lar as it is necessary lo mUet HO Tyy0

or bodily injury to any person socustody the imi's specifi0g Rs 75 takrs

Under Section Il-1(0) of Iha Pollcy-Doath of inSured or held in trust or in tho of contro' of (ha insurod up lo
lo lhe
proportyother lhan property belonging
sectuon V CSIRs 0.
|Deductible under Socion 0/- PA Covor for owngr-driver undor
deductible Rs 0/-()) Voluntary doductible Rs
Comoulsorv deductible Rs 4500 /-(n) Addtional compulsory
(ú)
Nomineo Detalls :
name
Relal1onship with O*or Dover
Age:
Appointee Name

Special Conditions:
NA occurrod prior to the commencemgnt of covar
are oxcluded from tno 9c000 of the poicy
bereby declared and agrood thal all pro-oxisting daages to the vehicle having
"n s website www.rollancegeneral. co.in
conditions and oxclusions are available on our
Tho polecy wording wíth detaitod te ms. applicablo for the Slato of Jammu and Kashmir
MHOO0023890201314E daled 10/11/2017 Not rheeiael
lConsolldated stannp duty paid vidos Receipt No Chaptar and Chapter XI of MV Ac 1A cte lo
are issU6d in accordanco with he provision af
rolatos as woll os his cortificate ot insurance of pronsed tha o y
hereby certily that the Policy to which the cerificale irrespect1ve whether a separate communication is sent or not No Ciaim Bonus witl only bo alow
We inception
dOcumont automatically:standg cancoled from
lof dishonor of cheQuo, this pokcyexpiny
is renewed within 90 days ot the of the provious policy
Insured's Declared Value
Elec./Electronic Accessories Value of CNGLPG Kit Tolal 1DV (Rs)
For the Vehicle (Rs) For Trailers (Rs) Non Elec. Accossories
(Rs) (Rs) (Rs)
900.C3C 00
0.00 0.00
900.000 00

Premium Schedule
Llability
Own Damage
9,025 02Basic Liability
1.750 G0
Basic CD 1.75) OO
9,025.02Basic Liability Premium
Baslc Own Damage Premium
9,025.00lLegai Liability
|TOTAL OWN DAMAGE PREMIUM
LLP Paid Drivers (IMT 40) No. of Person O
Total Legal Llability Premium 50.09

Total Llability Promium 1,800.00

Package Promium 10,825.00
1299 C0
Add Servce Tax (12% of Nat Promium)
Add Education Cess (2% of Service TYx) 25 98
Ada Socondary &Higher Educalion Cess(1% of Service Tax) 12.99

FINAL PREMIUM 12,163.0g

Service Tax Reg.No. AABCR6747BST001

Subject to IMI End Nos. &Memorandum pinted/harGin/attached hereto. 15,16.21,47 Category-General Insurance Business Service 00440005

iThe poicy has baen issuod based on the information providad by you and the policy is not vaid i# any of the intormaton provided is incorract Sut9ct otherwisa to the lerms corditions and eacusions of the Reianca
Mscelaneous and Special Typos of Vehicles Package Policy in vWitness whereofthis Pocy has been signed at Mumbai on 0508/2017 in leu of Cavar Noto No 313000303610 datad Na
Gheunlortunate evont of cam,please chllalong Wth your PollCYNOon
POlC 1800 A4999 (Eor022112000(StnonrdD
No. 0n 18000092222oToe1
Ratcorstonersa nsCcallalong I YONPoloy
IMPORTANT NOICE: ho insured is not indamniied tho vehlclo is usod or driven otherwise than In accordance with this Schedulo.
|Any payment made by the Company by roason of wider torms appealing in the Cortificate In order to comply with the tiotor Vahicie Act, i988 is
Irecoverabiefrom the Insured.See the clause headed 'AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For legal interpratation,
|English version will hold good.NOTE: Kindly acknowledge roceipt of this policy. In caso you find any varialions against your proposalor
|anydiscropancy in the policy,kindly contact us immediatoly
Reliance General Insurance Co. LId. 3uConstuted AbeyT
Registered Office: Reliance Centre, 19. Wachand Hirachand Marg. Ballard Estate, Mumbaí 400 001
Poicy issuing ifice C70 aigaum Cr:ss Ruad Neat to Royal lrdus:ia Estate. "ladala (). t'umsai -00C3*
Pollcy sGrvcing cifice 1ST FLOOR. VIJETHASANJEEVAN, H.NO.64-8,.OPP. GANDHI HOSPITAL, MUSHEERABAD, HYDERABAD (A P).
HroERABAD,ANDHRA PRAD£SH-300082