STAND-ALONE OWN DAMAGE PRIVATE CAR POLICY

Certificate of Insurance cum Policy Schedule

Summary

Hyundai Grand i10 Nios Valid from Valid till (midnight)

BR01FE4736 01 MAY 22 30 APR 23
Car owner Owner number Owner email
MASOOM RAZA XXXXXX3678 mXXXXXXXXXa@gmail.com
Plan Policy price Car value
Stand-Alone Own Damage ₹ 9782.38 ₹ 525200.0
Zero Depreciation
Please refer overlay for more details

WELCOME! We’re happy to have you at Acko, and promise to be there for you always. You’re now a part of the
Acko Advantage program, which takes care of everything if your car ever runs into trouble. Just call us
immediately on 1800 266 2256 when things go wrong and we’ll take it from there.

Acko Advantage* Non-Acko

Advantage
Free car pick-up
from home,
office or accident
site

Repairs at our
network of
expert garages.

3-day repair
guarantee.

Cab voucher**
worth Rs.
500/day if
there's a repair
delay.

Car drop at your

doorstep.

Cashless and
hassle-free
processing.

*Only applicable in selected cities provided you call us immediately - Ahmedabad | Bangalore | Chennai | Delhi | Hyderabad | Kolkata | Mumbai |
Pune
**Cab vouchers available in the cities mentioned above. Please refer the Terms & Conditions for more details

Please Note: Previous Policy document is required in case of claim within 30 days of Acko Policy Start Date.

If you are a workshop or garage staff

Please call Acko for quick settlements on 1800 209 9910 [ GST# for workshop Invoice 27AAOCA9055C1ZJ ]
Acko Ge ne ral Insurance Ltd.
Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park, Goregaon (E), Mumbai- 400063
Email: hello@acko.com | Phone: 18 00 266 2256 | www.acko.com
Product: Private Car Package Policy | CIN : U66000MH2016PLC28 738 5
IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ
UIN: IRDAN157RP0033V01201920/A0038 V01201920/A0035V01201
920/A0009V01201920/A0042V01201920 Page 1 of 6
What’s Covered
A snapshot of all the coverages in this policy.
Accide nts
Damages to the car due to an accident.
C alamitie s
Damage due to natural or man made
causes like earthquake, riots, etc.
Engine Pro te ct C ar
Covers repairs or replacement of internal
parts of the engine or gearbox and
differential assembly arising out of water
ingression, hydrostatic lock, or leakage
of coolant/lubricating oil.
What’s Not Covered
A snapshot of all the coverages that are not covered in this policy.
No n-Accide nt Damage
Like wear & tear, breakdown,
failures & breakages, and
deductibles.
T yre , T ube s & Engine
Not included unless the tyre,
tubes & engine are damaged
due to an accident.
The info rmatio n pro vide d he re in abo ve is fo r the purpo s e o f illus tratio n o nly. Fo r mo re de tails o n ris k facto rs , te rms ,
co nditio ns and e xclus io ns , ple as e re ad the po licy wo rdings ( https ://www.ack o .co m/do wnlo ad ) care fully.
Fire T he f t
In case your car catches fire, resulting If your car is stolen, we will pay you the
from self-ignition, explosion or lightning. value as per policy of your car.
C o nsumable s Ze ro de pre ciatio n
Covers the cost of consumables like nut, Covers the depreciation of parts which
bolt, lubricant etc. consumed during car are replaced during car repair.
repair due to accident.
Invo ice C o ve r
In the event of total loss/theft, get the
original invoice value or the current
replacement value of your car
(whichever is less), registration charges
and road tax included. Coverage will be
applicable for 1 claim.
C o nse que ntial Lo ss & Nucle ar Risk & War Ille gal Driving
C o ntractual Liability Damages to your car due to Damage due to the car driven by a
Indirect damage or liability nuclear risk, war & mutiny person without a valid driving
arising due to your car license or under influence of
accident. liquor/drugs.
C ar Re vie w Exce ptio n C o mme rcial usage o f the T hird - Party Lo sse s
Pre-existing Damages as C ar Death, injury or property
found on vehicle inspection. If the Car is registered as damage to any third party
Private vehicle & if it is used arising from your car.
for commercial purpose than
the losses or liability due to
accident during such usage is
not covered in this policy.
Page 2 of 6
 STAND-ALONE OWN DAMAGE PRIVATE CAR POLICY
Private Car Package Policy

POLICY DET AILS VEHICLE DET AILS

Insured Name: MASOOM RAZA Registration Number: BR01FE4736
Address/Pincode: 110010 Make/Model: Hyundai Grand i10 Nios
Period of Insurance: 01 May 22 00:00 hrs to 30 Apr 23 23:59 Purchase Year: 2021
hrs Engine CC: 1197
Policy Issuance Date: 29 Apr 22 Engine Number: G4LAMM8 78 544
Policy Number: DCOR005274518 74/00 Chassis No: MALB251CLMM167297

INSURED DECLARED VALUE (IDV)

Ve hicle IDV (₹) Acce sso rie s (₹) Bif ue l K it (₹) T o tal IDV (₹)

525200 0.0 0 525200.0

PREMIUM DET AILS (₹)

Own Damage Pre mium (A)

Basic Own Damage ₹ 7558 .68

NCB Discount ₹ (750.99)

Consumables ₹ 128 .93

Invoice Cover ₹ 670.77

Engine Protect ₹ 68 2.76

Net Own Damage Premium (A) ₹ 8 290.15

Total Package Premium ₹ 8 290.15

IGST (18 %) 1492.23

Total Premium ₹ 978 2.38

Geographical Area: India Voluntary Deductible: ₹0 Hypothecation: NA

No-Claim Bonus: 20% Compulsory Deductible: ₹ 1000
Limitatio ns As T o Us e : The Po licy co ve rs us e o f the ve hicle fo r any purpo s e o the r than: a) Hire o r Re ward b) C arriage o f go o ds (o the r than s ample s o r
pe rs o nal luggage ) c) Organize d racing d) Pace mak ing e ) S pe e d te s ting f) Re liability Trials g) Any purpo s e in co nne ctio n with Mo to r Trade . Pe rs o ns o r
Clas s o f Pe rs o ns e ntitle d to d rive : Any pe rs o n ((including the ins ure d), pro vide d that a pe rs o n driving ho lds a valid driving lice ns e at the time o f the
accide nt and is no t dis qualifie d fro m ho lding o r o btaining s uch a lice ns e . Pro vide d als o that the pe rs o n ho lding a valid le arne r's lice ns e may als o drive the
ve hicle and that s uch a pe rs o n s atis fie s the re quire me nts o f Rule 3 o f the C e ntral Mo to r Ve hicle s Rule s , 19 89 . T e rms , Co nd itio ns & Exclus io ns : As pe r
the Indian Mo to r Tariff. A pe rs o nal co py o f the s ame is available fre e o f co s t o n re que s t & the s ame is als o available at o ur we bs ite .
I / We he re by ce rtify that the po licy to which the ce rtificate re late s as we ll as the ce rtificate o f ins urance are is s ue d in acco rdance with the pro vis io n o f
chapte r X, XI o f Mo to r Ve hicle s Act, 19 88. "The s tamp duty o f Rs . 0.50 paid by e le ctro nic me dium vide GRAS De face no . 000433489 4202122 date d 24/11/2021
& GRAS De face no . 00043349 6 2202122 date d 24/11/2021 as pre s cribe d in Go ve rnme nt No tificatio n Re ve nue & Fo re s t De partme nt No . Mudrank -
2017/C .R.9 7/M-1, date d 09 /01/2018. GS TN: 27AAOC A9 055C 1ZJ. IMPO RT ANT NO T ICE: The Ins ure d is no t inde mnifie d if the ve hicle is us e d o r drive n
o the rwis e than in acco rdance with this S che dule . Any payme nt made by the C o mpany by re as o n o f wide r te rms appe aring in the C e rtificate in o rde r to
co mply with the Mo to r Ve hicle s Act, 19 88 is re co ve rable fro m the Ins ure d. S e e the claus e he ade d "AVOIDANC E OF C ERTAIN TERMS AND RIGHT OF
REC OVERY” in the po licy wo rdings . Dis claime r: The Po licy s hall be vo id fro m ince ptio n if the pre mium che que is no t re alize d. In the e ve nt o f
mis re pre s e ntatio n, fraud o r no n-dis clo s ure o f mate rial fact, the C o mpany re s e rve s the right to cance l the Po licy. The po licy is is s ue d bas is the info rmatio n
pro vide d by yo u, which is available with the co mpany. In cas e o f dis cre pancy/no n re co rding o f re le vant info rmatio n in the po licy, the ins ure d is re que s te d to
bring the s ame to the no tice o f the co mpany within 15 days . This Po licy is to be re ad in co njunctio n with the Po licy wo rdings
(https ://www.ack o .co m/do wnlo ad) available o n the we bs ite o f the C o mpany. On re ne wal, the be ne fits pro vide d unde r the po licy and/o r te rms and
co nditio ns o f the po licy including pre mium rate may be s ubje ct to change .

INT ERMEDIARY DET AILS

Policy Issuing Office: Direct - Mumbai Intermediary Name: Direct
Phone Number: NA Intermediary Code: NA

Acko Ge ne ral Ins urance Ltd .

Unit No . 301, 3rd Flo o r, F Wing, Lo tus C o rpo rate Park , Go re gao n (E), Mumbai- 40006 3
Email: he llo @ack o .co m | Pho ne : 1800 26 6 2256 | www.ack o .co m
Pro duct: Private C ar Pack age Po licy | C IN : U6 6 000MH2016 PLC 287385
IRDAI Re g No . 157 | HS N: 9 9 7134 | GS T: 27AAOC A9 055C 1ZJ
UIN: IRDAN157RP0033V012019 20/A0038V012019 20/A0035V012019 20 Fo r Ack o Ge ne ral Ins urance Ltd.
/A0009 V012019 20/A0042V012019 20 Duly C o ns titute d Atto rne y
Page 3 of 6
 PREMIUM RECEIPT

Received with thanks from MASOOM RAZA a sum of ₹ 9782.3 8 towards premium on Car Insurance Policy

INSURED DET AILS

Name of Insured: MASOOM RAZA
Period of Insurance: 01 May 22 00:00 hrs to 30 Apr 23 23:59
hrs
Policy Number: DCOR005274518 74/00
Payment Date: 29 Apr 22

PREMIUM DET AILS (₹)

Gross Premium ₹8 290.15

IGST (18 %) ₹ 1492.23

Total Premium ₹978 2.38

T ERMS & CONDIT IONS:

Issuance of this receipt does not amount to acceptance of the risk by Acko General Insurance Limited. The insurance cover for the risk shall be
as per the terms and conditions of the Insurance Policy if and when issued. * Cheque/DD/PO receipt is valid subject to realization of the
instrument.

Acko Ge ne ral Insurance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park, Goregaon (E), Mumbai- 400063
Email: hello@acko.com | Phone: 18 00 266 2256 | www.acko.com
CIN : U66000MH2016PLC28 738 5 | IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ
UIN: IRDAN157RP0033V01201920/A0038 V01201920/A0035V01201 For Acko General Insurance Ltd.
920/A0009V01201920/A0042V01201920 Duly Constituted Attorney
Page 4 of 6
 PROPOSAL FORM

Dear MASOOM RAZA,

We wish to inform you that the Insurance policy number DCOR00527451874/00 has been issued on the basis
of the information and declaration given by you, the transcript whereof is mentioned below.

Please be informed that this Policy shall be construed to be void ab initio/invalid in the event we find that you have not
disclosed material or correct information required for the purpose of providing the below insurance cover and in case of any
claim arising under the policy in such a scenario, we shall be under no obligation whatsoever to settle such claim to you and the
premium paid by you under this policy shall stand fully forfeited.

POLICY DET AILS PREVIOUS POLICY DET AILS

Policy Number: DCOR005274518 74/00 Previous Policy Expired: Not Expired
Period of Insurance: 01 May 22 00:00 hrs to 30 Apr 23 23:59 Previous Policy Insurer: The New India Assurance Co. Ltd
hrs
Policy Issuance Date: 29 Apr 22

CAR DET AILS CAR OWNER DET AILS

Car Number: BR01FE4736 Name: MASOOM RAZA
Make/Model: Hyundai Grand i10 Nios Email Address: mXXXXXXXXXa@gmail.com
Type: Private Mobile Number: XXXXXX3678
Fuel Type: petrol NCB: 20%
Registration Year: 2021 Address/Pincode: 110010
Registration Month: Jun
Insured Declared Value (IDV): 525200
Accessories (IDV): 0.0
Engine Number: G4LAMM8 78 544
Chassis Number: MALB251CLMM167297

Acko Ge ne ral Insurance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park, Goregaon (E), Mumbai- 400063
Email: hello@acko.com | Phone: 18 00 266 2256 | www.acko.com
CIN : U66000MH2016PLC28 738 5 | IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ
UIN: IRDAN157RP0033V01201920/A0038 V01201920/A0035V01201 For Acko General Insurance Ltd.
920/A0009V01201920/A0042V01201920 Duly Constituted Attorney
Page 5 of 6
 PROPOSAL FORM

COVER DET AILS

Add-o ns/ Othe rs Include d Exclude d

PA Cover -

Consumables -

Zero Depreciation -

Engine Protect Car -

Invoice Cover Car -

T ERMS & CONDIT IONS:

“I/We desire to insure with Acko General Insurance Limited in respect of the vehicle described in this proposal form and confirm that the
statements contained in this application are my/our true and accurate representations. I/We undertake that if any of the statements are found
to be false or incorrect, the benefits under this policy would stand forfeited. I/We agree that this application and declaration shall be promissory
and shall be the basis of the contract between me/us and Acko General Insurance Limited. I/We agree to the Company taking appropriate
measures to capture the voice log for all such telephonic transactions carried out by me/us as required by the procedures/regulations internal or
external to the Company and shall not hold the Company responsible or liable for relying/using such recorded telephonic conversation. In the
event of nonrealization of the cheque or non-receipt of the amount of premium by the Company the policy shall be deemed cancelled ‘ab-initio’
and the Company shall not be responsible for any liabilities of whatsoever nature under this Policy.” I/We agree to receive ‘Certificate of
Insurance or Policy Schedule’ only and shall access the policy terms, conditions and exclusions on the company’s website.

PROHIBIT ION OF REBAT ED (SECT ION 4 1) OF T HE INSURANCE ACT - 1938 (AS AMENDED):
1. No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue and
insurance in respect of any kind or risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any
rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate expect such
rebate as may be allowed in accordance with the prospectus or tables of the Insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to 10 lakh rupees.

Acko Ge ne ral Insurance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park, Goregaon (E), Mumbai- 400063
Email: hello@acko.com | Phone: 18 00 266 2256 | www.acko.com
CIN : U66000MH2016PLC28 738 5 | IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ
UIN: IRDAN157RP0033V01201920/A0038 V01201920/A0035V01201 For Acko General Insurance Ltd.
920/A0009V01201920/A0042V01201920 Duly Constituted Attorney
Page 6 of 6