Date: 20/04/2023

S.no: Vertical Recipient :

Samir Bharatbhai Soni
22 Maruti Dham-2, At And Po IsroliMahuva Anaval RoadSurat Pin Code : 394620
Policy No. : 2302204733454600000

Due Date : 26/06/2023 Premium Payable : ` 19212.00

If a Claim is registered post 20/04/2023 the revised premium payable will be ` 9,215.58 due to withdrawal of NCB.

Dear Customer,

BOSG Recipient:
You are our valued customer and we thank you for choosing HDFC ERGO as your preferred insurance partner. We would like to remind you that your Motor
Insurance Policy is due for renewal on 26-Jun-2023. We request you to renew your policy before expiry date for continuity of benefits of your existing policy.

VEHICLE DETAILS
Make Model - Variant Engine No. Chassis No. Mfg Yr Seats Body Type CC
GRAND I10-SPORTZ 1.2

Dispatch Location:
HYUNDAI G4LAJM838614 MALA851CLJM828719 2018 5 3 1197
KAPPA VTVT DUAL TONE

Registration No. RTO Location GVW Financing Institution

GJ-19-AM-4618 BARDOLI BARDOLI NAGRIK SAHAKARI BANK LIMITED

If you find any error in the above details, kindly intimate the same to us along with a copy of the Registration Certificate of your vehicle.

Branch name:6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai - 400 059.
Insured's Declared Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Value (IDV) 346,569 0 0 0 346,569
PREMIUM COMPUTATION

Own Damage Premium (a) Liability Premium (b)

Own Damage (OD) incl app Loadings, NCB @ 20% 7,215 Third Party Liability (TP) is charged as prescribed by IRDAI 4,041
Other Liability (optional coverages)
Personal Accident for owner driver and optional coverage 250
Total Package Premium (a+b) 11,256
GST as applicable 2,026
Total Premium Payable 13,282
#Add on cover Premium 5,930 Total Premium Payable (Including Add on cover) 19,212
Total Premium Payable (Including add on cover)

#   Add On Cover Premium Description : Cost Of Consumables : 818 Engine And Gear Box Protector : 1227 Zero Depreciation : 3885
QR Code
Online Contact Us SMS Courier Scan for instant Renewal
Renewal
Options

Visit "Renew - Renew your

Call on 022 - 6234 6234 / SMS "Renew” to Send duly filled renewal slip with
HDFC Ergo policy" on
0120 - 6234 6234 and 9999700700 & receive call premium cheque to customer
hdfcergo.com. Fill details &
renew instantly within 24 hours service address
Visit nearest branch & Pay via Cheque/DD/Cash/Credit Card : 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri
(E), Mumbai - 400 059.
Customer Service Address : D-301, 3rd Floor, Eastern Business District ( Magnet Mall), LBS Marg, Bhandup
(West).MUMBAI - 400078. Maharashtra. For instant renewal Call 022 - 6234 6234 / 0120 - 6234 6234

IMD Code:

RENEWAL SLIP
Policy No. 2302204733454600000 (Old HGI Policy

Issue Cheque/DD in favour of HDFC ERGO General Insurance Company Ltd. Please mention your policy number on the reverse.

Cheque No. Cheque Date Cheque Amount Name of Bank & Branch

In case of any change in your correspondence address / contact details, please update & help us serve you better
Address
City State Pin Code
Phone Mobile Email
Nominee Details - Name, Age & Relationship
For PA to named Passenger
(Not applicable for commercial vehicle)
Owner Driver

In case of more than one named passenger, please provide in the above format on a separate sheet.
Terms & Conditions: This renewal letter is generated on the basis of information of Claims, if any, in respect to your current policy as on 20/04/2023. if any additional claim is reported other than
the above mentioned, this offer letter stands withdrawn and the Company reserves the right to increase the renewal premium. In addition to the above, in case you have availed No Claim Bonus
benefit, you will be required to reimburse the same. In case you do not agree to pay the revised premium, the Company reserves the right to cancel the policy, if already issued, and return the
balance amount.Coverage will be effective on realisation of premium amount.
Goods and Services Tax Reg. No. 24AABCL5045N1ZE The Taxes will be charged as per the direction issued by Government / Regulatory Authority from time to time. The description of the add
on plans are illustrative and not exhaustive, To know more about the detailed description, terms and conditions you may refer to the policy wordings. The terms and conditions mentioned in the
Policy will supersede in case of any confict.

Customer Signature_________________________________