Relax. We’ve got you covered.

Mr. MAHIPAL SINGH

ROOM NO 16 GRD FLOOR RAMAPATHI CHL NO 4
MAJAS GAON TEKDI GUMPHA ROAD
JOGESHWARI EAST
Mumbai 400060, Maharashtra
Contact: +91 8691935444

Dear MAHIPAL,

A warm welcome from all of us.

You’ve made a great choice by selecting Edelweiss Goods Carrying Vehicle Liability Only Insurance.
Your Policy No. is 900248526.

We’re going to do our best to provide you amazing service at all times. Count on us to always give you
the full picture, and to be completely fair and honest.

After reading this letter, do take a little time to download and go through the relevant policy information
on our website www.edelweissinsurance.com. It will help you know all the important details of the cover
you now enjoy. We know that insurance documents can make simple things sound difficult, but we really
think you should read them, because this is important!

The above information bears the main features and benefits, of course, and just as importantly, the
features which are not covered under your policy.

You can download the relevant policy information by following the steps given below:
· Visit www.edelweissinsurance.com
· Visit product page
· Select the desired product
· Download the relevant policy information

We’re just a call or an email away if you need to ask us something.

Write to us at support@edelweissinsurance.com or call us at 1800 12000.
Once again, we’re delighted to have you with us.

Warm regards,

Shubhdarshini Ghosh
Executive Director & CEO

Edelweiss General Insurance Company Limited, Corporate Office: 5th Floor, Tower 3, Kohinoor City Mall,Kohinoor City, Kirol Road, Kurla (West), Mumbai -
400070, Registered Office: Edelweiss House, Off CST Road, Kalina, Mumbai -400 098, IRDAI Regn. No.: 159. CIN: U66000MH2016PLC273758 Reach us
on: 1800 12000,Email: support@edelweissinsurance.com, Website: www.edelweissinsurance.com, Issuing/Corporate Office: +91 22 4272 2200, Grievance
Redressal Officer: +91 22 4931 4422, Dedicated Toll-Free Number for Grievance: 1800 120 216216. Trade logo displayed above belongs to Edelweiss
Financial Services Limited and is used by Edelweiss General Insurance Company Limited under license.

15
Edelweiss Goods Carrying Vehicle Liability Only Insurance | UIN: IRDAN159P0003V01201718
 For more details
scan this QR code

Objects in this document

are simpler than they seem.
Edelweiss Goods Carrying Vehicle Liability Only Insurance - Policy Schedule
It won’t take long at all to go through your important policy details! Also, it would be great if you saved
a soft copy to your phone. #TakeUsForGranted to be there – we’re as close to you as we seem!
Intermediary Name: Invictus Insurance Broking Services P L
Intermediary Reference Code: 2210001359 Contact: 9004681650

Policy Details
Policy Servicing Office: PUNE Policy No.: 900248526
Period of Insurance: From [00:00:00 ] of 25/11/2021 to [23:59 :59] of 24/11/2022
Insured's Name: Mr. MAHIPAL SINGH Insured's GST No.: NA
Insured's Address: ROOM NO 16 GRD FLOOR RAMAPATHI CHL NO 4, MAJAS GAON TEKDI GUMPHA ROAD, JOGESHWARI EAST,
Mumbai 400060, Maharashtra
Insured's ID: 1000798745 Policy Issued On: 24-Nov-2021
Co-insurer Details: N.A Geographical Area: India
Proposal/Cover Note No.:89387292 Zone: A

Your vehicle is your business partner.

Here is what we know about it from you!
Vehicle Details
Registration Mark Engine No. Chassis Make Model Variant GVW Year of Seating
& Place of Registration No Manufacture Capacity
including driver
MH 02 EC 0152
8501797 194392 PIAGGIO APE XTRA LDX 975.00 2015 02
Mumbai (West)

How have we worked out your premium?

‘Liability’ means the damage to someone else.

Liability
Base Premium including Premium Add:
for TPPD `4,092.00 Legal Liability
Total `4,092.00 1) LL to driver / conductor/cleaner - No `50.00
Sub Total (additions) `50.00
TOTAL LIABILITY PREMIUM `4,142.00
CGST Amount @ 6% `250.02
UT/SGST Amount @ 6% `250.02
FINAL PREMIUM `4,642.04

25
Edelweiss Goods Carrying Vehicle Liability Only Insurance | UIN: IRDAN159P0003V01201718
 Did you love someone else before we met?
It’s OK, we’ll deal with it. Here are the details of your last insurer.

Previous Insurer: NA
Previous Policy No.: NA Expiry on: NA

Who’s your nominee?

It’s always good to have a Nominee, and you did the right thing by naming one. Given below are the details.
Name and Age of Nominee: legal hire & 43 Years Relationship with insured: Others
Name of Appointee (If Nominee is minor): NA
Relationship of Appointee with Nominee: NA

Red, orange or green?

What kind of loss/damage is covered, and what isn’t? As a thumb rule, here are a few things you should remember.

·Use of the vehicle:

The Policy covers the use of the vehicle for any purpose except Motor Trade, Hiring or Reward, Carrying Goods (other than samples or personal luggage),
Organized Racing, Pacemaking, Speed Testing, Reliability Trials etc.

· Who can drive?

The driver can be anybody including the insured, provided he/she holds an effective driving license at the time of the accident and is not disqualified
from holding a driving license. However, the driver must satisfy the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

· Loss/damage to others:
Section II-1 (i) of your policy, covers you for liability for an amount of `750000/ in case of loss/damage to someone else’s property, or unlimited liability for
injury/death to other third parties in case you have an accident.

This is most important! Slow down here.

Although we’d love to cover your vehicle without exception, we can’t. Your policy covers loss to your vehicle only if all the terms are met.And any
payment we make because of terms appearing in this Schedule, or to comply with the Motor Vehicles Act, 1988, is recoverable from you.You should
definitely read the clause, ‘Avoidance of certain terms and right of recovery’ in your Policy Wording.
Warranted that the Assured named herein/owner of the vehicle insured holds a valid Pollution Under Control (PUC) Certificate on the date of commencement
of the Policy and renews and maintains valid and effective PUC Certificate during the duration of the Policy period.
Subject to Endt. Nos. & Memorandum..... Printed/attached here.
Date of duly signed proposal 24-Nov-2021
In Witness whereof this Policy has been signed at: PUNE on this 24th day of Nov 2021
Receipt No.PP500258 Date.. 24-Nov-2021
Consolidated Stamp duty Paid vide Letter of Authorisation No. CSD/117/2021/3137/21 dated 23-Aug-2021 at General Stamp Office, Mumbai.
Received premium payment of ` 4,642.04 vide instrument / reference number PP500258 dated 24-Nov-2021 against receipt number PP500258
It is certified that your Policy and this Schedule have been issued according to the provisions of Chapter X and Chapter XI of the Motor Vehicles,Act, 1988.

For Edelweiss General Insurance Company Limited

Signature Not Verified
Digitally signed by DS EDELWEISS GENERAL INSURANCE COMPANY LIMITED 4
Address of Issuing Office: 802 , 8TH FLOOR, B-50, Date: 2021.11.24 21:46:26 IST
SUNIT CAPITAL, SENAPATI BAPAT ROAD, Reason: Authentication
Location: Mumbai
SHIVAJINAGAR,PUNE - 411005
Date of Issue:24/11/2021
Authorized Signatory

Tax is not payable under reverse charge by the recipient

Description of Good or Service : General
GST Registration No.: 27AAECE2328J1ZO HSN/SAC Code : 997134
Insurance Service
Place of Supply State: Maharashtra Code: 27

Edelweiss Goods Carrying Vehicle Liability Only Insurance | UIN: IRDAN159P0003V01201718 35

TRANSCRIPT OF THE PROPOSAL

Product Details Valid from (dd-mmm-yyyy) 25/11/2021

Edelweiss Goods Carrying 24/11/2022
Product Name Vehicle Liability Only Valid to (dd-mmm-yyyy)
Insurance
Product Type Liability Only Fitness Cerficate Valid upto NA
Business Type Rollover Previous History
Proposal Details Date of Purchase NA
Gender Male Vehicle was New or Second Hand at New
Proposer Title Mr. the time of purchase
Proposer Name MAHIPAL SINGH Vehicle be used exclusively for NA
Proposer DOB 08.06.1971 Private, Social, Domestic, Pleasure &
ROOM NO 16 GRD FLOOR
RAMAPATHI CHL NO 4,
MAJAS GAON TEKDI
Proposer Address with Pincode GUMPHA ROAD, Professional Purpose
JOGESHWARI EAST,
Mumbai 400060,
Maharashtra
Contact Number 8691935444 Carriage Goods other than sample or NA
anand.pandey547@gmail.c
Email ID om
personal luggage
PAN Number NA Vehicle in Good Condition (Yes/No) NA
GST Number NA If No (Not in Good Condition) - Details NA
Occupation Medium to High Has any company, in respect of the NA
Policy Period (OD) risk to which this Proposal relates,
Policy Start Date ever
Policy Start Time A) Declined a proposal, refused NA
Policy End Date renewal or terminated insurance
Policy End Time B) Required an increased premium or NA
Policy Period (3 Year TP) imposed special conditions
Policy Start Date 25/11/2021 Detail if A or B selected as "Yes" NA
Policy Start Time 00:00:00 Previous Insurance Details
Policy End Date 24/11/2022 Insurer Name NA
Policy EndTime 23:59:59 Policy Number NA
Policy Period (CPA) Policy Expiry Date NA
Policy Start Date Type of Cover NA
Policy Start Time
Policy End Date Claim Lodged NA
Policy EndTime Claim Year NA
Vehicle Details Number of Claims NA
Registration Number MH 02 EC 0152 Claim Amount NA
Registration Place Mumbai (West) Nominee Details
Registration Date 05/11/2015 Nominee Name legal hire
Engine Number 8501797 Nominee Age 43 Years
Chassis Number 194392 Relation with Proposer Others
Vehicle Make PIAGGIO Date of Birth
Vehicle Model and Variant APE & XTRA LDX Name of the Appointee (for Minor) NA
Cubic Capacity / GVW / HP 975.00 Relationship to the Nominee NA
Seating Capacity (Including Driver) 02 Insured Declared Value (IDV)
Carrying Capacity 02 Vehicle IDV 0.00
Colour Non Electrical Accessories IDV 0.00
Fuel Type DIESEL Electrical Accessories IDV 0.00
Body Type Saloon Trailer IDV 0.00
Year of Manufacture 2015 Fuel Value (CNG / LPG) IDV 0.00
Transmission Type NA Fuel discerption for
Vehicle Usage Business Non Conventional Source
Page 4 of 6
Edelweiss Goods Carrying Vehicle Liability Only Insurance | UIN: IRDAN159P0003V01201718
 Car Parking Place Proposed Coverage
Financier Details Type of Cover
Financier Type Geographical Area Extn. yes
Financier Name Geographical Area India
Financier Address Imported Vehicles without Custom
PUC Details Duty
PUC Number Fibre Glass Tanks NO

Vehicle Used for Driving Tuition NO Infirmity Details

Name of Automobile Association NO Involved / Convicted For Causing Any
Membership No Accident/Loss
Date of expiry of membership Pending Prosecutins Details
Annual Mileage 10000 - 20000 Km Date Of Accident
Voluntary Discount Loss /Cost
Anti-Theft Discount Circumstance Of Accident / Loss
Auto Mobile Association Discount Addon Cover
Vintage Car Consumable Expenses Protect
Used Confined to Own Premises Key and Locks Protect
Discount NCB Protect
Handicapped Discount Mandatory Deduction Protect
Restricted TPPD Personal Belongings Protect
Owner Driver Depreciation Protect
PA Unnamed Passenger SI Engine Protect
PA Unnamed Passenger Number Invoice Value Protect
Emergency Medical Expenses
PA Named Passenger Number
Protect
PA Named Passenger - Name Road Side Assistance
PA Named Passenger - CSI Pillion Protect
PA Named Passenger - Nominee Personal Accident Protect
PA Named Passenger - Relations Tyre Protect
Legal Liability To Employees EMI Protect
Number Payment Details
Legal Liability To Paid Drivers Payment Mode Net Banking
Legal Liability To Other than Paid Instrument Date 24-Nov-2021
Drivers Instrument / Reference Number PP500258
Legal Liability To Employee who Premium Amount ` 4,642.04
are not "Workman" Intermediary Details
Invictus Insurance Broking
Driver Details Intermediary Name Services P L
Driver Name Intermediary Reference Code 2210001359
Driver Relationship with the Intermediary Contact Number 9004681650
Proposer SELF Intermediary Email
Driver Date of Birth Intermediary Sales Person's Name
Driver Occupation Intermediary Sales Person's Contact
Experience - No. of Driving Years 1 Servicing Branch Name
Driver Suffer from Defective vision Servicing Branch Code
or Hearing or any Physical Infirmity

I do not want the physical copy of my policy documents.

I want the physical copy of the policy documents to be sent to my address, as mentioned in the proposal form
* These documents will figure in phyical form unless our system allows upload of information. There should be a corresponding sentence in this box and
it should read as 'Documents related to and submited in pursuance to this proposal shall form part of this proposal.'
*The information, together with all statements, disclosure, representation and declaration, received from you (proposer), as has been reproduced above,
forms the basis of the insurance policy issued to you. Please inform us (insurer) immediately in case of any error or omission contained in such information.
Proposal Transcript Generation Date: 25/11/2021 Time: 00:00:00
As a go-green initiative, Edelweiss General Insurance Co. Ltd. shall be sending the policy documents to your e-mail address, as provided by you in
this proposal form.
Page 5 of 6
Edelweiss Goods Carrying Vehicle Liability Only Insurance | UIN No:IRDAN159P0003V01201718
Edelweiss General Insurance Company Limited, Corporate Office: 5th Floor, Tower 3, Kohinoor City Mall,Kohinoor City, Kirol Road, Kurla (West), Mumbai -
400070, Registered Office: Edelweiss House, Off CST Road, Kalina, Mumbai -400 098, IRDAI Regn. No.: 159. CIN: U66000MH2016PLC273758 Reach us
on: 1800 12000,Email: support@edelweissinsurance.com, Website: www.edelweissinsurance.com, Issuing/Corporate Office: +91 22 4272 2200, Grievance
Redressal Officer: +91 22 4931 4422, Dedicated Toll-Free Number for Grievance: 1800 120 216216. Trade logo displayed above belongs to Edelweiss
Financial Services Limited and is used by Edelweiss General Insurance Company Limited under license. Insurance is the subject matter of solicitation.
 Edelweiss General Insurance Company Limited
Acknowledgment of Premium Receipt
Registered Office Address: Edelweiss House, Off CST Road, Kalina, Mumbai, Maharashtra 400098

Issuing Office Address: 802 , 8TH FLOOR, B-50, SUNIT CAPITAL, SENAPATI BAPAT ROAD, SHIVAJINAGAR,PUNE - 411005

Product Name: Edelweiss Commercial Vehicle Insurance Policy No.: 900248526

Receipt Generation
Office Code Office Location Receipt Number
Date/Time

13 Maharashtra PP500258 24-Nov-2021

Name of
Intermediary/Agency Intermediary/Agency
Policyholder’s ID Policyholder/
Code Name
Financier
Invictus Insurance
2210001359
Broking Services P L
1000798745 Mr. MAHIPAL SINGH

Payment Instrument/
Mode of Cheque Instrument
Received Transaction
Payment Drawn on Date
From Number
MAHIPAL SINGH Net Banking PP500258 - 24-Nov-2021

Branch Address PUNE 2B Sahar Road Mumbai Maharashtra India 400099

Note:Premium amount is inclusive of GST.

This acknowledgment confirms receipt, by Edelweiss General Insurance Co. Ltd. (Company), of the proposal deposit made in connection with the proposal
for insurance and does not,in any way, constitute confirmation towards accceptance of risk. The acceptance of risk, if and when takes place, shall be
evidenced by the policy schedule issued by the Company. In the event of non-acceptance of the said proposal for insurance, the proposal deposit stated
herein will be refunded bereft of interest.