Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade,Sir Theyagaraya Road, T.Nagar.

April 25, 2023

.
Mr. AVNEESH KUMAR
E 228 GRD FLOOR,NEW ASHOK NAGA
Intermediary Code: BR500291
R,DELHI, Intermediary Name: Policybazaar Insurance
DELHI,
110096
Brokers Private Limited
Telephone :
Mobile : xxxxxx1285
Contact: 1800 208 8787
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
1 Year Two Wheeler Policy – Liability only
Policy Period: Period Of Insurance
Certificate of Insurance and Policy No.
VMPT306914000100 From 00:00:00 hours on 27/04/2023 To 23:59:59 hours on 26/04/2024
INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date
Mr. AVNEESH KUMAR 10/05/1979 India DELHI 09/05/2013
The Vehicle: any of the following (Two-wheeler shall be deemed to include a sidecar attached to it)
VEHICLE DETAILS
SPLENDOR PRO CAST ES -
Registration Number DL7SBQ6177 Model Description
2 SEATER
Engine Number HA10ELD9D06440 Type of Body SOLO
Chassis Number MBLHA10ASD9D03204 Cubic Capacity 98
Make of the Vehicle HERO HONDA Year of Manufacture 2013
Seating Capacity 2 Total Premium(in Rs.) 842.52
DRIVER: Any person including the Insured:• Provided that a person driving holds an
LIMITATIONS AS TO USE:The Policy covers use of the vehicle for any purpose
effective driving license at the time of the accident and is not disqualified from holding or
other than: a) Hire or Reward b) Tution c) Carriage of goods (other than samples or
obtaining such a license. • Provided also that the person holding an effective Learner’s
personal luggage) d) Organised racing e) Pace making f) Speed testing g) Reliability
License may also drive the vehicle and that such a person satisfies the requirements of
Trials h) Any purpose in connection with Motor Trade
Rule 3 of The Central Motor Vehicles Rules, 1989.
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 Rs.1,00,000Personal Accident cover for Owner - Driver under section III: CSI Rs. 15,00,000.00

Nominee Name : Nominee Age : Relationship with :

Guardian Name : Guardian Age : Guardian Relation :
LIABILITY
1. Basic premium including premium for TPPD 714.00
2. Less: TPPD restricted to statutory limit of Rs.6000/- (Endt. IMT. 20) 0.00
3. Bi-fuel kit (CNG/LPG) 0
Add:
4. PA to Paid Driver CSI Rs. (IMT 17)
0.00
Number of Persons-1
5. Geographical Area Extn.Endt.IMT-1 0.00
6. PA cover for Owner - Driver under Section III CSI Rs. 15,00,000.00 0.00
7. PA to Unnamed Passengers (IMT 16) 0.00
8. Enhanced PA for Unnamed Passengers, CSI Rs. 0 0.00
9. Enhanced PA for Owner Driver, CSI Rs. 0 0.00
10. Enhanced PA for Paid Driver, CSI Rs. 0 0.00
Legal Liability ADD: IGST
128.52
11. Legal Liability To Paid Driver (IMT 28) 0.00
12. Legal Liability To Employees (IMT 29) 0.00
TOTAL LIABILITY PREMIUM (B) 714.00 842.52
Subject to IMT Endt. Nos. & memorandum 22 (refer Terms & Conditions for relevant wording)
In Witness whereof this Policy has been signed at Chennai on in lieu of Cover note No. dated Receipt No. .Subject to IMT Endt. Nos & Memorandum . I/We hereby certify that the Policy to which this
Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X and Chapter XI of the Motor Vehicles Act, 1988.
Signature Not
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 Verified
by reason of wider terms appearing
in the 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"
Digitally signed by under Policy
Terms and Conditions. TAIKAD MAHADEVAN
SHYAMSUNDER
For Royal Sundaram General Insurance Co. Limited
Date: 2023.04.25
17:20:35 GMT+05:30
Reason: For
RoyalSundaram
Location: Chennai

Authorised Signatory
Consolidated Stamp Duty Paid to Govt of TamilNadu This document is digitally signed, hence counter signature / stamp is not required.
For Legal interpretation, English version will hold good. ServiceTaxNo: AABCR7106GST001 UIN: PAN Number : AABCR7106G

Document Code:
Fastag ID:
 GST Invoice
Royal Sundaram General Insurance Co. Limited
No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade
Sir Theyagaraya Road, T.Nagar,

GSTIN : 33AABCR7106G1ZQ

Policy Number : VMPT306914000100

GST Invoice Number : VMPT30691400000
Inception Date : 27/04/2023 12:00:00
Policy Posted Date : 25/04/2023 05:20:23

Address of insured:
E 228 GRD FLOOR,NEW ASHOK NAGA
R,DELHI,
DELHI
State:Delhi
Pincode: 110096

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable premium 714.00

Add: IGST 18% 128.52

Gross Premium 842.52

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.