Service Branch Address: 1st Floor Gang Tower, 11 Upper Chopasni Road,Near Arora Motor,Jodhpur -342001 (Rajasthan),Jodhpur,Rajasthan

May 27, 2023

Mr. SUJA RAM

S/O MANARAM, R/O CHOUDHARIYO
KA WA MIRGESAR, TEH- BALI PALI
PALI Your policy is due
RAJASTHAN, 306701 for renewal on
Telephone:
28/05/2024
Mobile: xxxxxx4534

Certificate of Insurance and Policy No. Policy Period:

VNCC072057000100 From 14:24:19 hours on 29/05/2023 To 23:59:59 hours on 28/05/2024

Dear Mr. SUJA RAM,

Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are delighted
to have you as our customer.

We are enclosing the Certificate of Insurance & Policy Schedule pertaining to the
insurance of your vehicle.

The Policy Schedule is an important document that you may be required to produce whilst
your vehicle is in use. We request you to verify the above documents and ensure everything
is in order. In case of any discrepancies, please contact us immediately.

To read the "policy" & "add on" terms, conditions, exceptions and applicable endorsement,
please log on to our website www.royalsundaram.in

Should you have any queries, please contact our Customer Service helpline number
1860-425-0000. You may also write to customer.services@royalsundaram.in

Assuring you of our best services at all times.

Yours sincerely,

Authorized Signatory

Note: To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in

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 Service Branch Address: 1st Floor Gang Tower, 11 Upper Chopasni Road,Near Arora Motor,Jodhpur -342001 (Rajasthan),Jodhpur,Rajasthan

MAY 27, 2023

Mr. SUJA RAM

S/O MANARAM, R/O CHOUDHARIYO Intermediary Code: BR501650
KA WA MIRGESAR, TEH- BALI PALI
PALI, RAJASTHAN
Intermediary Name: Invictus Insurance Broking Pvt Ltd
306701
Telephone :
Contact: 1800-266-0101
Mobile : xxxxxx4534

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy

Certificate of Insurance & Policy No. Policy Period: Period Of Insurance

VNCC072057000100 From 14:24:19 hours on 29/05/2023 To 23:59:59 hours on 28/05/2024

INSURED DETAILS
Name of Insured Insured Date of Birth Geographical Area Business/Profession Registration Authority Registration Date

Mr. SUJA RAM 15/11/1972 INDIA PALI 17/06/2014

INSURED'S DECLARED VALUE (IDV) (in Rs.)
Year For the Vehicle For Side-car Non Electrical Accessories Electrical/ Electronic Total IDV
Accessories

1st Year 26,671.00 0.00 0.00 0.00 26,671.00

The Vehicle: any of the following (Two-wheeler shall be deemed to include a sidecar attached to it)
VEHICLE DETAILS
Registration Number RJ-22-SV-3038 Type of Body STREET
Engine Number HA10EJEHC61696 Cubic Capacity 97
Chassis Number MBLHA10AMEHC37797 Year of Manufacturer 2014
Make of the Vehicle HERO MOTOCORP Seating Capacity 2
SPLENDOR PLUS DRUM 100 MILLION Total Premium (in Rs.)
Model Description EDITION BSVI - 2 SEATER
1,157.58

LIMITATIONS AS TO USE: DRIVER:

The Policy covers use of the vehicle for any purpose other than: Any person including the Insured
a) Hire or Reward • Provided that a person driving holds a valid Driving Licence at the time of the
b) Tution accident and is not disqualified from holding or obtaining such a Licence.
c) Carriage of goods (other than samples or personal luggage) • Provided also that the person holding an effective Learner’s Licence may also
d) Organized racing drive the vehicle and that such a person satisfies the requirements of Rule 3 of
e) Pace making The Central Motor Vehicles Rules, 1989.
f) Speed testing
g) Reliability Trials
h) Any purpose in connection with Motor Trade

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.1,00,000/--
Personal Accident cover for Owner - Driver under section III: CSI Rs. 15,00,000.00

Deductible under Section I: Rs.100 in respect of each and every claim.(Compulsory Deductible[100.00], Voluntary Deductible[0.00] and Imposed Deductible[Rs.0]) /- in respect of each and
every claim.

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 CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy

Policy No. VNCC072057000100

A - OWN DAMAGE Premium B - LIABILITY Premium

in Rs. in Rs.
Basic premium on Vehicle and Accessories Basic premium including premium for TPPD
1. Vehicle 267.00 1. Vehicle 714.00
2. Less: TPPD restricted to statutory limit of Rs.6000/- (Endt.
2. Accessories: 0.00 IMT. 20) 0.00
3. Electrical & Electronic @ 4% (Endt. IMT. 24) 0.00
ADD: ADD:
4. Loading for Imported Vehicle 0.00 3. Legal Liability To Paid Driver (IMT 28) 0.00
5. Geographical Area Extn.Endt.IMT-1 0.00 4. Geographical Area Extn.Endt.IMT-1 0.00
5. PA to Paid Driver (IMT 17)
6. Fibre Glass Tanks 0.00 Number of Persons-1 0.00
7. Non Electrical Accessories 0.00 6. Legal Liability To Employees (IMT 29) 0.00
7. PA cover for Owner - Driver under Section III (CSI) Rs.
8. Driver Tution fees 0.00 15,00,000.00* 0.00
9. Rally Cover 0.00 8. PA to Unnamed Passengers (IMT 16) 0.00
10. Addtional Towing Charges 0.00
LESS:
11. Side Car Discount 0.00
12. Discount for Anti-theft devices (IMT 10) 0.00
13. 50% Discount for Vehicles designed/modifed for physically/
mentally challenged persons. 0.00
14. Voluntary Deductible amount for Rs. 0.00 0.00
15. Automobile Association Discount (IMT 8) 0.00
16. Deduct 0% for NCB 0.00 9. TOTAL LIABILITYPREMIUM (B) 714.00
17. ADD: 0% for Underwriter Loading 0 10. ADD: Underwriter Loading % 0.00
Add: Additional Cover for Package Policies 11. NET PREMIUM (A+B) 981.00
18. Depreciation Waiver Clause (IRDAN102A0012V01202021) 0.00
19. Engine Protector Cover 0.00
20. Return to Invoice Cover
(IRDAN102A0015V01202223) 0.00
21. RoadSideAssistance Cover (IRDAN102A0008V01202223) 0.00

12. Add: SGST 88.29

13. Add: CGST 88.29

22. TOTAL OWN DAMAGE PREMIUM (A) 267.00 14. TOTAL PREMIUM PAYABLE 1,157.58
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous year. b) The insured is entitled for a No
Claim Bonus (NCB) on the Own Damage Section of the policy, if no claim is made or pending during the preceding year(s), as per the details given below:
Period of Insurance % of NCB on Subject to I.M.T. Endt. Nos & Memorandum 22 (refer Terms & Conditions for relevant wording)
OD Premium
The preceding year 20 Nominee Name Nominee Age Relationship with

Preceding two consecutive years 25 Guardian Name Guardian Age Guardian Relation

Preceding three consecutive years 35

Preceding four consecutive years 45 Date & Signature of Proposal/Renewal notice: 27/05/2023

Preceding five consecutive years 50

Signature Not
Verified
In Witness whereof this Policy has been signed at Chennai on 29/05/2023 in lieu of Cover note No. dated Receipt No. IMC1641611.Digitally I/We hereby
signed bycertify that
the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of ChapterTAIKAD
X and MAHADEVAN
Chapter XI of the
SHYAMSUNDER
Motor Vehicles Act, 1988. Date: 2023.05.27
14:24:23 GMT+05:30
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 by reason ofReason: Forappearing in the
wider terms
RoyalSundaram
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 RIGHT OF RECOVERY” underChennai
Location: Policy Terms and
Conditions.
For Royal Sundaram General Insurance Co. Limited
Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty Paid to Govt. of Tamil Nadu
GSTIN: 08AABCR7106G1ZJ UIN - IRDAN102RP0001V01200607 PAN Number: AABCR7106G

For Legal interpretation, English version will hold good.

c32e1a83eadb91e1284409b8953800e5
 GST Invoice

Royal Sundaram General Insurance Co. Limited

1st Floor Gang Tower, 11 Upper Chopasni Road
Near Arora Motor
Jodhpur -342001 (Rajasthan)
GSTIN : 08AABCR7106G1ZJ

Policy number : VNCC072057000100

Invoice number : VNCC07205700000
Inception Date : 29/05/2023 12:00:00
Policy Posted Date : 27/05/2023 02:24:19

Address of Insured :

S/O MANARAM, R/O CHOUDHARIYO

KA WA MIRGESAR, TEH- BALI PALI
PALI
State : Rajasthan
Pincode : 306701

Accounting code of service : 997134

Description of service : Motor vehicle insurance services

Taxable premium 981.00

Add: SGST 9% 88.29

Add: CGST 9% 88.29

Gross premium 1,157.58

Indication if tax payable under reverse charge - No

"I/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 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.":’
Note: This document is digitally signed, hence counter signature / stamp is not required.