COMPREHENSIVE POLICY

Certificate of Insurance cum Policy Schedule

Summary

Hyundai i20 Valid from Valid till (midnight)

KA01MP29 8 4 19 DEC 22 18 DEC 23

Car owner Owner number Owner email

ANN M OLIVER XXXXXX0021 aXXXXXXXXX5@ gmail.com
Plan Policy price Car value
Comprehensive (Super Saver), ₹ 5797.22 ₹ 439577.0
Voluntary Deductible

Comprehensive Super Saver plan is a reduced price plan under the condition that during claims, you notify us first
and have your car repaired at one of our network garages. Please note that if you choose to take your car to any
other garage before notifying us, an additional Rs.5000 deductible will be applied during settlement.

WELCOME! We're happy to have you at ACKO and promise to be there for you always. Now, you are also a part of the
Acko Advantage program, which takes care of everything if your car ever runs into trouble. To intimate a claim,
simply log in to acko.com or call us on 1800 266 2256.

Acko Non-Acko
Advantage* 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 | Kolk ata | Mumbai | Pune
**Cab vouchers available in the cities mentioned above. Please refer the T erms & 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 ]
Ack o General Ins urance Ltd.
Unit No. 301, 3rd Floor, E Wing, Lotus Corporate Park , Goregaon (E), Mumbai- 4 00063
Email: hello@ack o.com | T oll Free: 1800 266 2256 | www.ack o.com
Product: Private Car Pack age Policy | CIN : U66000MH2016PLC287385
IRDAI Reg No. 157 | HSN: 997134 | GST : 27AAOCA9055C1ZJ
UIN: IRDAN157RP0001V01201718/IRDAN157RP0024 V01201819 Page 1 of 6
What's Covered
A snapshot of all the coverages in this policy.

Accidents Fire Theft

Damages to the car due to an accident. In case your car catches fire, resulting from If your car is stolen, we will pay you the value
self-ignition, explosion or lightning. as per policy of your car.

Calam ities Third - Party Los s es Cons um ables

Damage due to natural or man made causes Death, injury or property damage to any third Covers the cost of consumables lik e nut,
lik e earthquak e, riots, etc. party arising from your car. bolt, lubricant etc. consumed during car
repair due to accident.

Car Owner Cover

Death and disability cover for the car owner.

What's Not Covered

A snapshot of all the coverages that are not covered in this policy.

Non-Accident Dam age Cons equential Los s & Nuclear R is k & War Illegal Driving
Lik e depreciation, wear & tear, Contractual Liability Damages to your car due to Damage due to the car driven by a
break down, failures & Indirect damage or liability nuclear risk , war & mutiny person without a valid driving license
break ages, and deductibles. arising due to your car accident. or under influence of liquor/drugs.

Tyre, Tubes & Engine Car R eview Exception Com m ercial us age of the Car Voluntary deductible
Not included unless the tyre, Pre-existing Damages as found If the Car is registered as Private T he policyholder will bear Rs. 5000 in
tubes & engine are damaged on vehicle inspection. vehicle & if it is used for the event of a claim not availed at
due to an accident. commercial purpose than the Ack o partner garages, over and above
losses or liability due to the aforementioned exclusions.
accident during such usage is
not covered in this policy.

T h e in fo rma tio n pro vide d h e re in a bo ve is fo r th e purpo se o f illustra tio n o n ly. Fo r mo re de ta ils o n risk fa cto rs, te rms,
co n ditio n s a n d e xclusio n s, ple a se re a d th e po licy wo rdin gs ( h ttps://www.a ck o .co m/do wn lo a d ) ca re fully.
Page 2 of 6
 COMPREHENSIVE POLICY
Private Car Package Policy

POLICY DETAILS VEHICLE DETAILS

Insured Name: ANN M OLIVER Registration Number: KA01MP2984
Address/Pincode: 560025 Mak e/Model: Hyundai i20
Period of Insurance: 19 Dec 22 00:00 hrs to 18 Dec 23 23:59 hrs Registration Year: 2016
Policy Issuance Date: 03 Dec 22 Registration Month: Dec
Policy Number: DCAR00717823853/00 Engine CC: 1197
Seating Capacity: 5

INSURED DECLARED VALUE (IDV)

Vehicle IDV (₹ ) Acces s ories (₹ ) Bifuel Kit (₹ ) Total IDV (₹ )

4 39577 0.0 0 4 39577.0

PREMIUM DETAILS (₹)

Own Dam age Prem ium (A) Liability Prem ium (B)

Basic Own Damage ₹ 1885.79 Basic T hird Party Liability ₹ 34 16.00

NCB Discount ₹ (84 8.60) PA for Owner Driver ₹ 399.00

Consumables ₹ 60.72

Net Own Damage Premium (A) ₹ 1097.90 Net Liability Premium (B) ₹ 3815.00

T otal Pack age Premium ₹ 4 912.90

IGST (18%) 884 .32

T otal Premium ₹ 5797.222

Geographical Area: India Hypothecation: NA Voluntary Deductible: ₹ 5000*

No-Claim Bonus: 4 5% Compulsory Deductible: ₹ 1000
*T he policyholder will bear Rs. 5000 over and above the standard charges in the event of a claim not availed at Ack o partner garages
L i mi ta ti o ns As T o Us e: T h e Po licy co ve rs use o f th e ve h icle fo r a n y purpo se o th e r th a n : a ) Hire o r Re wa rd b) Ca rria ge o f go o ds (o th e r th a n sa mple s o r pe rso n a l
lugga ge ) c) O rga n ize d ra cin g d) Pa ce ma k in g e ) Spe e d te stin g f) Re lia bility T ria ls g) A n y purpo se in co n n e ctio n with Mo to r T ra de . P ers o ns o r Cl a s s o f P ers o ns enti tl ed
to d ri ve: A n y pe rso n ((in cludin g th e in sure d), pro vide d th a t a pe rso n drivin g h o lds a va lid drivin g lice n se a t th e time o f th e a ccide n t a n d is n o t disqua lifie d fro m h o ldin g
o r o bta in in g such a lice n se . Pro vide d a lso th a t th e pe rso n h o ldin g a va lid le a rn e r's lice n se ma y a lso drive th e ve h icle a n d th a t such a pe rso n sa tisfie s th e re quire me n ts
o f Rule 3 o f th e Ce n tra l Mo to r Ve h icle s Rule s, 1989. L i mi ts o f L i a b i l i ty. 1. Un de r Se ctio n II-1 (i) o f th e po licy - De a th o f o r bo dily in jury - Such a mo un t a s is n e ce ssa ry to
me e t th e re quire me n ts o f th e Mo to r Ve h icle s A ct, 1988. 2. Un de r Se ctio n II - 1(ii) o f th e po licy -Da ma ge to T h ird Pa rty Pro pe rty - Rs. 7 50000 3. P. A . Co ve r un de r Se ctio n
III fo r O wn e r - Drive r (CSI): Rs. 1500000 T erms , Co nd i ti o ns & Exc l us i o ns : A s pe r th e In dia n Mo to r T a riff. A pe rso n a l co py o f th e sa me is a va ila ble fre e o f co st o n
re que st & th e sa me is a lso a va ila ble a t o ur we bsite .
I / We h e re by ce rtify th a t th e po licy to wh ich th e ce rtifica te re la te s a s we ll a s th e ce rtifica te o f in sura n ce a re issue d in a cco rda n ce with th e pro visio n o f ch a pte r X, XI o f
Mo to r Ve h icle s A ct, 1988. Sta mp Duty o f Rs ** /- is pa id a s pro vide d un de r A rticle 47 o f In dia n Sta mp A ct, 1899 a n d in clude d in Co n so lida te d Sta mp Duty Pa id to th e
Go ve rn me n t o f Ma h a ra sh tra T re a sury vide O rde r o f A ddl. Co n tro lle r o f Sta mps, Mumba i a t Ge n e ra l Sta mp O ffice , Fo rt, Mumba i - 400001., vide th is O rde r No .
(LO A /CSD/393/2022/Va lidity Pe rio d Dt. 15/07 /2022 T o Dt. 31/12/2023 / 2912 Da te :01/07 /2022). GST N: 27 A A O CA 9055C1ZJ. I MP O R T ANT NO T I CE: T h e In sure d is n o t
in de mn ifie d if th e ve h icle is use d o r drive n o th e rwise th a n in a cco rda n ce with th is Sch e dule . A n y pa yme n t ma de by th e Co mpa n y by re a so n o f wide r te rms a ppe a rin g in
th e Ce rtifica te in o rde r to co mply with th e Mo to r Ve h icle s A ct, 1988 is re co ve ra ble fro m th e In sure d. Se e th e cla use h e a de d " A VO IDA NCE O F CERT A IN T ERMS A ND RIGHT
O F RECO VERY" in th e po licy wo rdin gs. Di s c l a i mer: T h e Po licy sh a ll be vo id fro m in ce ptio n if th e pre mium ch e que is n o t re a lize d. In th e e ve n t o f misre pre se n ta tio n , fra ud
o r n o n -disclo sure o f ma te ria l fa ct, th e Co mpa n y re se rve s th e righ t to ca n ce l th e Po licy. T h e po licy is issue d ba sis th e in fo rma tio n pro vide d by yo u, wh ich is a va ila ble
with th e co mpa n y. In ca se o f discre pa n cy/n o n re co rdin g o f re le va n t in fo rma tio n in th e po licy, th e in sure d is re que ste d to brin g th e sa me to th e n o tice o f th e co mpa n y
with in 15 da ys. T h is Po licy is to be re a d in co n jun ctio n with th e Po licy wo rdin gs (h ttps://www.a ck o .co m/do wn lo a d) a va ila ble o n th e we bsite o f th e Co mpa n y. O n re n e wa l,
th e be n e fits pro vide d un de r th e po licy a n d/o r te rms a n d co n ditio n s o f th e po licy in cludin g pre mium ra te ma y be subje ct to ch a n ge .

INTERMEDIARY DETAILS
Policy Issuing Office: Direct - Mumbai Intermediary Name: Direct
Phone Number: N/A Intermediary Code: N/A

Ack o General Ins urance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park , Goregaon (E), Mumbai- 4 00063
Email: hello@ack o.com | T oll Free: : 1800 266 2256 | www.ack o.com
Product: Private Car Pack age Policy | CIN : U66000MH2016PLC287385
IRDAI Reg No. 157 | HSN: 997134 | GST : 27AAOCA9055C1ZJ For ACKO General Insurance Ltd.
UIN: IRDAN157RP0001V01201718/IRDAN157RP0024 V01201819 Duly Constituted Attorney
Page 3 of 6
 RECEIPT

Received with thanks from ANN M OLIVER a sum of ₹ 5797.22 towards premium on Car Insurance Policy

INSURED DETAILS
Name of Insured: ANN M OLIVER
Address/Pincode: 560025
Period of Insurance: 19 Dec 22 00:00 hrs to 18 Dec 23 23:59 hrs
Policy Number: DCAR00717823853/00
Payment Date: 03 Dec 22

PREMIUM DETAILS (₹)

Gross Premium ₹4 912.90
IGST (18%) ₹ 884 .32

T otal Premium ₹5797.22

We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified
under sub-rule (4 ) of rule 4 8 of CGST Rules 2017, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

TERMS & CONDITIONS:

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.

Ack o General Ins urance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park , Goregaon (E), Mumbai- 4 00063
Email: hello@ack o.com | T oll Free: : 1800 266 2256 | www.ack o.com
CIN : U66000MH2016PLC287385 | IRDAI Reg No. 157 | HSN: 997134 | GST : 27AAOCA9055C1ZJ For ACKO General Insurance Ltd.
UIN: IRDAN157RP0001V01201718/IRDAN157RP0024 V01201819 Duly Constituted Attorney
Page 4 of 6
 PROPOSAL FORM

Dear ANN M OLIVER,

We wish to inform you that the Insurance policy number DCAR00717823853/00 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.
The vehicle shall be repaired at Acko's partner garages only. In case of any vehicle repaired outside the partner garages,
policyholders will have to bear the voluntary deductible of Rs. 5000/-. In case of a dispute the decision lies with Acko General
Insurance.
POLICY DETAILS PREVIOUS POLICY DETAILS
Policy Number: DCAR00717823853/00 Previous Policy Expired: Not Expired
Period of Insurance: 19 Dec 22 00:00 hrs to 18 Dec 23 23:59 hrs Previous Policy Insurer: Ack o General Insurance
Policy Issuance Date: 03 Dec 22 Previous Policy T ype: Pack age

CAR DETAILS CAR OWNER DETAILS

Car Number: KA01MP2984 Name: ANN M OLIVER
Mak e/Model: Hyundai i20 Email Address: aXXXXXXXXX5@gmail.com
Fuel T ype: petrol Mobile Number: XXXXXX0021
Registration Year: 2016 Pincode: 560025
Registration Month: Dec
Insured Declared Value (IDV): 4 39577
Accessories (IDV): 0.0

Ack o General Ins urance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park , Goregaon (E), Mumbai- 4 00063
Email: hello@ack o.com | T oll Free: 1800 266 2256 | www.ack o.com
CIN : U66000MH2016PLC287385 | IRDAI Reg No. 157 | HSN: 997134 | GST : 27AAOCA9055C1ZJ For ACKO General Insurance Ltd.
UIN: IRDAN157RP0001V01201718/IRDAN157RP0024 V01201819 Duly Constituted Attorney
Page 5 of 6
 PROPOSAL FORM
COVER DETAILS

Add-ons / Others Included Excluded

PA Cover -

Consumables -

Zero Depreciation -

Voluntary Deductible (₹ 5000*) -

T he policyholder will bear Rs. 5000 over and above the standard charges in the event of a claim not availed at Ack o partner garages

TERMS & CONDITIONS:

"I/We desire to insure with Ack o 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 undertak e 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 Ack o General Insurance Limited. I/We agree to the Company tak ing 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.

PROHIBITION OF REBATED (SECTION 41) OF THE 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 tak e out or renew or continue and insurance in respect
of any k ind 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 tak ing 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 mak ing default in complying with the provisions of this section shall be liable for a penalty which may extend to 10 lak h rupees.

Ack o General Ins urance Ltd.

Unit No. 301, 3rd Floor, F Wing, Lotus Corporate Park , Goregaon (E), Mumbai- 4 00063
Email: hello@ack o.com | T oll Free: 1800 266 2256 | www.ack o.com
CIN : U66000MH2016PLC287385 | IRDAI Reg No. 157 | HSN: 997134 | GST : 27AAOCA9055C1ZJ For ACKO General Insurance Ltd.
UIN: IRDAN157RP0001V01201718/IRDAN157RP0024 V01201819 Duly Constituted Attorney
Page 6 of 6