Policy Number : P0121300025/4102/100012

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

(www.magmahdi.com)
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0002V02201213

Date : 17/04/2020

To,
Mr VINCENT AROKIYA DASS S
VICTORIA COTTAGE P NO:29 ,ROSE VALLEY NEAR BISMILLA
NAGAR ALASANATHAM HOSUR
KRISHNAGIRI
TAMILNADU 635109
Mobile:9962226026

Agent/ Intermediary Name and Code:KEERTHI MOTORS MSP0000179

Sub: Risk Assumption Letter

Dear Sir /Madam,

Thank you for choosing Magma- HDI General Insurance Company Limited as your preferred General Insurance Company. Please find enclosed
Policy No. P0121300025/4102/100012, which has been issued based on the details furnished to us as below:
Insured & Vehicle Details

Name of Insured M r VINCENT AROKIYA DASS S

Period of Insurance 22/04/2020 TO 21/04/2021

Vehicle Make/Model HONDA / CB UNICORN STANDARD
RTO HOSUR
Vehicle Registration No. T N 70 V 5105
Vehicle Registration Date 22/05/2017
Engine No. KC31E80010928
Chassis No. ME4KC311DH8010882
Previous Policy Details
Previous Policy No P0020300025/4102/100012
Previous Policy Period 22/04/2019 TO 21/04/2020
Previous Year NCB% 25
Previous Insurer Name MAGMA HDI
Previous Policy Type Package

The information received from you are reproduced in the proposal attached with this Risk Assumption Letter and your proposal has been processed
accordingly. Coverage of risk is subject to realisation of the full premium post which, insurance coverage under the policy would commence. In case
the premium is not received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab- initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at
customercare@magma- hdi.co.in or calling our toll free helpline on 1800 266 3202. Absence of any communication from you in this regard within a
period of 20 days of date of this letter, would mean that the issued policy is in order and as per your proposal.The Risk Assumption Letter is to be
read in conjunction with the policy and shall be considered as null and void without the same.

Thanking You,
Regards

For Magma HDI General Insurance Co Ltd.

Page 1 / 8
 Policy Number : P0121300025/4102/100012

Authorised Signatory

Page 2 / 8
 Policy Number : P0121300025/4102/100012

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0002V02201213

TWO WHEELER PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office NAVIN''S PRESIDIUM, 3RD FLOOR, N.M ROAD, NEW NO: 17/19, OLD NO: 103, "B" BLOCK, 3A, NELSON MANICKAM ROAD, ,CHENNAI -
600029 ,TAMILNADU , PH: (0) 9042004935
Policy No P0121300025/4102/100012
Insured Mr VINCENT AROKIYA DASS S
Address VICTORIA COTTAGE P NO:29 ,ROSE VALLEY NEAR
BISMILLA
Period Of Insurance 00:00 Hrs of 22/04/2020
NAGAR ALASANATHAM HOSUR
To Midnight of 21/04/2021
KRISHNAGIRI
Agent No.: MSP0000179
TAMILNADU 635109
Agent Contact No.: 9944026600
Mobile:9962226026
Contact Number 9962226026
Email ID:
GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & No. & Year of
Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
RTA Location Manufacture
TN 70 V 5105 / HONDA CB
2017 KC31E80010928 ME4KC311DH8010882 149 2
HOSUR UNICORN STANDARD/BIKE
IDV (INSURED'S DECLARED VALUE)
Electrical/electronic Accessories
IDV of Vehicle Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
51964 0 0 0/0 0 51964
OWN DAMAGE(A) LIABILITY(B)
Basic OD 609.64 Basic TP 752.00
Sub Total 609.64 PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s) 375.00
Less: Sub Total 1,127.00
No claim bonus 35% 213.37
Sub-Total Deductions 213.37
Total Own Damage Premium(A) 396.00

Total Liability Premium(B) 1,127.00

Premium Computation
Total Package Premium(A+B) 1,523.00
CGST @ 9% 137.07
SGST @ 9% 137.07
TOTAL 1,797.00

LIMITATIONS AS TO USE - The Policy covers use of the vehicle for any purpose other than a) Hire or Reward b)Carriage of goods (other than samples or
personal luggage) c)Organized racing d)Pace making e)Speed testing f) Reliability Trials g)Use in connection with Motor Trade
Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license.Provided also
Driver
that the person holding an effective Learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles
Clause :
Rules, 1989.
LIMITS OF LIABILITY
Under Excess in respect of each and every claim under Sec I Under In respect of any one Under Damage to Third Party Property Rs. Under PA Owner – Driver as
Section I of motor policy Section accident -- As per Section 100000/- in respect of any one Section per premium
Compulsory : Rs. 100/- Voluntary : Rs. 0/- II-I (i) Motor Vehicle Act II-I (ii) claim or series of claims arising out III: computation table
Imposed : Rs. 0/- Total : Rs. 100/- of one event.
Subject to I.M.T Endorsement Nos. IMT 22
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Percentage
JOSEPHINE ZENIFER 22/08/1987 32 100
Date of Signature of proposal 17/04/2020
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 Collection Details :- [Collection No - ReceiptDate - Amount] : P/300025/21/100005808- 17/04/2020 , 1797
Premium Amount in Word's ( ) :- One Thousand Seven Hundred Ninety-Seven Only
For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 266 3202

Date of Issue : 17/04/2020

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1661 FT, dated 25.09.2019
GST Number of MHDI 33AAGCM1685C1ZQ
GST Invoice Number - POL3304210000794
Accounting Code for Service - 997134, Motor vehicle insurance services
Authorised Signatory
Previous GST Invoice No. -POL3303190019855

Place of Supply:TAMILNADU ( 33 )

Whether Tax is payable on Reverse Charge - No

Page 3 / 8
 Policy Number : P0121300025/4102/100012

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.

Page 4 / 8
 Policy Number : P0121300025/4102/100012

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

(www.magmahdi.com)
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0002V02201213

Date : 17/04/2020

To,
Mr VINCENT AROKIYA DASS S
VICTORIA COTTAGE P NO:29 ,ROSE VALLEY NEAR BISMILLA
NAGAR ALASANATHAM HOSUR
KRISHNAGIRI
TAMILNADU 635109
Mobile:9962226026

Agent/ Intermediary Name and Code:KEERTHI MOTORS MSP0000179

Sub: Risk Assumption Letter

Dear Sir /Madam,

Thank you for choosing Magma- HDI General Insurance Company Limited as your preferred General Insurance Company. Please find enclosed
Policy No. P0121300025/4102/100012, which has been issued based on the details furnished to us as below:
Insured & Vehicle Details

Name of Insured M r VINCENT AROKIYA DASS S

Period of Insurance 22/04/2020 TO 21/04/2021

Vehicle Make/Model HONDA / CB UNICORN STANDARD
RTO HOSUR
Vehicle Registration No. T N 70 V 5105
Vehicle Registration Date 22/05/2017
Engine No. KC31E80010928
Chassis No. ME4KC311DH8010882
Previous Policy Details
Previous Policy No P0020300025/4102/100012
Previous Policy Period 22/04/2019 TO 21/04/2020
Previous Year NCB% 25
Previous Insurer Name MAGMA HDI
Previous Policy Type Package

The information received from you are reproduced in the proposal attached with this Risk Assumption Letter and your proposal has been processed
accordingly. Coverage of risk is subject to realisation of the full premium post which, insurance coverage under the policy would commence. In case
the premium is not received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab- initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at
customercare@magma- hdi.co.in or calling our toll free helpline on 1800 266 3202. Absence of any communication from you in this regard within a
period of 20 days of date of this letter, would mean that the issued policy is in order and as per your proposal.The Risk Assumption Letter is to be
read in conjunction with the policy and shall be considered as null and void without the same.

Thanking You,
Regards

For Magma HDI General Insurance Co Ltd.

Page 5 / 8
 Policy Number : P0121300025/4102/100012

Authorised Signatory

Page 6 / 8
 Policy Number : P0121300025/4102/100012

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0002V02201213

TWO WHEELER PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office NAVIN''S PRESIDIUM, 3RD FLOOR, N.M ROAD, NEW NO: 17/19, OLD NO: 103, "B" BLOCK, 3A, NELSON MANICKAM ROAD, ,CHENNAI -
600029 ,TAMILNADU , PH: (0) 9042004935
Policy No P0121300025/4102/100012
Insured Mr VINCENT AROKIYA DASS S
Address VICTORIA COTTAGE P NO:29 ,ROSE VALLEY NEAR
BISMILLA
Period Of Insurance 00:00 Hrs of 22/04/2020
NAGAR ALASANATHAM HOSUR
To Midnight of 21/04/2021
KRISHNAGIRI
Agent No.: MSP0000179
TAMILNADU 635109
Agent Contact No.: 9944026600
Mobile:9962226026
Contact Number 9962226026
Email ID:
GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & No. & Year of
Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
RTA Location Manufacture
TN 70 V 5105 / HONDA CB
2017 KC31E80010928 ME4KC311DH8010882 149 2
HOSUR UNICORN STANDARD/BIKE
IDV (INSURED'S DECLARED VALUE)
Electrical/electronic Accessories
IDV of Vehicle Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
51964 0 0 0/0 0 51964
OWN DAMAGE(A) LIABILITY(B)
Basic OD 609.64 Basic TP 752.00
Sub Total 609.64 PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s) 375.00
Less: Sub Total 1,127.00
No claim bonus 35% 213.37
Sub-Total Deductions 213.37
Total Own Damage Premium(A) 396.00

Total Liability Premium(B) 1,127.00

Premium Computation
Total Package Premium(A+B) 1,523.00
CGST @ 9% 137.07
SGST @ 9% 137.07
TOTAL 1,797.00

LIMITATIONS AS TO USE - The Policy covers use of the vehicle for any purpose other than a) Hire or Reward b)Carriage of goods (other than samples or
personal luggage) c)Organized racing d)Pace making e)Speed testing f) Reliability Trials g)Use in connection with Motor Trade
Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license.Provided also
Driver
that the person holding an effective Learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles
Clause :
Rules, 1989.
LIMITS OF LIABILITY
Under Excess in respect of each and every claim under Sec I Under In respect of any one Under Damage to Third Party Property Rs. Under PA Owner – Driver as
Section I of motor policy Section accident -- As per Section 100000/- in respect of any one Section per premium
Compulsory : Rs. 100/- Voluntary : Rs. 0/- II-I (i) Motor Vehicle Act II-I (ii) claim or series of claims arising out III: computation table
Imposed : Rs. 0/- Total : Rs. 100/- of one event.
Subject to I.M.T Endorsement Nos. IMT 22
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Percentage
JOSEPHINE ZENIFER 22/08/1987 32 100
Date of Signature of proposal 17/04/2020
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 Collection Details :- [Collection No - ReceiptDate - Amount] : P/300025/21/100005808- 17/04/2020 , 1797
Premium Amount in Word's ( ) :- One Thousand Seven Hundred Ninety-Seven Only
For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 266 3202

Date of Issue : 17/04/2020

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1661 FT, dated 25.09.2019
GST Number of MHDI 33AAGCM1685C1ZQ
GST Invoice Number - POL3304210000794
Accounting Code for Service - 997134, Motor vehicle insurance services
Authorised Signatory
Previous GST Invoice No. -POL3303190019855

Place of Supply:TAMILNADU ( 33 )

Whether Tax is payable on Reverse Charge - No

Page 7 / 8
 Policy Number : P0121300025/4102/100012

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.

Signed by : Magma HDI General Insurance Company limited

Time & Date : 17-Apr-2020 22:50:33 IST Page 8 / 8