Welcome to Tata Motors Insurance Broking And Advisory Services Ltd.!

MR. AMIT KHATTAK

P-14/1, NASHIK ROAD DEOLALI CANTONMENT, , NASHIK , MAHARASHTRA-422401

Proposal No. : PPVBU14901186

Dear Customer,

Thank you for choosing Tata Motors Insurance Broking And Advisory Services Ltd (TMIBASL) as your preferred Insurance broking and
advisory partner!

TMIBASL focusses its expertise & efforts to effectively deliver innovative products and services to suit customer͛s needs. We bring
you years of professional experience, expertise, strong product knowledge and wide range of insurance products from leading
insurance companies to suit your requirements.

As a Composite Broker, we are well positioned to help both our retail and corporate customers to select the best insurance plans
offered by various General, Health and Life Insurance companies for all lines of products including Motor, Health, Property, Marine,
Reinsurance, Cyber, etc.

We provide end-to-end timely assistance in claim settlement so that our clients get their rightful claim at the right time.

We request you to kindly go through the contents and terms and conditions mentioned in the proposal form and policy schedule.
Details furnished basis which the policy has been issued is attached herewith for your kind perusal. We urge you to review the
information and revert to us in case of any discrepancies within 15 days, failing which it is deemed that the information mentioned
is correct and complete. You may please further note that failure to provide material information or withholding any material
facts/information and declarations or providing wrong information would make the Policy Void ab initio and in such case no claim
will be considered by the insurer, if any apart from forfeiture of the premium as per policy terms and conditions.

We assure you the best of our services and look forward to serve you in the near future for all your insurance cover needs.

Thanking you,

For Tata Motors Insurance Broking And Advisory Services Limited

Authorized Signatory

In case of any claim or assistance required please contact our help line at - 1800 209 0060 or email us at
support@tmibasl.com or visit our website - https://www.tatamotorsinsurancebrokers.com
Dear MR. AMIT KHATTAK ,

We wish to inform you that the contract under policy number '3001/TMP-100150950/00/000' has been finalized based on the
proposal / information and declaration given by you, the transcript whereof is mentioned below. You are requested to verify the
same. In case of any disagreement or objection or any changes with respect to information mentioned below, we request you to
please revert back within a period of 15 days from date of your receipt of this transcript along with Policy failing which it will be
deemed that you have positively confirmed/ are satisfied with the correctness of the details mentioned below. Kindly note that
as the contents and declarations contained in this transcript is the basis on which the policy have been issued to you, we advise
you to please ensure that you have provided/disclosed and or not withheld any material facts/information and declarations, as
Policy becomes Void ab initio if material facts are not provided/disclosed and or withheld and and in such case no claim will be
considered by the insurer, if any apart from forfeiture of the premium as per policy terms and conditions.

Details provided by you :

A. Proposer details
Proposer Type Individual
Proposer Name MR. AMIT KHATTAK
Proposer Address P-14/1, NASHIK ROAD DEOLALI CANTONMENT, , NASHIK , MAHARASHTRA-422401
Proposer Mobile Number 8131006641
Proposer Residential Number NA
Proposer e-mail id captkhat@rediffmail.com
Occupation
Proposer GSTIN

B. Vehicle Details
Registration Number Month / Year of Vehicle Make Vehicle Model Vehicle Variant
Regn
TATA MOTORS TATA SAFARI SAFARI XT+ BS 6
Cubic Capacity Fuel Type Year of Manufacture Seating Capacity Engine Number
1956 DIESEL 2023 7 46354442-4261860
Chassis Number Vehicle Usage Invoice Date Invoice Value Place of Registration
MAT631020PWF24733 Private 20-JUL-2023 1962900 NASHIK
Vehicle IDV (in Rs.) Electrical Non-Electrical CNG/LPG Unit Total IDV (in Rs.)
Accessories Accessories IDV (in (Extra fited)
IDV (in Rs.) Rs.) IDV (in Rs.)
1864755 0 0 0 1864755

C. Coverage opted

1. Proposal No. PPVBU14901186

2. Cover Type. 1 YEAR OD AND 3 YEARS TP
Own Damage Period 20-JUL-2023(15:20) To 19-JUL-2024
(Midnight)
Motor Liability Period 20-JUL-2023(15:20) To 19-JUL-2026
(Midnight)
3. Insurance Broker Name : TATA MOTORS INSURANCE BROKING
AND ADVISORY SERVICES LTD

a) Category: Composite Broker

b) License Validity 13-MAY-23 To 12-MAY-26
c) CIN Number: U50300MH1997PLC149349

In case of any claim or assistance required please contact our help line at - 1800 209 0060 or email us at
support@tmibasl.com or visit our website - https://www.tatamotorsinsurancebrokers.com
 d) IRDAI Lic. No: 375
4. Is your vehicle fitted with external LPG/CNG kit No
5. Electrical Accessories cover Opted (If Applicable) No
6. Non - Electrical Accessories cover Opted (If Applicable) No
7. Is Voluntary Excess opted No. No
Amount of voluntary excess opted 0
8. Is any additional compulsory deductible imposed and agreed upon Yes
Amount of additional compulsory deductible imposed 2000
9. Whether geographical area extension is opted No
Details of Countries to which geographical area extension cover is given
10. Total Premium (excluding GST) , quoted and agreed upon is 65299
11. NCB (No Claim Bonus) claimed by you and granted by us based on your 0
declaration of no claim during your previous policy
12. Previous Own Damage Policy Detail
(i) Insurer Name: NA
(ii)Previous Policy No. NA, Previous Policy Expiry Date : NA
13. Whether your vehicle is hypothecated No
14. Name of Financer
15. Whether PA cover is opted for owner-driver Yes
16. CPA Tenure 3
17. Nominee Details:
Nominee Name: MRS. MEENU KHATTAK
Nominee Age: 46
Nominee Gender: Female
Relationship with Insured: SPOUSE
Name of Appointee (If applicable): NA
Appointee Relation (If applicable): NA
18. Add on Cover(s) opted Yes
Plan Name: CONSUMABLES..(Consumables:1865),Engine Protection .(Engine Protect:1865),NIL Depreciation(Nil
Depreciation:6527),RETURN TO INVOICE .(Return To Invoice:2798),Road Side assistance(Road Side Assistance:499)

In case of any claim or assistance required please contact our help line at - 1800 209 0060 or email us at
support@tmibasl.com or visit our website - https://www.tatamotorsinsurancebrokers.com
Declaration: I/ we hereby declare and state that the above statements made by me/ us are true and complete. No part of it is
false. I/ we desire to effect an insurance as describe herein with and I/ we agree that this proposal and declarations shall be the
basis of contract between me/ us and the and I/ we agree to accept the policy subject to the condition specified by the
Insurance Company.
I hereby confirm that I have mandated to place my insurance cover and have read and agreed on the terms and conditions
and also give my unconditional consent for receiving a call from or its affiliated entities on my number even if the number is
enrolled under NDNC/DND registry
INSURANCE ACT 1938, SECTION 41- PROHIBITION OF REBATES
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, except 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 extend
to ten lakh rupees.

Proposer: MR. AMIT KHATTAK

Date: 20-JUL-2023

Kindly go through the above details and review the information. Please verify the nominee details mentioned above. In case the
nominee details were not provided earlier, you may kindly provide the same to incorporate it in the policy document. In case of
any disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please contact
our toll free number & register your objections/changes/disagreement to the contents of this transcript or you may also send us
email or written correspondence at the following details within a period of 15 days from date of your receipt of this transcript
along with Policy.

In case of any claim or assistance required please contact our help line at - 1800 209 0060 or email us at
support@tmibasl.com or visit our website - https://www.tatamotorsinsurancebrokers.com