA -520008 ,ANDHRA PRADESH
Policy No P0021300051/4107/100999
Insured Mr ADINARAYANA KATURU
Address S/O BALARAJU Period Of Insurance Agent 00:00 Hrs of 29/06/2021
H NO 149 To Midnight of 28/06/2022
SC COLONY No.: AGD0003837
GAMPALAGUDEM Agent Contact No.: 9848398695
KRISHNA DT
Contact Number ANDHRA PRADESH Hypothecation with
Email ID:
GST Number Unregistered

INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION

Registration Mark & No. & Trolley Chassis Year of Public/Private SEATING
Trolley Serial ID Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW
RTA Location No. Manufacture Carrier CAPACITY
AP16TS6623/ MAHINDRA & MAHINDRA
ELURU / WEST GODAVARI AP39Y8494 AANMDA19A 07/2018 SWARAJ 744 FE 33.00/3136 1
2414JA2TT 43.1024/SZH247 WZCH4D622104284
S DECLARED VALUE)
47
IDV (INSURED'

Electrical/electronic
IDV of Vehicle Trailers Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
0 0 0 0 0/0 0 0
OWN DAMAGE(A) LIABILITY(B)
Basic - OD 1,201.90 Basic - TP 6,847.00
Trailers-IMT 48 69.60 Trailers - IMT-48 2,341.00
Sub Total 1,271.50 PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s) 500.00
Total Own Damage Premium(A) 1,272.00 Under WC act-Driver/cleaner/employees-IMT 28 50.00
Sub Total 9,738.00
Total Liability Premium(B) 9,738.00
Premium Computation
Total Package Premium(A+B) 11,010.00
CGST @ 9% 990.90
SGST @ 9% 990.90
TOTAL 12,992.00
Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :
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
Vehicle's Act 1988. Use only for agricultural and forestry purpose. The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing
a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle (only for Passenger Carrying Vehicles).
The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing a trailer except the towing (other than for reward) of any one
disabled Mechanically propelled vehicle (only for Passenger Carrying Vehicles).
Persons or classes of persons
Any person including Insured:
entitled to drive:
Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license.
Non-transport Vehicles Provided also that the person holding an effective learner's license may also drive the vehicle when not used for the transport of passengers at the time of the
LIMITS OF LIABILITY accident and that such a person satisfies the requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.

Under Compulsory excess in respect of each and every claim Under In respect of any one Under Damage to Third Party Property Rs. Under PA Owner – Driver as per
Section I under Sec I of motor policy : Rs. 2525/- Imposed : Rs. Section accident -- As per Section 750000/- in respect of any one claim Section III: premium computation
0/- II-I (i) Motor Vehicle Act II-I (ii) or series of claims arising out of one table
event.
SNuObjMecINt IM 7,IM 21,IMT 28,IM 48
AtoT IO.MN.TDEnTdAoIrLsSement T T T
Nos.

Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship Percentage
NA NA NA NA NA
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 ( ) :- Twelve Thousand Nine Hundred Ninety-Two Only

For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 266 3202

Date of Issue 29/06/2021

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1661 FT, dated 29/06/2021
GST Number of MHDI - 37AAGCM1685C1ZI
GST Invoice Number - POL3711210004754
Accounting Code for Service - 997134, Motor vehicle insurance services
Authorised Signatory
Place of Supply:ANDHRA PRADESH ( 37 )

Whether Tax is payable on Reverse Charge - No

UIN : IRDAN149RP0006V02201213
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.