Aut o Se cure - Liabilit y Only Po licy

N ame : M r M AN OH AR LAL | +91 98 96006715 | F I N H UBH I SAR @GM AI L.COM Val i d fr om Val i d ti l l
Addr e ss: 5917 , BH UN A,, F ate h abad -125111,
F ATE H ABAD - 125111, TP Cove r Pe r i od 27 Jan '24(00:00 H r s) 26 Jan '25(M i dn i gh t)
H AR YAN A
P re mium Amount : ₹ 2,54 2

De ar M r M AN OH AR LAL
We l come to Tata AI G Ge n e r al I n su r an ce Compan y Li mi te d fami l y & we th an k you for ch oosi n g ou r pol i cy for you r motor ve h i cl e i n su r an ce . You r Pol i cy N o.
6 2 0 2 4 7 5 6 5 5 h as be e n i ssu e d base d on th e i n for mati on an d de cl ar ati on pr ovi de d by you . You ar e r e qu e ste d to vi si t ou r we bsi te www. tataaig. co m for fu l l
pol i cy wor di n gs

Ce r t if icat e o f Insur ance and Po licy Sche dule Fo r m 51 o f t he Ce nt r al Mo t o r Ve hicle Rule s, 1 98 9

P olic y D e t ails Ve hic le D e t ails

Pol i cy N o & Ce r ti fi cate N o : 6202475655 00 00 R e gi str ati on n o : H R 26 AH 5547

I n su r e d N ame : M r M AN OH AR LAL R e gi str ati on Au th or i ty : GUR GAON H R 26

Addr e ss : 5917 , BH UN A,, F ate h abad -125111, F ATE H ABAD - 125111, M ake /M ode l : H YUN DAI / SAN TR O
H AR YAN A,
Var i an t : GS
I N DI A
F u e l Type : PE TR OL
TP cove r pe r i od : 27 Jan '24(00:00 H r s) to 26 Jan '25(M i dn i gh t)
E n gi n e N u mbe r /Batte r y N u mbe r : G4H G6M 960017 /
Pol i cy I ssu an ce Date : 26 Jan '24
Ch assi s n u mbe r : M ALAA51H R 6M 970122
Cu stome r / Le ssor GSTI N : N A
E n gi n e /Batte r y Capaci ty (CC/ K W) : 999
Cu stome r I D : N A
Se ati n g Capaci ty (i n cl u di n g dr i ve r ) : 5
Cu stome r con tact n u mbe r : 98 96006715
M fg Ye ar : 2006
Pr oposal N o : PR /24/6200224556
Date of R e gi str ati on : 17/01/2007
Cove r n ote n o / I ssu an ce date : N A
Body Type : H ATCH BACK
Al te r n ate Pol i cy N o : N A
Tr ai l e r R e gn N o. / Ch assi s N o. : N A

H P/H YP/Le ase : N A

Zon e : B

Ge ogr aph i cal Ar e a : I n di a

Schedule o f Premium

Sectio n II Liability (B)

Third Party Pre m ium

Basi c TP pr e mi u m ₹ 2,094.00

Add: CN G / LPG ki t TP (I M T 25) ₹ 60.00

PA Be n e fi ts
Total Li abi l i ty Pr e mi u m (B) ₹ 2,154.00

N e t Pr e mi u m (B) ₹ 2,154.00

I GST@18 % ₹ 38 8 .00

T ot al P olic y P re mium ₹ 2542.00

 Aut o Se cure - Liabilit y Only Po licy

Agent Contact Number : 8930003981 (or

Agent Name : SANDEEP Agent License code : POSPBSMPK5656H
Landline)

POSP De tai l s :N ame -N A Code -N A PAN N o -BSM PK 5656H Aadh ar car d -N A Con tact N o -N A

D rive rs Claus e : Pe r son s or cl asse s of pe r son s e n ti tl e d to dr i ve : An y pe r son i n cl u di n g th e i n su r e d. Pr ovi de d th at a pe r son dr i vi n g h ol ds an e ffe cti ve dr i vi n g
l i ce n se at th e ti me of th e acci de n t an d i s n ot di squ al i fi e d fr om h ol di n g or obtai n i n g su ch a l i ce n se . Pr ovi de d al so th at th e pe r son h ol di n g an e ffe cti ve
Le ar n e r 's Li ce n se may al so dr i ve th e ve h i cl e an d th at su ch a pe r son sati sfi e s th e r e qu i r e me n ts of R u l e 3 of th e Ce n tr al M otor Ve h i cl e s R u l e s, 198 9.
Limitatio ns as to us e : Th e Pol i cy cove r s u se of th e ve h i cl e for an y pu r pose oth e r th an : a) H i r e or R e war d oth e r th an for th e pu r pose of dr i vi n g tu i ti on s b)
Car r i age of goods (oth e r th an sampl e s or pe r son al l u ggage ) c) Or gan i z e d r aci n g d) Pace M aki n g e ) Spe e d te sti n g f) R e l i abi l i ty Tr i al s g) An y pu r pose i n
con n e cti on wi th M otor Tr ade
Warrante d that th e i n su r e d n ame d h e r e i n /own e r of th e ve h i cl e h ol ds a val i d Pol l u ti on Un de r Con tr ol (PUC) Ce r ti fi cate , as appl i cabl e , on th e date of
comme n ce me n t of th e Pol i cy an d u n de r take s to r e n e w an d mai n tai n a val i d an d e ffe cti ve PUC an d/or fi tn e ss Ce r ti fi tate , as appl i cabl e , du r i n g th e
su bsi ste n ce of th e Pol i cy.
Limits o f Liability Un de r Se cti on I -1 (i ) of pol i cy (De ath of or bodi l y i n j u r y) : Su ch amou n t as i s n e ce ssar y to me e t th e r e qu i r e me n ts of th e M otor Ve h i cl e s Act,
198 8
Unde r S e ctio n I- 1 (ii) of pol i cy (Th i r d Par ty Pr ope r ty Damage ) :₹ 7,50,000
N o mine e de tails :
N ame o f the N o mine e : N A N omi n e e Age : N A R e l ati on sh i p of th e N omi n e e wi th th e I n su r e d : N A

Su bj e ct to: (A) I M T E n dor se me n t N o. : 25,32,22 GSTI N :07AABCT3518 Q1ZY-H AR YAN A Se r vi ce Accou n ti n g Code : 997134
TATA AI G Au to Se cu r e e n dor se me n t N o. (TA): 08

F or & On Be h al f of T ata AIG G e ne ral Ins urance Co mpany Ltd.

I /We h e r e by ce r ti fy th at th e Pol i cy to wh i ch th i s Ce r ti fi cate r e l ate s as we l l as th i s
Ce r ti fi cate of I n su r an ce ar e i ssu e d i n accor dan ce wi th pr ovi si on s of Ch apte r X an d XI of
M otor Ve h i cl e s Act, 198 8 . I n wi tn e ss wh e r e of th i s Pol i cy h as be e n si gn e d at M u mbai on :
R e ce i pt (s) : PD300005939177 26/01/2024

Con sol i date d Stamp Du ty h as be e n pai d to th e State E xch e qu e r

Pol i cy N u mbe r : 6202475655/00/00 • GSTN N u mbe r : 07AABCT3518 Q1ZY Au th or i z e d Si gn ator y

P o licy S e rvicing Of f ice : DE LH I - N E W F R I E N DS COLON Y, 22, 2N D F LOOR , COM M UN I TY CE N TE R ,, N E W F R I E N DS COLON Y, N E W DE LH I , DE LH I - N E W F R I E N DS COLON Y 110065
Te l . N o : 740001048 5

Impo rtant No tice

Th e I n su r e d i s n ot i n de mn i fi e d i f th e ve h i cl e i s u se d or dr i ve n oth e r wi se th an i n accor dan ce wi th th i s Sch e du l e . An y payme n t made by th e Compan y by
r e ason of wi de r te r ms appe ar i n g i n th e Ce r ti fi cate i n or de r to compl y wi th th e M otor Ve h i cl e s Act, 198 8 i s r e cove r abl e fr om th e I n su r e d. Se e th e cl au se
h e ade d “AVOI DAN CE OF CE R TAI N TE R M S AN D R I GH T OF R E COVE R Y”.
N o te : You ar e advi se d to go th r ou gh th e pol i cy sch e du l e cu m ce r ti fi cate of i n su r an ce wh i ch i s i ssu e d base d on i n for mati on an d de cl ar ati on pr ovi de d by you .
Tr an scr i pt of I n for mati on & De cl ar ati on i s al so pr ovi de d h e r e wi th to e n abl e you to go th r ou gh th e same agai n an d i f an y e r r or / di scr e pan cy i s fou n d i n
r e spe ct of ve h i cl e de tai l s, N o Cl ai m Bon u s or an y oth e r i n for mati on pr ovi de d by you , i t sh ou l d be br ou gh t to ou r n oti ce wi th i n 15 days of r e ce i pt of th i s pol i cy for
n e ce ssar y cor r e cti on al on g wi th th e su ppor ti n g docu me n ts, oth e r wi se i t wi l l be de e me d to be cor r e ct. You may vi si t th e compan y we bsi te at www.tataai g.com
for de tai l e d be n e fi ts, te r ms & con di ti on s an d e xcl u si on s of th e pol i cy i ssu e d an d h e l d by you . You may al so r e ach u s at ou r 24*7 h e l pl i n e 18 00 266 778 0 i n case
you de si r e to h ave a pr i n te d copy of pol i cy wor di n g. Ou r gr i e van ce r e dr e ssal pr oce du r e an d de tai l s abou t ombu dsman ar e avai l abl e at th e compan y
we bsi te www.tataai g.com. You may al so r e ach u s at ou r 24*7 h e l pl i n e 18 00 266 778 0 for gr i e van ce r e dr e ssal pr oce du r e an d de tai l s abou t ombu dsman . Pl e ase
n ote th at an y mi s-r e pr e se n tati on , fr au d, n on -di scl osu r e of mate r i al facts or n on -coope r ati on of th e i n su r e d wi l l l e ad to can ce l l ati on of pol i cy ab i n i ti o wi th
for fe i tu r e of pr e mi u m an d n on con si de r ati on of cl ai m, i f an y. We wi l l spe ci fi cal l y se e k con fi r mati on on N o Cl ai m Bon u s avai l e d by you fr om you r pr e vi ou s
i n su r e r . I n case we r e ce i ve con fi r mati on th at you h ad l odge d cl ai m wi th th e m th e n we wi l l i n ti mate you to pay th e N o cl ai m Bon u s Amou n t wi th i n 20 days. I n
case we don ’t r e ce i ve th e N o Cl ai m Bon u s r e cove r y th e n i t wi l l be adj u ste d agai n st cl ai m amou n t payabl e to you i f an y. Th i s Sch e du l e , Pol i cy te r ms an d
con di ti on s avai l abl e on th e compan y we bsi te an d E n dor se me n ts me n ti on e d h e r e i n above sh al l be r e ad toge th e r an d an y wor d or e xpr e ssi on to wh i ch a
spe ci fi c me an i n g h as be e n attach e d to/i n an y par t of th i s Pol i cy or of th e Sch e du l e sh al l be ar th e same me an i n g wh e r e ve r i t may appe ar . An y
ame n dme n ts/modi fi cati on s/al te r ati on s made on th i s syste m ge n e r ate d pol i cy docu me n t i s n ot val i d an d th e Compan y sh al l n ot be l i abl e for an y l i abi l i ty
wh atsoe ve r ar i si n g fr om su ch ch an ge s u n l e ss wr i tte n r e qu e st i s made to th e Compan y an d th e Compan y acce pts th e r e qu e ste d
ame n dme n ts/modi fi cati on s/al te r ati on s an d r e cor ds th e same th r ou gh se par ate e n dor se me n t.

Receipt
R e ce i pt N o.: PD300005939177 R e ce i pt Date : 26/01/2024 Pol i cy N o.: 6202475655 00 00

Uti l i z e d fr om th e r e ce i pt
Sr . N o. Pol i cy N u mbe r M ode of Payme n t Total Pr e mi u m (₹ ) Bal an ce (₹ )
for pol i cy (₹ )

1 6202475655 00 00 payme n tLi n kCu stome r 2542.00 2542.00 0.00

Paye r N ame : MAN OH AR LAL

N o te :
1. Th i s i s a compu te r ge n e r ate d r e ce i pt an d doe s n ot r e qu i r e a si gn atu r e .
2. Upon i ssu an ce of th i s R e ce i pt, al l pr e vi ou sl y i ssu e d te mpor ar y r e ce i pts, i f an y, r e l ate d to th i s Pol i cy sh al l be con si de r e d n u l l an d voi d.
3. Amou n ts r e ce i ve d by ch e qu e sh al l be su bj e ct to r e al i sati on .
4. An y amou n t r e ce i ve d i n e xce ss of th e Pr e mi u m i s be i n g/sh al l be r e fu n de d by th e Compan y.

G S T IN : 0 7 AABCT 35 18 Q1Z Y H AR YAN A S e rvice Acco unting Co de : 9 9 7 134

R e ve n u e (con sol i date d) Stamp Du ty du l y pai d vi de ch al l an N o.N A date N A for appl i cabl e case s.
I ssu an ce of th i s r e ce i pt doe s n ot amou n t acce ptan ce of th e r i sk by Tata AI G Ge n e r al I n su r an ce Compan y Li mi te d. Th e i n su r an ce cove r for th e r i sk sh al l
be as pe r th e te r ms an d` con di ti on s of th e i n su r an ce pol i cy i f an d wh e n i ssu e d.
 Aut o Se cure - Liabilit y Only Po licy

T r anscr ipt o f Inf o r mat io n/De clar at io n

Insure d and Ve hicle De tails

1. N ame (R e gi ste r e d Own e r of th e M otor Ve h i cl e )* : Mr MAN OH AR LAL

2. Ve h i cl e De tai l s: H YUN D AI / S AN T R O/ G S / H AT CH BACK
3. Addr e ss for Commu n i cati on * : 5 9 17 , BH UN A, , Fate habad - 12 5 111, FAT EH ABAD - 12 5 111, H AR YAN A, IN D IA.
4. Ve h i cl e Type : H AT CH BACK
5. F u e l Type : P ET R OL
6. I n su r e d’s De cl ar e d Val u e : ₹ 0
7. Date of R e gi str ati on : 17 /0 1/2 0 0 7
8 . Pr opose d Pe r i od of I n su r an ce
TP cove r pe r i od: 2 7 Jan ' 2 4 (0 0 :0 0 H rs ) to 2 6 Jan ' 2 5 (Midnight)

Pre vious Insurance De tails

1. Pol i cy N u mbe r : N A
2. Date of e xpi r y: 0 1/0 1/19 0 0
3. Type of cove r : N A
4. N ame & addr e ss i f th e I n su r e r : N A, N A
5. Cl ai m i n Pr e vi ou s Pol i cy Pe r i od: N O
6. Pe r i od of i n su r an ce
OD cove r pe r i od: N A(0 0 :0 0 H rs ) to N A(Midnight)
TP cove r pe r i od: N A(0 0 :0 0 H rs ) to N A(Midnight)

Nom ine e De tails

1. N ame of N omi n e e : N A
2. Age of N omi n e e : N A
3. R e l ati on sh i p: N A
4. N ame of Appoi n te e (i f N omi n e e i s mi n or ): N A

I h e r e by gi ve my con se n t to r e ce i ve on e page i n su r an ce pol i cy.

AML Guide line s :
I /We h e r e by con fi r m th at al l pr e mi u ms pai d / payabl e i n fu tu r e wi l l be fr om bon afi de sou r ce s an d n ot pai d ou t of pr oce e ds of cr i me an d th at su ch
pr e mi u ms ar e n ot di spr opor ti on ate to my/ou r i n come . I / we u n de r stan d th at th e Compan y h as th e r i gh t to cal l for docu me n ts to e stabl i sh sou r ce s of
fu n ds an d to can ce l th e i n su r an ce pol i cy i n case I / we ar e fou n d gu i l ty by an y compe te n t cou r t of l aw u n de r an y of th e statu te s, di r e ctl y or i n di r e ctl y
gove r n i n g th e pr e ve n ti on of mon e y l au n de r i n g l aw i n I n di a.
I /We ar e n ot Pol i ti cal l y E xpose d Pe r son s * n or ar e th e i r cl ose r e l ati ve s / fami l y me mbe r s / associ ate s. I / we sh al l ke e p th e compan y i n for me d i f we
su bse qu e n tl y be come a Pol i ti cal l y E xpose d Pe r son / cl ose r e l ati ve / fami l y me mbe r / associ ate of Pol i ti cal l y E xpose d Pe r son s.
“Pol i ti cal l y E xpose d Pe r son s” sh al l h ave th e me an i n g assi gn e d to i t u n de r Pr e ve n ti on of M on e y-Lau n de r i n g (M ai n te n an ce of R e cor ds) Ame n dme n t R u l e s,
2023 as ame n de d fr om ti me to ti me .

Disclaimer : Insurance is the subject matter of solicitation. For more details on benefits, ex clusions, limitations, terms & conditions, please refer sales brochure/ policy wordings on www.tataaig.com carefully, before concluding a sale. Purchase of Tata
AIG General Insurance Company Limited products are purely on voluntary basis.
Prohibition of R ebates - S ection 41 of Insurance Act, 1938 as amended by Insurance Laws I Amendment) Act, 2015. 1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an
insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy
accept any rebate, ex cept such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer. 2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may
ex tend to ten lakh rupees.
Grievance R edressal Procedure : As per Regulation 17 of IRDA of India (Protection of Policyholders Interests) Regulation, 2017.
S ection 6 4 VB of the Insurance Act 19 38 : Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.
Auto S ecure - Liability Only Policy - UIN : IRDAN108 RP0008 V01200001
Tata AIG General Insurance Company Limited
Registered Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013.Maharashtra, India • 24X7 Toll Free No : 18 00 266 778 0 • Email : customersupport@tataaig.com • website : www.tataaig.com • IRDA of India
Registration No: 108 • CIN: U8 5110MH2000PLC128 425
TAGIC/PS /MRPC/Jan 22/06 Ver1 /All 2536