IRDAI REGN. NO.

- 137

SHRIRAM GENERAL INSURANCE COMPANY LIMITED

E-8,EPIP,SITAPURA INDUSTRIAL AREA,JAIPUR,
RAJASTHAN-302022
CONTACT(TOLL FREE): 1800–3003000, 1800–103309

10061-Address-E - 8, RIICO INDUSTRIAL AREA, SITAPURA, JAIPUR, RAJASTHAN - 302022

CERTIFICATE CUM POLICY SCHEDULE

GOODS CARRYING VEHICLE LIABLITY POLICY
UIN No.IRDAN137R001200809 - SAC Code: 997134

Certificate of Insurance and Policy Policy Period: Period Of Insurance

No.850120720 From 00:00:00 hours on 17/01/2023 To 23:59:59 hours on 18/01/2024
INSURED DETAILS
Insured Geographical Registration Registration
Name of Insured Business/Profession
date of birth Area Authority Date
M/S CHHOTELAL PATLE India NAGPUR 02/2013
CIN NO.U6601006PLC029979

VEHICLE DETAILS
Registration Number MH40Y2971 Model Description ACE BS III
Engine Number 13829 Type of Body GOODS
Chassis Number 01263 Cubic Capacity 0000
Make of the Vehicle TATA MOTORS LTD Year of Manufacture 2013
Seating Capacity 02 Total Premium(in Rs.) 18937

LIMITATIONS AS TO USE:The Policy covers use of the vehicle for any DRIVER: Any person including the Insured:• Provided that a person driving
purpose other than: a) Hire or Reward b) Tuition c) Carriage of goods (other
holds an effective driving license at the time of the accident and is not
than samples or personal luggage) d) Organized racing e) Pace making f) disqualified from holding or obtaining such a license. • Provided also that the
Speed testing g) Reliability Trials h) Any purpose in connection with Motor person holding an effective Learner’s License may also drive the vehicle and
Trade that such a person satisfies the requirements of Rule 3 of The Central Motor
Vehicles Rules, 1989.
LIMITS OF LIABILITY :Under Section II-1 (i) of the Policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles
Act, 1988. Under Section II-1 (ii) of the Policy -Damage to Third Party Property - Rs Rs.6000 Personal Accident cover for Owner - Driver under section III: CSI Rs.
15,00,000.00
Nominee Name : Nominee Age : Relationship with :
Guardian Name : Guardian Age : Guardian Relation :
LIABILITY
1. Basic premium including premium for TPPD 16049.00
2. Less: TPPD restricted to statutory limit of Rs.6000/- (Endt. IMT. 0.00
20) 0
3. Bi-fuel kit (CNG/LPG)
Add:
4. PA to Paid Driver CSI Rs. (IMT 17) 0.00
5. Geographical Area Extn.Endt.IMT-1 0.00
6. PA cover for Owner - Driver under Section III CSI Rs. 0.00
15,00,000.00 0.00
7. PA to Unnamed Passengers (IMT 16) 0.00
8. Enhanced PA for Unnamed Passengers, CSI Rs. 0 0.00
9. Enhanced PA for Owner Driver, CSI Rs. 0 0.00
10. Enhanced PA for Paid Driver, CSI Rs. 0

Legal Liability 2888

ADD: IGST
11. Legal Liability To Paid Driver (IMT 28) 0.00 18937
12. Legal Liability To Employees (IMT 29) 0.00
TOTAL LIABILITY PREMIUM (B) 16049.00 Signature Verified
Subject to IMT Endt. Nos. & memorandum 22 (refer Terms & Conditions for relevant wording)

In Witness whereof this Policy has been signed at Chennai on in lieu of Cover note No. dated Receipt No. .Subject to IMT Endt. Nos & Memorandum . I/We
hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X
and Chapter XI of the Motor Vehicles Act, 1988.

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 yterms appearing
in the Certificate in order to comply with the Motor Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS
AND RIGY" under Policy Terms and Condition

Shriram General Insurance Co.Ltd.

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 Authorized Signatory
Consolidated Stamp Duty paid vide Inspector General Registration and Stamp Ajmer order No. F7 (77)Gen/2022/3332 dated 11/03/2022
For Policy Wordings, NEFT/RTGS/IMPS or any other online payment kindly visit our website "www.shriramgi.com" Validity of policy
is subject to KYC verification.

Note :- Claim intimation after 48 hours will be considered as delayed intimation.

All the Amounts mentioned in this policy are in Indian Rupees
GSTIN No. 08AAKCS2509KZ3