Service Branch Address: 108 / 109 & 111,1st floor, Ambadeep,14, K.G.

Marg , Connaught Place, New Delhi,

Mr. Akhter Ahmad Bhat

C 90 GULMOHAR LANE SUBWAY Intermediary Code: BR503146
CHATTARPUR NEW DELHI Intermediary Name: GIRNAR INSURANCE
DELHI, DELHI
110000 BROKERS PRIVATE
Telephone : LIMITED
Mobile : xxxxxx9941
Contact: 7551196989
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.
VPTP483677000100
From 20:44:58 hours on 20/02/2024 To 23:59:59 hours on 19/02/2025
INSURED DETAILS
Name of Insured Geographical Registration
Business/Profession Registration Date
Area Authority
Mr. Akhter Ahmad Bhat INDIA DELHI 01/01/2007
VEHICLE DETAILS
Registration Number DL02CAH3331 Model Description 800 AC - 4 SEATER Gross Vehicle Weight(Kgs) 0
Engine Number F8DN3481699 Type of Body HATCHBACK Seating Capacity (including Driver) 4
Chassis Number MA3EYD81S01085939 Cubic Capacity 796
Make of the Vehicle MARUTI UDYOG LTD. Year of Manufacture 2007 Total Premium (in Rs.) 2,470.92
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 : Nominee Age : Relationship with :
Guardian Name : Guardian Age : Guardian Relation :
LIABILITY
1. Basic premium including premium for TPPD 2,094.00
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 0.00
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.0.00 (IMT 17)
0.00
Number of Persons-1
ADD:Legal Liability ADD: SGST 188.46
10.To Paid Driver (IMT 28) 0.00 ADD: CGST 188.46
11.To Employees (IMT 29) 0.00
TOTAL LIABILITY PREMIUM 2,094.00 TOTAL PREMIUM 2,470.92
Subject to IMT Endt. Nos. & memorandum 22 (refer Terms & Conditions for relevant wording)
In Witness whereof this Policy has been signed at Chennai on 20/02/2024 in lieu of Cover note No. IMC1910663 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
Verified
For Royal Sundaram General Insurance Co. Limited
Digitally signed by
TAIKAD MAHADEVAN
SHYAMSUNDER Authorised Signatory
Consolidated Stamp Duty Paid to Govt of TamilNadu This document is digitally signed, hence counterDate: 2024.02.18
signature / stamp is not required.
20:45:02 GMT+05:30
For Legal interpretation, English version will hold good. GSTIN: 07AABCR7106G1ZL UIN: IRDAN102P0004V02201617 PAN Reason: For AABCR7106G
Number:
RoyalSundaram
Location: Chennai
3745fbcb4742297a2eb2b38fd8688ccb

Document Code:
Fastag ID:
 GST Invoice
Royal Sundaram General Insurance Co. Limited
108 / 109 & 111,1st floor, Ambadeep
14, K.G.Marg , Connaught Place, New Delhi,
Delhi - UT - 110001
GSTIN: 07AABCR7106G1ZL

Policy Number : VPTP483677000100

GST Invoice Number : VPTP48367700000
Inception Date : 20/02/2024
Policy Posted Date : 18/02/2024 20:44:58

Address of insured (Interstate):

C 90 GULMOHAR LANE SUBWAY
CHATTARPUR NEW DELHI
NEWDELHI
State:DELHI
Pincode: 110000

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable premium 2,094.00

SGST 9% 188.46

CGST 9% 188.46

Gross premium 2,470.92

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. VPTP483677000100 which has been issued based on the details submitted
to us by the Insurance Broker - GIRNAR INSURANCE BROKERS PRIVATE LIMITED. A copy of the risk details submitted by the
Insurance Broker is also enclosed herewith for your records.