Insured's Address Policy Issuing Office Address

Insured's Name: VIJAY PAL IFFCO TOKIO GEN INSU. CO. LTD., SCO 28,
Address: H.NO-9,DEVLAWAS, Second Floor, Sector 14, GURGAON, HARYANA
VILL-DEVLAWAS, PIN CODE:122001-INDIA
TECH-PATAUDI, Phone#:4108790
GURGAON, HARYANA - 122414 Agent#: 25001014
Tie-up Code 25001635
Phone#: Agent Name:KUMARI, ARCHANA
Agent Phone#:8527277079
MOTOR RENEWAL NOTICE General Insurance Services: 9971
GSTIN : 06AAACI7573H1ZG

Date: 22/07/2023
State Code: 06 State Name HARYANA GSTIN
Country: INDIA UIN

Subject: Notice for Renewal of Motor Insurance Policy no. MQ006670 valid till 27/07/2023 for Vehicle No. HR76G0582

Dear Valued Customer,

We thank you for choosing IFFCO TOKIO General Insurance for your Insurance needs. We wish to inform that your policy for captioned vehicle is falling due for
renewal. The details of vehicle are as under:-
Registration Year Of Type Of Engine No. Seating
Model/Type of Vehicle GVW
Mark & No. Manuf. Coverage K10BN8559461 Capacity
Stand Alone Chassis No.
HR76G0582 2021 MARUTI WAGON R LXI(O) CNG BSVI NA 5
OD MA3JMT31SMG526693
RENEWAL IDV Breakup:-
Premium Payable
Vehicle Trailer Non Elec. Acces. Elec. Acc. Bi-Fuel Kit Total IDV
(Inc Taxes)
440000.00 0.00 0.00 0.00 Y 440000.00 11482.41
A. Own Damage Additional Loading
B. Third Party
Universal Sompo
Own Damage Premium(A) 4212.05 T.P. Liability TP Inception Date: 07/28/2021 00:00:00
Ins.2367/64199220/00/
Premium(B) TP Expiry Date: 07/27/2024 23:59:59
000
C. Additional Coverage Premium 5517.80 Total Premium (A) +(B)+(C) 9730.85
NCB% 25.00 Net Premium(For Annual Policy) 11482.41
CGST SGST UTGST IGST CESS
Percentage 9.00 9.00
Amount 875.78 875.78 0.00 0.00
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Additional Value Auto Coverages:- 1.Depreciation Waiver, 2.Consumable, 3.Engine Gear Box Protection, 4.Loss of Key, 5.New Vehicle Replacement, 6.Towing
& Related,
Complimentary Road Side Assitance cover to ITGI customers:-
a. Policy issued In :-Delhi/NCR,Raj,Uttarakhand,Karnataka,Tamilnadu,Kerala,AndhraPradesh,Mumbai & ROM,Goa & Gujarat TOLL FREE :- 18002587775
b. Policy issued in :-Punjab,HP,Haryana,J&K,UP,Rajasthan,MP,Chhattisgarh,WB,Odisha,NorthEast,Jharkhand & Bihar TOLL FREE :- 18002676787

PLEASE NOTE:-
1. Above premium calculation is on Nil Claims in previous year; however in case claim is reported on or before expiry of policy no. MQ006670 , renewal premium will be Rs.
13139.15.
2. To ensure continuity of your policy, kindly renew before expiry date failing which an inspection of your vehicle will have to be done at the time of renewal and the inspection/survey fees
would have to be borne by the insured.
3. You are requested to remit renewal premium through Cheque/DD drawn in favor of "IFFCO-TOKIO General Insurance Co. Ltd" before the expiry of the policy to your agent or to above
mentioned policy issuing office directly.
4. The contract of Insurance is based on facts declared in proposal form. You are advised to inform any changes which have occurred since policy inception or last renewal date. Please also
retain copies of record supplied to company for renewal of policy.
5. Please visit our website www. iffcotokio.co.in or call toll free no 18001035499 to check company's complaint handling procedures.
6. Coverage is only for Own Damage and no other liability in connection with the vehicle shall be entertained under this policy

7. If the Vehicles is declared to be Obsolete by the manufacturer, New Vehicle Replacement coverage will Not be allowed for this policy.
Exclusion: Losses or damages caused directly or indirectly due to any infectious or contagious disease, pandemic /epidemics as declared by WHO and / or Government of India will be an
exclusion under this policy.
8. In case of any revision in Motor Third Party (TP) rates, the difference in premium due to the revised rates will be payable by the policyholder immediately, and if such revised premium is not
paid then the motor insurance policy will not be valid.

Thanking you for placing your trust and confidence in IFFCO TOKIO and assuring you of our best attention at all times.

Subrata Mondal
Authorized Signatory
(IFFCO-TOKIO General Insurance Co. Ltd)
-----------------------------------------------------------------------Tear this portion and attach with Cheque/DD----------------------------------------------------------
Insured Name: VIJAY PAL Policy Number: MQ006670 Renewal Premium Amt: ` 11482.41
Information Update Form: In the event you notice any mistake in personal contact or vehicle details, please fill in correct details in form below and send it to us with your Cheque/DD.You can
also update your information by visiting our website www.iffcotokio.co.in and register with us or simply email at support@iffcotokio.co.in
Customer Name :-____________________________________________________Vehicle Registration No.:-___________________________
Address:- ______________________________________________________________________City:- Pin:-____________

Phone # (Land-Line):- ________________________Mobile #:-____________________Email ID:-_____________________________________

Signature of the Policy Holder