"A"PolicyforActLiabilityInsurance(FourWheeler)-PolicySchedule

PolicyNumber: 131522123480004986 Proposal/CovernoteNo: R22012137201

Insured'sName: VIJAY KUMAR Period ofInsurance:

From 00:01 Hrs on 23-DEC-2021to23:59Hrsof 22-DEC-2022

CommunicationAddress : 528R MODEL TOWN LUDHIANA PolicyServicingBranch:

PB 141002 C-1,3RDFLOOR,NEWKRISHNAPARK,ADJUSTANT
TOJANAKPURIMETROSTATIONWESTNEWDELHI DELHI110018

Limite
Mobile No :

Email-ID:asffr9@gmail.com GSTIN/UIN&Place ofSupply:

Nominee Name:

InsuredVehicleDetails

RegistrationNo. PB10EZ0033 Mfg.Month& Year MAR-2017

Make/ Model FORD
CC/HP/Watt 3198

Compa
Engine No./ChassisNo. 73292/73292 S eatingCapacityofsidecar (ifany) including driver 7
Typeof Body/LCC SALOON TotalPremium ` 14884.00
RTOLocation PB TotalIDV ` NA

Hypothecation/Lease NA

InsuredDeclared Value(IDV)

Vehicle` Trailer `
Electrical / ElectronicAccessories ` Total CoverSI` 0.0
Non Electrical Accessories ` TotalIDV ` NA

Own Damage
Basic OD
Insura n
Amount(`) Liability-SectionII
0.00BasicLiability(TPPD1)
Amount(`)
12564.00
TotalBasicLiabilityPremium 12614.00
PA Benefits - SectionIII 50
TOTALLIABILITYPREMIUM 12564.00
TOTALPACKAGEPREMIUM(SecI+II+III) 12614.00
CGST(@9.00%) 1135.00

TOTALPREMIUM PAYABLE(`) Gene r SGST(@9.00%) 1135.00

14884

, Subjectto I.M.T.Endt.Nos.
Description ofservices : Motorvehicleinsuranceservices

Limitsofliability : (a)Under SectionII(1)(i)of the Policy-Deathoforbodilyinjury toanyperson sofarasitisnecessary

tomeettherequirementsoftheMotorVehicleAct,1988.(b)UnderSectionII(1)(ii)ofthePolicy-
Damagetopropertyotherthanpropertybelonging totheinsuredorheldintrust orinthecustodyorcontrol of the insureduptothelimits
specified-(TPPD1SumInsured - `1,00,000/-, TPPD 2SumInsured- `6000/-).(iii)PAcoverforowner-driver undersectionIII
CSI`0.0/-
Limitationsastouse :ThePolicy coversuseforanypurpose otherthan:(a)Hireor
Reward,(b)Carriageofgoods(otherthansamplesorpersonalluggage),(c)Organizedracing,(d)Pace making,(e)Speedtesting,(f)
Reliabilitytrials,(g)AnypurposeinconnectionwithMotorTrade
Persons/Classes :AnypersonincludingtheInsuredprovidedthatapersondrivingholdsavaliddrivinglicenseat thetimeof the
ofpersonsentitledtodrive accidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.ProvidedthatthepersonholdingavalidLearner'sLicensemay
drivethevehicleandthatsuchapersonsatisfiestherequirementsofRule3 oftheCentralMotorVehiclesRules,1989.

13BRG488/GirnarInsuranceBrokersPvtL 7551196989
td insurance.backoffi
ce@girnarsoft.co
m

IntermediaryCode/Name IntermediaryContactNo. IntermediaryE-mailID