MAGMA HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800-3002-3202

POS-COMMERCIAL VEHICLE LIABILITY ONLY 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 , PH: 30003976
Policy No P0019300021/4193/100909
Insured Mr PRAVEEN KUMAR GORREPATI
Address S/O : SRINIVASA RAO
Period Of Insurance 00:00 Hrs of 29/06/2021
D.NO: 4-124
To Midnight of 28/06/2022
CHAKKAPALLI
MUSUNURU
K V S RAMU-POS0001076-
KRISHNA DT Agent No.:
ANDHRA PRADESH
Agent Contact No.:
Contact Number NA
Email ID:
GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration PASSENGER
Year of CUBIC VEHICLE SUB
Mark & No. & Engine No. Chassis No. Make/Model/Type of Body CARRYING SEATING CAPACITY
Manufacture CAPACITY CLASS
RTA Location CAPACITY
MBX0000ZFTA2 PIAGGIO VEHICLES
AP16TH3287 2016 R5M2730412 11146 APE D3S 436 AUTO RICKSHAW 3 4

LIABILITY
LIABILITY(B)

Basic - TP 2,595
PA Owner Driver -SI Rs.200000 100
LL to Paid Driver IMT 28 50
Legal Liability to Passenger 3,723
Sub Total 6,468
Premium Computation
Total Liability Premium 6,468
CGST @ 9% 582
SGST @ 9% 582
TOTAL 7,632
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.
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
Any person including Insured:
persons 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
Stage carriage/Contract
obtaining such a license.Provided also that the person holding an effective learner's license may also drive the vehicle when not used for
Carriage/ Private Service
the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of The Central Motor
Vehicle
Vehicles Rules, 1989.
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.Provided also that the person holding an effective learner's license may also drive the vehicle when not used for
Non-transport Vehicles
the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of The Central Motor
Vehicles Rules, 1989.
LIMITS OF LIABILITY
Under Compulsory excess in respect of each and every Under In respect of any Under Damage to Third Party Property Under PA Owner – Driver as
Section claim under Sec I of motor policy Section one accident -- As Section Rs. 750000/- in respect of any Section III: per premium
I II-I (i) per Motor Vehicle II-I (ii) one claim or series of claims computation table
Act arising out of one event.
Subject to I.M.T Endorsement Nos. IMT 28
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship Percentage
NA NA NA FATHER 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 Collection Details :- [Collection No - ReceiptDate - Amount] : P/300021/19/100006378- 29/06/2021, 7632
Premium Amount in Word's ( ) :- Seven Thousand Six Hundred Thirty-Two Only
For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 - 3002 - 3202

Date of Issue : 29/06/2021

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1891, dated
25.10.2017
GST Number of MHDI - 37AAGCM1685C1ZI
GST Invoice Number - POL3704190000993
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

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.