LIBERTY GENERAL INSURANCE LIMITED

PRIVATE CAR PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
IMPORTANT ­ 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization 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.
3) In the event of misrepresentation, fraud or non­disclosure of material facts, the company reserves the right to cancel the policy from inception.
Policy Issuing Office 10th Floor, Tower A Peninsula Business Park, Ganpath Rao Kadam Marg Lower Parel MUMBAI MAHARASHTRA ­ 400013 Phone: +91 22 6700 1313 Fax: +91 22
6700 1606
Policy Servicing Office 3rd Floor, Mayuri Complex, Building no­1­8­6­10, , Opposite to Vidyut Bhavan, Balasanudram, Nakkalagutta, WARANGAL TELANGANA 506001 PH: +91
8655914132 FAX: +91 0 0
Period Of Insurance From 11:30Hrs of 28/03/2024
To Midnight of 27/03/2025
(Section III ­ PA OWNER­ From 11:30Hrs of 28/03/2024
DRIVER )
To Midnight of 27/03/2025
Policy No 2011­500501­23­1000142­00­000 Policy Issued On 28/03/2024
Geographical Area India Covernote No/Ecovernote No
Insured M R AITA NAGARAJA RAO Covernote Date
Address H NO: 1­5­214 JUBILEE MARKET RTO Location RANGAREDDY Zone Zone­B
WARANGAL TELANGANA 506003 UIN CODES IRDAN150RP0035V01201213
Customer UIN
Contact Number (M) +918639505142 Customer ID 4112609220 POSP Name: SILIKALA SARITHA
GSTIN No/State Name NA/TELANGANA POSP Code: POS1018053
Aadhaar Card/PAN: ­ / IDUPS6161M
POSP Contact Number: 9676089511

Agent Name
Agent Code Agent Contact No
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Year of
Manufacture/Date Licensed Carrying
Registration Trailer Trailer Trailer
Of Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW/KW capacity including
Mark & No. Registration/Invoice Registration No. Chassis No. IDV
Driver
date
AP 29 AS TOYOTA/INNOVA 2.5 VX 8
2011/28­12­2011/ 2KD6935632 MBJ11JV40073026581211 2494 8
6288 SEATER BS IV/Muv
IDV (INSURED'S DECLARED VALUE)
Year IDV of Vehicle( ) Trailers( ) Side Car( ) Non Electrical Accessories Electrical/Electronic Bi Fuel kit (CNG/LPG)( ) Total Value ( )
( ) Accessories( )
1 350,000.00 0.00 0.00 0.00 0.00 0.00 / 0.00 350,000.00
Section I ­ OWN DAMAGE (A) Section II ­ LIABILITY (B)
Own Damage Premium on vehicle and accessories Third Party Premium
Basic Cover Basic Cover
Basic ­ OD 3,459.23 Basic ­ TP 7,897.00
DISCOUNTS UNDER OWN DAMAGE SECTION Legal Liability
No claim bonus 50% 1,729.61 LL to Paid Driver IMT 28 50.00
TOTAL OWN­DAMAGE PREMIUM (A) 1,730.00 TOTAL LIABILITY PREMIUM (B) 7,947.00
Section III­ PA OWNER­DRIVER (D)
PA Owner Driver 375.00
Net Premium(A+B+D) Taxable Value 10,052.00
CGST(9% ­ TELANGANA) 904.68
SGST(9% ­ TELANGANA) 904.68
TOTAL POLICY PREMIUM 11,861.00

Hire Purchase/ Lease /Hypothecated with NA

LIMITATION AS TO USE : The Policy covers use of vehicle for any purpose other than: a) Hire or Reward b)Carriage of goods(other than sample of personal luggage) c)
Organized racing d)Pace Making e)Speed Testing f)Reliability Trial g)Use in connection with motor trade.
DRIVERS CLAUSE
Persons or Classes of Person entitled to drive:Any person including the insured 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 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 Vehicle Rules, 1989.
LIMITS OF LIABILITY
Deductible Compulsory Deductible: Rs 2000/­, Under Section II­I (i) of such amount necessary to Under Section II­I 750,000.00 P.A. cover for 1500000
under Voluntary Deductible: Rs 0 /­, the policy (Death of or meet the requirements of (ii) of the policy owner­ Driver
section ­ I Imposed Excess : Rs 0 /­. bodily injury): motor vechile Act,1988 (Damage to third under section
Additional excess : Rs /­ party property) III : CSI
Theft excess : Rs /­
EV Secure­Damage to Charger Deductible :
Rs 0 /­
EV Secure­Damage to Property
Deductible : Rs 0 /­
Subject to I.M.T Endorsement Nos. IMT 22,IMT 28
NOMINATION DETAILS

Name of the Nominee Relationship with Insured Name of Appointee (if nominee is minor) Relationship with the Nominee

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.
In witness whereof this Policy has been signed at Mumbai on 28/03/2024
Receipt No: 10250050123101414803 For Liberty General Insurance Limited
In case of Claims, Please contact us at : Toll Free No ­ 18002665844,
email id ­ care@libertyinsurance.in
Date of Issue : 28/03/2024
Place : Mumbai
Stamp Duty of Rs.0.5 /­ is paid as provided under Article (47.B.ii) of Indian Stamp Act, 1899 and included
in Consolidated Stamp Duty Paid to the Government of Maharashtra Treasury vide Order of Addl.
Controller of Stamps, Mumbai at General Stamp Office, Fort, Mumbai ­ 400001., vide this Order No % DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g

(LOA/ENF­2/CSD/10/2024/(Validity Period Dt. 07/02/2024 to 06/02/2025)/OW.NO.1245/ Dated

313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re

08/02/2024).
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h

Invoice No. 3623011001317390

282 240 170 -164 re
B
Q

Branch GSTIN No : 36AABCL9950A1ZM Digitally signed by: SACHIN Authorised Signatory

SAC Code : 997134; Description of Service : General Insurance JOSHI
Date: 2024-03-29 03:53:56
Service; Place of Supply : TELANGANA/36 IST
IRDA Regn. No. 150 Location: Mumbai
CIN No. U66000MH2010PLC209656
Tax is not payable under reverse charge by the recipient
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 sub­ rule (4) of rule 48, we are not
required to prepare an invoice in terms of the provisions of the said sub­
rule
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.

% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q

Digitally signed by: SACHIN

JOSHI
Date: 2024-03-29 03:53:56
IST
Location: Mumbai
Insurance is the subject matter of the Solicitation IRDAN150RP0035V01201213
Liberty General Insurance Limited
10th Floor, Tower A, Peninsula Business Park,
Ganpath Rao Kadam Marg, Lower Parel
MUMBAI ­ 400013
Phone: +91 22 6700 1313 Fax: +91 22 6700 1606
Email: care@libertyinsurance.in
IRDA registration number: 150 • CIN: U66000MH2010PLC209656

INFORMATION SUMMARY ­ PROPOSAL

(8 (2) of the Insurance Regulatory & Development Authority (Protection of Policyholders Interests) Regulations, 2017 or any amendment or repealment thereto)
To, Date: 28/03/2024
AITA NAGARAJA RAO
H NO: 1­5­214 JUBILEE MARKET
(M) +918639505142

Dear Customer,

We thank you for choosing us for your insurance requirement. We, at Liberty General Insurance Limited, believe 'Insurance' is not only an assurance to compensate in the event of an
unfortunate circumstance, but one that signifies protection and support you can count on when you need it the most. We are firmly committed to stand beside you and fulfill your insurance
requirement whenever the need arises.

We write to inform you that we have received the below details for insuring your under mentioned vehicle;

Period Of From 11:30Hrs of

Insurance 28/03/2024
To Midnight of
Product Name PRIVATE CAR PACKAGE POLICY 27/03/2025
(Section III ­ PA From 11:30Hrs of
OWNER­DRIVER ) 28/03/2024
To Midnight of
27/03/2025
Policy No: 2011­500501­23­1000142­00­000

Motor Vehicle details

Licensed
Year of Manufacture/Date Vehicle
Registration Trailer Chassis Make/Model/Type of Carrying
RTO Location Of Registration/Invoice Engine No. Chassis No. Sub CC/HP/GVW/KW
Mark & No. No./Registration No. Body Capacity
Date Class
Including Driver
AP 29 AS TOYOTA/INNOVA 2.5 VX
RANGAREDDY 2011/28­12­2011/ 2KD6935632 MBJ11JV40073026581211 / 2494/ 8
6288 8 SEATER BS IV/Muv

IDV (INSURED'S DECLARED VALUE)

Year IDV of Vehicle( ) Trailers( ) Side Car( ) Non Electrical Accessories Electrical/Electronic Bi Fuel kit (CNG/LPG)( ) Total Value ( )
( ) Accessories( )
1 350,000.00 0.00 0.00 0.00 0.00 0.00 / 0.00 350,000.00

Add on Covers Hire Purchase/Lease/Hypothecated with: Voluntary deductible

NA 0

Previous policy details

Previous Policy Number Previous Insurer Name Previous Policy Period Previous Policy Type Previous Year NCB Claim made in Previous Policy
VPC1074875000104 Royal Sundaram 31/01/2023 to 30/01/2024 PackagePolicy 45 NO

The above information provided has been recorded by us under Regulation 4 (4) of the Insurance Regulatory & Development Authority (Protection of Policyholders Interests) Regulations,
2002 and believing the furnished information as correct, we have issued the enclosed insurance policy for your said vehicle. We are hereby providing the information for your confirmation
and records.

Kindly note that this policy has been issued on basis of the inspection carried out by the company, the report of which has been duly acknowledged by you. Hence the company shall not be
liable for any existing damages to the insured vehicle mentioned in the inspection report.

To know updated list of our authorized garages please visit our website www.libertyinsurance.in.

For any further assistance please feel free to write to us on care@libertyinsurance.in or call us on our Toll Free number 1800 266 5844 (between 8:00am to 8:00pm, 7 days of the
week), you can also visit our nearest branch, our representatives will be glad to help you.

To enable us to serve you better, we request you to check your contact details and communicate to us by any of the above medium incase any changes required.

In the absence of any communication from you in this regards within a period of 15 days of receipt of this letter, we would take this as a confirmation that the issued policy is in order and as
per your requirement. Incase, any of the above information is found to be incorrect subsequently, the company may, at its sole discretion cancel the policy or any part thereof as deemed fit.

Correct No Claim Bonus (NCB) declaration on the part of insured is extremely important for a seamless customer experience and if the NCB declaration is found to be incorrect, all benefits
under Section I (Own Damage) of the Policy stand forfeited. Hence, we strongly recommend that you verify the NCB details on your policy and in case of any correction, write to us at
ncbconfirmation@libertyinsurance.in or call us on 18002665844 not later than 15 days from the date of this letter.

Liberty General Insurance Limited,

Authorized Signatory

% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q

Digitally signed by: SACHIN

JOSHI
Date: 2024-03-29 03:53:56
IST
Location: Mumbai
Insurance is the subject matter of the Solicitation IRDAN150RP0035V01201213