Issuing Office:

IFFCO TOKIO GEN INSUR CO LTD. 28 (OLD NO.195) NORTH USMAN ROAD T NAGAR

IFFCO-TOKIO GENERAL INSURANCE CO. LTD

Regd. Office: IFFCO Sadan C1 Distt. Centre, Saket, New Delhi - 110017
TWO WHEELER POLICY CERTIFICATE OF INSURANCE CUM SCHEDULE Insured's Name : N. SURENDAR Address: 20, PALAYAPPAN ST, SEVEN WELLS, CHENNAI-600001 TAMILNADU CHENNAI INDIA Phone # (988) 409-6406 Insured Motor Vehicle Details & Premium Calculation Registration Mark & No. Year of Manuf. Type of Body Make of Vehicle TVS APACHE CC Coverage

CHENNAI TAMILNADU INDIA Phone # 044 - 42178881/ 82/ 83 Policy # : 1-8VL01W

600017

P400 Policy # :72227001

Pin Code 600001 Cover Note # : Agent No. 91777777

Date of Issuance : 22/01/2012 Period of Insurance From: 27/01/2012 00:00:00 To : Midnight on 26/01/2013 00:00:00 Geographical Area : Within India Only

Engine No. IDV in Rs. OH1G42096120 Chassis No. DHVEJL38040

Seating Capacity 2

TN02AQ1785

2010

160

Package

49,000.00

Registration Authority : Two Wheeler 49,000.00 Side Car 0.00 Accessories 0.00 A. Own Damage (Rs.) Basic Own Damage Total Bonus Percent 25.00% Bonus Percent (Deductions) Total Own Damage Premium Add : Rallies (IMT 31) Foreign Vehicle Loading (IMT 19) Geographical Area Extension (IMT 1) Elec./Elect. Acc. 0.00 Bi-Fuel Kit 0.00 Total Value 49,000.00 B. Third Party (Rs.) 863.00 Basic Third Party Liability 863.00 PA Cover for Owner-Driver of Rs 100000 216.00 Unnamed PA Cover of Rs 100000 216.00 647.00 Add : 0.00 Legal Liability to Driver (IMT 28) 0.00 Legal Liability to Employee (IMT 29) 0.00 PA to Passenger (IMT 16) Rallies (IMT 31) Geographical Area Extension (IMT 1) Less : 0.00 Third Party Property Damage (IMT 20) 0.00 Limit of Liability Under Section II-I (ii) 0.00 0.00 0.00 -144.15 -44.05 Any Other Loading Discount 132.14 Net (B) Total Premium (A + B) Net Premium Service Tax (Inc Edu.cess and Higher Edu.cess) Premium Paid Rs. 330.00 50.00 70.00 Net Premium Rs. 1097.00

0.00 0.00 0.00 0.00 0.00 0.00 100,000.00

Less : Voluntary Excess Less 0% (IMT 22A) Anti Theft Device (IMT 10) Automobile Association (IMT 8) Handicap Discount (IMT 12) Vehicle Use (IMT 13) No Claim Discount Any Other Loading/Discount Net (A) Co-Insurance Details Co-Insurer 1 Co-Insurer 2 Co-Insurer 3 Co-Insurer 4

( 45% ) ( -25% )

0.00 450.00 Rs. 1097.00 1097.00 113.00 Rs. 1210.00

Agent No./Share No Co-Insurer! No Co-Insurer! No Co-Insurer! No Co-Insurer! NA

Under Hire Purchase /Hypothecated/Lease Aggreement with Subject to IMT Endorsement Nos. Limitation as to use :

Printed herein/attached hereto Driver Clause :

Any person including insured: provided that the person driving holds and 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 The Central Motor Vehicles Rules, 1989.

Use only for social domestic and pleasure purpose and for the insured's business or profession. The policy does not cover use for hire or reward, tution, racing, pacemaking,reliability trails, speed testing, carriage of goods(other than samples or personal luggage) in connection with any trade or business or use for any purpose in connection with Motors Trade.

No Claim Bonus : The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made or pending during the preceding year(s) as per the following table:s Period of Insurance Percentage of NCB on OD Premium The preceding year 20 % Preceding two consecutive year 25% Preceding three consecutive year 35% Preceding four consecutive year 45% Limit of Liability Under Section II-I(i) Under Section II-I(ii) Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988 As per premium computation table

Preceding five consecutive year 50% No claim bonus will only be allowed, provided the policy is renewed within 90 days of the expiry date of the previous policy

Under Section III PA Owner- Driver as per premium computation table Compulsory Excess (IMT 22) Rs. 50 0.00 Imposed Excess Partial Loss 0.00 Imposed Excess Total Loss

Receipt Particulars Cash / Cheque No : Premium : Bank Details : 1210.00 ONLINE 008001

S.Tax.No. D-III/ST/R-IV/GEN.INS./01/03 Dated : 22/01/2012

For IFFCO-TOKIO General Insurance Co. Ltd.

Authorised Signatory

FOR CLAIMS CALL 1800 103 5499(Toll Free),0124-4285499 or SMS"CLAIM" to 56161