Service Branch Address: SCO 82, I & II Floor, ,Sector 40-C, Chandigarh 160 040,Chandigarh 160 040,Chandigarh Branch,Chandigarh

Mr. JAGIR SINGH

BATALA Intermediary Code: BR501650
GURDASPUR PUNJ AB 143506 Intermediary Name: Invictus Insurance Broking
PATIALA, PUNJAB
143506 Pvt Ltd
Telephone : Contact: 1800-266-0101
Mobile : xxxxxx4590

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Policy – Liability only
Policy Period:Period of insurance
Certificate of Insurance and Policy No.
VPTP443096000100
From 18:48:48 hours on 27/11/2023 To 23:59:59 hours on 26/11/2024
INSURED DETAILS
Name of Insured Geographical Registration
Business/Profession Registration Date
Area Authority
Mr. JAGIR SINGH INDIA PATIALA 01/12/2015
VEHICLE DETAILS
Registration Number PB-11-BU-6812 Model Description INNOVA 2.5 E - 7 SEATER Gross Vehicle Weight(Kgs) 0
Engine Number 2KDS607570 Type of Body MPV Seating Capacity (including Driver) 7
Chassis Number MBJ11JV4007559882 Cubic Capacity 2494
TOYOTA KIRLOSKAR
Make of the Vehicle Year of Manufacture 2015 Total Premium (in Rs.) 9,719.66
MOTOR LTD.
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) Carriage of goods (other than samples or personal
obtaining such a license. • Provided also that the person holding an effective Learner’s
luggage) c) Organised racing d) Pace making e) Speed testing f) Reliability Trials g) Any
License may also drive the vehicle and that such a person satisfies the requirements of
purpose in connection with Motor Trade.
Rule 3 of The Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY:
Under Section I-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 I-1 (ii) of the
Policy -Damage to Third Party Property - Rs Rs.7,50,000-In respect of any one claim or series of claims arising out of one event/-
Nominee Name : JARNAIL SINGH Nominee Age : 23 Relationship with : SON
Guardian Name : Guardian Age : Guardian Relation :
LIABILITY
1. Basic premium including premium for TPPD 7,897.00
2. Less: For restricted TPPD cover for Rs.6000/- (IMT 20) 0.00
3. Trailers (IMT30) 0.00
4. Bi-fuel kit (CNG) 0.00
Add:Personal Accident Benefits
5. Under Section III (Owner Driver), CSI Rs. 15,00,000.00 315.00
6. Named Passengers, CSI Rs.0 each as per list attached (IMT 15) 0.00
7. Unnamed Passengers, CSI Rs.0.00 0.00
8. Geographical Area Extn.Endt.IMT-1 0.00
9. P.A Cover to Paid Driver, CSI Rs.50,000.00 (IMT 17)
25.00
Number of Persons-1
ADD:Legal Liability ADD: IGST 1,482.66
10.To Paid Driver (IMT 28) 0.00
11.To Employees (IMT 29) 0.00
TOTAL LIABILITY PREMIUM 8,237.00 TOTAL PREMIUM 9,719.66
Subject to IMT Endt. Nos. & memorandum 17,22 (refer Terms & Conditions for relevant wording)
In Witness whereof this Policy has been signed at Chennai on 27/11/2023 in lieu of Cover note No. IMC1823509 dated . 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.
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 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" under Policy
Terms and Conditions.
Signature Not
For Royal Sundaram General Insurance Co. Limited
Verified
Digitally signed by
TAIKAD MAHADEVAN
Authorised Signatory
*
CPA cover for owner driver will expire on 26/11/2024 SHYAMSUNDER
Date: 2023.11.25
Consolidated Stamp Duty Paid to Govt of TamilNadu This document is digitally signed, hence counter18:49:52
signatureGMT+05:30
/ stamp is not required.
Reason: For
For Legal interpretation, English version will hold good. GSTIN: 04AABCR7106G1ZR UIN: IRDAN102P0004V02201617 PAN Number: AABCR7106G
RoyalSundaram
Location: Chennai
a178c98304756017774ab30934bc4305

Document Code:
Fastag ID:
 GST Invoice
Royal Sundaram General Insurance Co. Limited
SCO 82, I & II Floor,
Sector 40-C, Chandigarh 160 040
Chandigarh 160 040
GSTIN: 04AABCR7106G1ZR

Policy Number : VPTP443096000100

GST Invoice Number : VPTP44309600000
Inception Date : 27/11/2023
Policy Posted Date : 25/11/2023 18:48:48

Address of insured (Interstate):

BATALA
GURDASPUR PUNJ AB 143506
GURDASPUR
State:PUNJAB
Pincode: 143506

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable premium 8,237.00

IGST 18 % 1,482.66

Gross premium 9,719.66

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 the 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”

Dear Customer, Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are delighted to have you as our
customer. Please find enclosed Private Car Policy No. VPTP443096000100 which has been issued based on the details submitted to
us by the Insurance Broker - Invictus Insurance Broking Pvt Ltd. A copy of the risk details submitted by the Insurance Broker is also
enclosed herewith for your records.