IRDAI Regn No - 137

Signature Not Verified

This Document is Digitally Signed
Signer : RANJAN KUMAR SAHOO
Date : 1/15/2021 7:23:21 PM
Reason:Signing Policy For SGI

CERTIFICATE CUM POLICY SCHEDULE

PCCV-4 wheelers - carrying passengers-capacity NOT > 6 PACKAGE POLICY - ZONE A
CIN No. U66010RJ2006PLC029979

MOTOR COMMERCIAL VEHICLE (PACKAGE POLICY) - UIN NO. IRDAN137RP0018V01200809 - SAC Code. 997134
Issue Office: 10047 - Address:- E - 8, RIICO INDUSTRIAL AREA SITAPURA -JAIPUR RAJASTHAN 302022 Tel
Policy No : 10047/31/21/000835 Prev Policy No - Geographical Area INDIA
Insured's Code/ Name: 142765835 MR.PRATEEK GUPTA
Address: H NO. 1/10061 A GALI NO. 3 H WEST GORAKH PARK SHAHDARA DELHI-DELHI
NEW DELHI 110032
Executive: NA0000000100 Agent Details :BG0000000011 M/S.S & D U S P L - CA0171 / / Contact No: 8006085008
Period of Insurance : From 19:22 on 15/01/2021 To Midnight of 14/01/2022 Prop No. - Issue date
Gross Premium: 20,494 GST:3689 Cess : 0 Total: 24,183

Registration Engine No Make - Model Type of Body / Cubic Seat Cap

Date Of Regn /
Capacity/
Mark & Place Chassis No Fuel Type Year of Manf
Delivery (IncL Driver)
DL 1 ZC 7824 377700 MARUTI SUZUKI-DZIRE TOUR SEDAN 1197 02-08-19 4+1
S
North Delhi C19510 CNG 2019
Trailer Registration No. :

IDV For the IDV For Non Electrical Electrical IDV of CNG/LPG KIT SI Total Value
Vehicle Trailers Accessories Accessories side car
5,00,000 0 0 5,00,000

SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY
OD TOTAL ADD :BASIC TP COVER 8,749.00 11,320.00
TOTAL PREMIUM 20,494.00
ADD :IN-BUILT CNG/LPG KIT - TP COVER 60.00
ADD :IGST 18 % ADD :GR36A-PA FOR OWNER DRIVER 3,689.00 315.00
FINAL PREMIUM 24,183.00 ADD :LL TO PAID DRIVER COUNT : 1 50.00
TP TOTAL 11,745.00
* NCB discount - % Previous Policy : NA Nominee PA for Owner Driver : Mitali Gupta- Age : 31 - Relationship : SPOUSE -
Appointee Name : NA - Appointee Relationship : NA
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association, Voluntary Excess, Anti-Theft, Handicap Person, Driver Tuition, Fibre Glass,
CNG/LPG Unit, Geographical Extn, Imported Vehicle etc wherever applicable)
Deductibles under Section-I : Compulsory Deductible Rs.500
Subject to IMT Endorsement Printed herein/attached to : IMT-22,IMT-23,IMT-25,IMT-28,IMT-40,IMT-7
Hypothecation Agreement with: KOTAK MAHINDRA PRIME LIMITED

Hire Purchase/Lease Agreement with:

-
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 Owner - Driver (CSI) : Rs. 1500000
Driver's Clause
Any person including 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 when not used for
the transport of passengers at the time of accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules,
1989.
Limitations as to Use
The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor Vehicle's Act 1988
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms attached.Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the
policy shall be void abinitio (from inception). 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 authorised by and on behalf of the company has/have herein to set his/their hands at HEAD OFFICE-47

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 isrecoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION.
Preinspection Report: SCRATCHED BODY PARTS :AS PER THE PI PHOTOS DATED ON 14-01-2021 11 55 AM, DENTED BODY PARTS :AS PER THE PI PHOTOS DATED ON 14-
01-2021 11 55 AM, BROKEN BODY PARTS :AS PER THE PI PHOTOS DATED ON 14-01-2021 11 55 AM- Claim not payable for: Claim for existing dents and scratches are excluded
from scope of cover. Replacement/repair of all dented/scratched/Broken panels excluded from the scope of cover as well.
Broker POS Details : Name : - ID No : 2
Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.
In case of Claims/Grievance, Please contact us at: Toll Free No - 180030030000, 18001033009 Email id - chd@shriramgi.com
For NEFT/RTGS/IMPS or any other online payment kindly visit our website " www.shriramgi.com"

For and on behalf of

SHRIRAM GENERAL INSURANCE COMPANY LTD

Place : JAIPUR
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the expiry date of your
policy. If you do not want us to contact you, kindly send an e-mail for the same on dnd@shriramgi.com
Consolidated Stamp Duty paid vide Inspector General Registration and Stamp Ajmer order No. F7(77)Gen/2020-21/8397 dated
22/04/2020 Authorised Signatory
All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be ***DIGITALLY SIGNED
GSTIN No. - 08AAKCS2509K1Z3 considered as delayed intimation.
Page 1 of 1