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Go Digit General Insurance Ltd.

Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718
Name TEJAS C . Vehicle Registration No. KA05KA8151
PAYTM INSURANCE BROKING PRIVATE
Door No 619 2nd Cross 3rd Stage 3d Phase Partner Name: LIMITED
Address Banashankari,Kathriguppe Water Tank,Bangalore- 1041113
N 560085
Partner Code:
Mobile xxxxxxxxx6974 Partner Mobile No. --
Email exxxxxxxxxxxxxxxxx0@gxxxl.com Partner Email insurance.support@paytminsurance.co.in
PB
Aadhar No. -- For Claims,contact us at 1800-258-5956

YOUR POLICY DETAILS

Policy No. D058566900 / 01032022 Policy Issue Date 01-Mar-2022 Invoice No. IA060123954 Invoice Date 01-Mar-2022
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Period of Policy Own Damage Cover and Add On(s) if Opted Third Party Liability Cover PA Owner Driver

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From 03-Mar-2022 18:08:18 03-Mar-2022 18:08:18

01
--

12
To 02-Mar-2023 23:59:59 02-Mar-2023 23:59:59 --

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Compulsory NCB % (Current Policy) 50 %
100

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Deductible (`)

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Voluntary
Deductible 0.00 Additional Excess --

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(`) (`)

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Coverages Opted Digit Two Wheeler Package Policy
110

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Add On(s) Opted --

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YOUR VEHICLE DETAILS

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RTO Location Bengaluru,KARNATAKA Make HONDA Model/Vehicle

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Variant (Sub- ACTIVA/4G
Engine No. JF50EU5079988 Chassis No. ME4JF507CHU079944 Type)

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P ac Year of
Regn/Year of
Body Type Scooter Fuel Type Petrol Mfg. 2017/2017
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Odometer
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Seating Capacity 2 Cubic Capacity 110 CC Reading (KM) --

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YOUR VEHICLE IDV

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Year Vehicle IDV Non-Electrical Accessories IDV Electrical Accessories IDV CNG/LPG IDV Total IDV PA Owner Driver
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Year 1 20270 -- -- 20270 --

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--
02

Year 2 -- -- -- -- 0 --
MAK
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PB Year 3 -- -- -- -- 0 --
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Year 4 -- -- -- -- 0 --
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20

Year 5 -- -- -- -- 0 --
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OWN DAMAGE PREMIUM [A] (`) LIABILITY PREMIUM [B]

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(`)
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Own Damage Premium (`) 30.00 Basic Third-Party Liability (`) 752.00
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Add-Ons Premium (`) 0.00 PA cover for Owner-Driver (`) --

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NCB Discount Amount -15.00 Legal Liability to Employees (`) --

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202 (`)
15.00 Legal Liability to Paid Driver (`) --
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15 PA cover for 2 unnamed passengers each (`) --

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PA cover for Paid Driver (`) --

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Total OD Premium
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(`) 15.00 Total Act Premium (`) 752.00

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Net Premium 767.00

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(`)
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IGST @ 18% = (`138.06) 138.06

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2. Final Premium 905.06

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IG Note:The above total OD premium is inclusive of all applicable loading / discounts viz (automobile association memberships, voluntary excess, anti-theft
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handicap person, driver tuition, fiber glass, CNG/ LPG unit, imported vehicle etc., wherever applicable).
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If the “Own Damage Cover” under your policy is cancelled during the policy period, then your policy shall be governed by the standard terms and conditions
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13 of “Act only” policy for the Third Party Cover during the remaining period of policy
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ENDORSEMENT
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Invoice Number Invoice Date Gross Premium Igst Cgst Sgst Utgst Cess Net Premium

0.00 0.00 0.00 0.00 0.00 0.00 0.00

Policy No: D058566900

Page No: 1 of 2

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095. IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 07AACCO4128Q1Z2 HSN: 997134/General Insurance Services, GSTIN Address: Institutional North
Business centre,5th Floor, B Wing, IFCI Tower, 61, Nehru Place,New Delhi,Delhi,PIN-110019
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718

OTHER DETAILS
Previous Insurer ICICI Lombard General Insurance Co. Ltd. Previous Policy No. 2555
Previous Policy 08-Feb-2022
IMT - Endorsements IMT-22 Expiry Date
GSTIN/UIN No. Unregistered State Code 29
Receipt No. RA062114168 Receipt Date --
Financier Details -- Nominee Details --

Other Details

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Follow these rules like you follow the rules of the road.

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Geographical Area: Any accidental loss, damage and/or liability caused, sustained or incurred within India shall be covered subject to Policy Terms and Conditions, unless specifically
agreed and endorsed. Limitation as to use The policy covers use of the vehicle for any purpose other than hire or reward, racing, pace making, reliability trial, speed testing and use

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for any purpose in connection with the Motor Trade. Person or Class of persons entitled to drive: Any person including the insured 1) Provided that a person driving holds a valid &

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effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. 2) Provided also that the person holding a valid & effective
Learner's License may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989 and any subsequent amendment as

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applicable. Limits of Liability: 1) Under Section I of the policy_ IDV as shown in the schedule. 2) Under Section II - 1 (i)of the policy: Death of or bodily injury _ Such amount as is

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necessary to meet the requirements of the Motor Vehicles Act, 1988 and any subsequent amendment as applicable. 3) Under Section II _ 1 (ii)of the policy: Damage to Third Party
Property(` 100000) 4) P.A. Cover for Owner Driver under Section III (CSI) (per annum) - (` 0)

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Big Legal words

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NCB Declaration: The premium has been charged and policy has been issued subject to NCB declared by you as an insured. In the event of NCB found wrongly declared at any point

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of time during policy period, all benefits and coverages under the Policy in respect of section I of the Policy will stand forfeited. If there is any disagreement, write to us within 7 days

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from the date of issuance of policy or before the start date of period of insurance whichever is earlier. PUC Declaration: The Policy has been issued subject to valid Pollution Under

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Control (PUC) Certificate disclosed by you as an insured on or before the date of commencement of the Policy . Cheque dishonor / Non-receipt of payment: If premium paid through
Cheque, the policy is void ab-initio in case of dishonor of Cheque or non-receipt of payment. This policy is subject to the standard policy wordings, warranties and conditions

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applicable for this product in addition to coverages and exclusions specified in the motor vehicle tariff published by IRDAI. The insured is not indemnified if the vehicle is used or driven

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otherwise than in accordance with this Schedule. Any payment made by the Company by reason of wider terms appearing in 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”. Pre-existing Damages: All types of pre-existing
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damages or cost of repair of such damage will be excluded at the time of claim settlement.Violation of Motor Vehicle Act: This policy is issued in accordance with the provision of
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Chapter X and Chapter XI of MV act, 1988 and any subsequent amendment as applicable. Any violation will forfeit all benefits and coverages under the Policy. Important Notice: The
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company may cancel the policy by sending 7 days notice in case of fraud, misrepresentation, non disclosure of material fact or non co-operation of the insured. This policy is subject
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to the standard policy wordings, warranties and conditions applicable for this product in addition to Indian Motor Tariff. Break in Insurance: The policy is issued subject to acceptance
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of risk after evaluation of the Vehicle Inspection report. Own Damage cover (Section - I) would not commence unless the satisfactory Vehicle Inspection report has been received by
us. If the Company does not receive the Vehicle Inspection report or the report is adverse, the Company, at its discretion, will cancel Policy as per the Motor Tariff
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Note: The terms and conditions detailed in this policy schedule as well as the policy document sent by Digit shall prevail in case of any dispute
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The Policy has been issued without Compulsory Personal Accident Cover to Owner Driver on the basis of your declaration that you do not hold a valid Driving License on or before the
date of commencement of this Policy / already have an alternate Personal Accident insurance cover of Rs. 15 Lakhs
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For & On Behalf of Go Digit General Insurance Ltd.

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In case of claim or any other query, please contact our 24-hour Call
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Centre at 1800-258-5956 or email us at hello@godigit.com

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or visit our website www.godigit.com.

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Praveen Bhat
Senior Vice President - Customer Experience
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praveen.bhat@godigit.com
Authorized Signatory
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Printed, Signed, and Executed at Bengaluru

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Consolidated Stamp Duty has been paid as per Letter of

Authorization No.67-B/04/2017-18 Date: 30th May 2017
issued by Department of Stamps and Registration ,
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Bengaluru- 560009 - KARNATAKA.

Hey, our document is now digitally signed
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Click here to view the certificate.

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For instant resolution, you can ping us “Hi”

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on WhatsApp at 702 606 1234

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Policy No: D058566900

Page No: 2 of 2

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095. IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 07AACCO4128Q1Z2 HSN: 997134/General Insurance Services, GSTIN Address: Institutional North
Business centre,5th Floor, B Wing, IFCI Tower, 61, Nehru Place,New Delhi,Delhi,PIN-110019