DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149RP0006V02201213

TWO WHEELER VEHICLE THIRD PARTY PACKAGE VEHICLES POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office H728+PV3, BANERJEE BAJAJ BUILDING, GRAND TRUNK RD, BHIRINGI, WEST, DURGAPUR, WEST BENGAL 713203
Policy No P0023400006/4113/102388
Insured Mr SUKUMAR BAURI
Address S/O DILIP BAURI Period Of Insurance Agent 00:00 Hrs of 06/07/2022
MANIKARA AMLAJORA, To Midnight of 05/07/2027
MANIKARA,KANKSA, No.: AGD0003837
PASCHIM BURDWAN-71321 Agent Contact No.: Unregistered
WEST BENGAL
Contact Number Hypothecation with TVS CREDIT SERVICES LTD
Email ID: Unregistered
GST Number

INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION

Registration Mark & No. & Year of Public/Private SEATING
Maker Model Engine No. Chassis No. Body Type / Color CC/HP/GVW
RTA Location Manufacture Carrier CAPACITY
WB40AU7913 / SOLO WITH PILLION /
DURGAPORE / WEST BENGAL TVS MOTOR TVS STAR CITY 2022 MD625AK27N3F02715 8.08/109.7 2
CK2FN3601032 BLUE+SILVER
COMPANY LTD PLUS IDV (INSURED'S DECLARED VALUE)

Electrical/electronic
IDV of Vehicle Trailers Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
0 0 0 0 0/0 0 0
OWN DAMAGE(A) LIABILITY(B)
Basic - OD 479.00 Basic - TP 3,801.00
Trailers-IMT 48 331.00 Trailers - IMT-48 331.00
Sub Total 810.00 PA Owner Driver -SI Rs.65000 Tenure 1 Year(s) 214.00
Total Own Damage Premium(A) 810.00 Under WC act-Driver/cleaner/employees-IMT 28 50.00
Sub Total 4,396.00
Total Liability Premium(B) 4,396.00
Premium Computation
Total Package Premium(A+B) 5206.00
CGST @ 9% 468.54
SGST @ 9% 468.54
TOTAL 6,143.08
Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :
LIMITATIONS AS TO USE -The Policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor
Vehicle's Act 1988. Use only for agricultural and forestry purpose. The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing
a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle (only for Passenger Carrying Vehicles).
The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing a trailer except the towing (other than for reward) of any one
disabled Mechanically propelled vehicle (only for Passenger Carrying Vehicles).
Persons or classes of persons
Any person including Insured:
entitled to drive:
Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license.
Non-transport Vehicles Provided also that the person holding an effective learner's license may also drive the vehicle when not used for the transport of passengers at the time of the
LIMITS OF LIABILITY accident and that such a person satisfies the requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.

Under Compulsory excess in respect of each and every claim Under In respect of any one Under Damage to Third Party Property Rs. Under PA Owner – Driver as per
Section I under Sec I of motor policy : Rs. 2525/- Imposed : Rs. Section accident -- As per Section 750000/- in respect of any one claim Section III: premium computation
0/- II-I (i) Motor Vehicle Act II-I (ii) or series of claims arising out of one table
event.
SNuObjMecINt IM 7,IM 21,IMT 28,IM 48
AtoT IO.MN.TDEnTdAoIrLsSement T T T
Nos.

Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship Percentage
NA NA NA NA NA
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 M.V. Act, 1988.

Premium Amount in Word's ( ) :- Six Thousand One Hundred Forty Three Only
For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 266 3202

Date of Issue 06/07/2022

Place : Paschim Burdwan

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1661 FT, dated 06/07/2022
GST Number of MHDI - 37AAGCM1685C1ZI
GST Invoice Number - POL3711210004754
Accounting Code for Service - 997134, Motor vehicle insurance services
Authorised Signatory
Place of Supply:DURGAPORE WEST BENGAL ( 40 )

Whether Tax is payable on Reverse Charge - No

UIN : IRDAN149RP0006V02201213
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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For
legal interpretation English version will be good.

For Complete details of coverage , terms, conditions & exclusion please refer the standard policy wording attached with this schedule

IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.