https://

MA Go Digit General Insurance Ltd. Schedule/Receipt

Digit Two-Wheeler Liability Only Policy
UIN No.: IRDAN158RP0003V01201718

N Name PREMJI JERAMBHAI BHALSOD Vehicle Registration No. GJ10AF7359

Address Rameshwar nagar,Jamnagar,Jamnagar- Partner Name Girnar Insurance Brokers Private Ltd
361008 1000087
Partner Code

Mobile xxxxxxxxx4558 Partner Mobile No. 7551196989

Li
Email sxxxxxxxxx9@gxxxl.com Partner Email support@insurancedekho.com

er
Aadhar No. For Claims, contact us at 1800-258-5956
PB

el
he
W
YOUR POLICY DETAILS

o-
Policy No. D048843270 / 31102021 Policy Issue Date 31-Oct-2021 Invoice No. IA051621717

w
From 01-Nov-2021 23:03:20

tT
Period of Policy Policy Term 1 Year
To 31-Oct-2022 23:59:59

i
ig
1
From --

D
Period of Policy for PA Owner Driver Invoice 31-Oct-2021
To Date

1
--

-3
IGS YOUR VEHICLE DETAILS

10
RTO location Jamnagar,GUJARAT Make HERO MOTOCORP Model/Vehicle

-
PB

22
Variant (Sub- CD 100/DELUXE

20
Engine No. 06k29e41599 Chassis No. 06k29f40890 Type)
Body Type Motor Cycle Fuel Type Petrol Year of Regn 2006

0 1
Seating

1-
2
MAK Capacity Cubic Capacity 100 CC Year of Mfg. 2006

-1
G80
135.3
6

21
ENDORSEMENT

20
Invoice Number Invoice Date Gross Premium Igst Cgst 0Sgst Utgst Cess Net Premium
10
IA051569517 2021-10-31 887.36 135.36 0.00 0.00 0.00 0.00 752.00
CD

B
IA051621717 2021-11-01 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RP
CO

LIABILITY PREMIUM (`)

Basic Third-Party Liability (`) 752.00 PA cover for Owner-Driver (`) --
TO

M PA cover for 2 unamed passengers each 0 (`) -- PA cover for Paid Driver 0 (`) --
O

FH
Prim
M

IGS Legal Liability to Employees (`) -- Legal Liability to Paid Driver (`) --
e
O

Net Premium (`) 752.00

FH
ER

Brok IGST @ 18% = (`135.36) 135.36

H
9

MAKL
35

Final Premium (`) 887.36

F7
0A

OTHER DETAILS
J1

Previous Insurer -- Previous Policy No. --

G
D

Previous Policy
IMT - Endorsements -- --
O

N Expiry Date
LS

GSTIN/UIN No. Unregistered State Code 24

A

--
H

Receipt No. Receipt Date

IB

Te Financier Details -- Nominee Details --

A
BH
M

I do hereby confirm that the details provided for this endorsement are true and correct to the best of
RA

my knowledge. I understand that in the event of any discrepancy found later on in this regard, the
JE

Other Detials Company shall remain entitled to take appropriate action against me, including legal action.
JI

Following are the non-financial endorsements changes :

EM

LastName: JERAMBHAI BHALSOD

PR

http

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095.IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 29AACCO4128Q1ZW HSN: 997134/General Insurance Services, GSTIN Address: Bangalore Broker
Business Centre,Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block,Bengaluru,Karnataka,PIN-560095
https://

MA Go Digit General Insurance Ltd. Schedule/Receipt

Digit Two-Wheeler Liability Only Policy
UIN No.: IRDAN158RP0003V01201718

Geographical Area: Any liability incurred within India shall be covered subject to Policy Terms and Conditions, unless specifically agreed and
endorsed. Limitation as to use: The policy covers use of the vehicle for any purpose other than hire or reward, racing, pace making, reliability trial,
speed testing and use for any purpose in connection with the Motor Trade. Person or Class of persons entitled to drive: Any person including the
insured. 1) Provided that a person driving holds a valid effective driving license at the time of the accident and is not disqualified from holding or
obtaining such a license. 2) Provided also that the person holding a valid effective Learner’s License may also drive the vehicle and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989 and any subsequent amendment as applicable. Limits of
Liability: 1) 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

Li
Vehicles Act, 1988 and any subsequent amendment as applicable. 2) Under Section II - 1 (ii) of the policy: Damage to Third Party Property -

er
(`100000) 3) P.A. Cover for Owner Driver under Section III (CSI) -(`)(per annum).

el
he
W
PA Owner Driver Declaration:The Policy has been issued without Compulsory Personal Accident Cover to Owner Driver on the basis of

o-
your declaration that you do not hold a valid Driving License on or before the date of commencement of this Policy / already have an
alternate Personal Accident insurance cover of Rs. 15 Lakhs

w
tT
Important Note: Please inform the Company in case of change on account of addition of CNG/PNG kit.

i
ig
D
PUC Declaration:The Policy has been issued subject to valid Pollution Under Control (PUC) Certificate disclosed by you as an insured on or before

1
the date of commencement of the Policy .Cheque dishonor / Non-receipt of payment premium paid through Cheque, the policy is void ab-initio in

-3
case of dishonor of Cheque or non-receipt of payment. Violation of Motor Vehicle Act: This policy is issued in accordance with the provision of

10
Chapter X and Chapter XI of MV act, 1988 and any subsequent amendment as applicable. Any violation will forfeit all benefits and coverages
under the Policy. The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment

-
22
made by the Company by reason of wider terms appearing in Certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from

20
the insured. See the Clause headed (Avoidance Of Certain Terms And Right Of Recovery) in the policy. This policy is subject to the standard
policy wordings, warranties and conditions applicable for this product in addition to coverages and exclusions specified in the motor vehicle tariff

1
published by IRDAI. Policy would be void on the ground that it was obtained by non- disclosure of material fact or by a representation of fact

0
1-
Note: The terms and conditions detailed in this policy schedule as well as the policy document sent by Digit shall prevail in case of any dispute.

-1
21
For & On Behalf of Go Digit General Insurance Ltd.

20
In case of claim or any other query, please 0
10
contact our 24-hour C all C entre at 1800-
CD

258-5956 or email us at hello@godigit.com Praveen Bhat

Senior Vice President – Customer Experience
or visit our website www.godigit.com. praveen.bhat@godigit.com
Authorized Signatory
RP

Printed, Signed, and Executed at Bengaluru

Consolidated Stamp Duty has been paid as per Letter of
CO

Authorization No.67-B/04/2017-18 Date: 30th May 2017

issued by Department of Stamps and Registration ,
Bengaluru- 560009 - KARNATAKA.
TO

Hey, our document is now digitally signed

Click here to view the certificate.
O

For instant resolution, you can ping us “Hi”

M

on WhatsApp at 702 606 1234

O
ER
H
9
35
F7
0A
J1
G
D
O
LS
A
H
IB
A
BH
M
RA
JE
JI
EM
PR

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095.IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 29AACCO4128Q1ZW HSN: 997134/General Insurance Services, GSTIN Address: Bangalore Broker
Business Centre,Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block,Bengaluru,Karnataka,PIN-560095