BANGALORE

19/05/2014
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
Place :
Date :
For and on behalf of
The Oriental Insurance Company Limited
Authorised Signatory
B N Prasad
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485.
This is an electronically generated document (Policy Schedule).
The Policy document duly stamped will be sent by post.
Page 1 of 3
1 Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not
cover use for hire or reward, tuition, racing, pace making, reliability trial, 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
Motor Trade
KA 03 HN 5239
F4862009931 -
CAEC8137025
2012 OTHERS 1 + 1 125 SUZUKI INDIA-
SUZUKI ACCESS
UZ 125
421504/31/2015/1519 Policy No 421504/31/2014/1629 Prev Policy No :
-
#A1, ARMY INSTITUTE OF HOTEL
MANAGEMENT, SURVEY
NO.19,NAGARESHWARA
NAGENAHALLI,KOTHANUR
POST,BANGALORE-560077
BANGALORE KARNATAKA 560077
CBO17, NO12, BELLARY ROAD,
HEBBAL, NEXT TO CANARA BANK
BANGALORE KARNATAKA 560024
FROM 00:00 ON 28/05/2014 TO MIDNIGHT OF 27/05/2015
9731722084 / /
fabian02gomes@gmail.com
080-23544118/ 23434131 / /
tgsathyanarayana@orientalinsurance.co.
in
1,081 134 .5 1,215
MOTORISED-TWO WHEELERS PACKAGE POLICY - ZONE A
CC 9121001592 - 19/05/2014
INDIA
FABIAN GOMES CBO -17 HEBBAL
55414408 421504
Bangalore East
Cover Note No :
Insured's Code :
Insured's Name :
Address :
Tel /Fax /Email : Tel /Fax /Email :
Address :
Cover Note Dt :
Issue Office Code :
Issue Office Name :
Agent/Broker Details
//// Tel /Fax /Email :
Period of Insurance :
Collection No & Dt :
Gross Premium : Service Tax : Stamp Duty : Total :
Geographical Area : Area Extension :
Particulars of Insured Vehicle:
Registration
Mark & Place
Engine No. &
Chassis No.
Make - Model
Year Of
Manufacture
Type Of Body Seating Capacity
(including Driver)
Cubic
Capacity
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 Vehicles
Rules, 1989.
Limitations as to use:
The Policy covers use only under a permit within the meaning of the Motor Vehicles Act 1988 or such a carriage falling under
Sub-section 3 of Section 66 of the Motor Vehicles Act 1988.
Driver :
MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE
Agent/Broker :
NA0000002739 DIRECT
Address :
Dev.Off.Code :
Digitally signed by
PRASAD BRAHMADEO
NARAYAN
Date: 2014.05.19
15:16:08 IST
Signature Not Verified
BANGALORE
19/05/2014
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
Place :
Date :
For and on behalf of
The Oriental Insurance Company Limited
Authorised Signatory
B N Prasad
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485.
This is an electronically generated document (Policy Schedule).
The Policy document duly stamped will be sent by post.
Page 2 of 3
100000
For the Vehicle For the Side Car
Non Electrical
Accessories
Electrical
Accessories
Value of LPG/CNG Total Value
44,242 0 0 0 0 44,242
421504/31/2015/1519
Subject to IMT Endorsement Printed herein/attached to : IMT-22
Hypothecation Agreement with: -
(Details of IMT Endorsements and GR also available on internet TAC website www.tac.org.in)
B. LIABILITY A. OWN DAMAGE
BASIC TP COVER
BASIC TP TOTAL
ADD :PA FOR OWNER DRIVER-GR36A
TP TOTAL
TOTAL PREMIUM
ADD :SERVICE TAX
STAMP DUTY
TOTAL AMOUNT
464.00
464.00
50.00
514.00
1,081.00
134.00
0.50
1,215.00
BASIC OD COVER
MOTOR OD BASIC - NEW
BASIC OD TOTAL
OD TOTAL
LESS :NO CLAIM BONUS-GR27
MOTOR TOTAL OD
755.65
755.65
755.65
756.00
188.91
567.00
* NCB discount - 25 %
100000
COMPULSORY DEDUCTIBLE Rs.100
Limit of Liability:
Under Section II-I(1) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-I(ii) in respect of any one claim or series of claims arising out of one event is Rs.
P.A. Cover under Section III for Registered Owner Cum Driver (CSI) : Rs.
Insured's Declared Value
SCHEDULE OF PREMIUM
Deductibles under Section-I :
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC
endorsements mentioned herein above which are available on Company's website: www.orientalinsurance.org.in or
on demand from the policy issuing office
In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured will
comply with the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as well
as company's website.
Attached to and forming part of policy number
Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).
Claim for theft of vehicle not payable if theft not reported to Company within 48 hours of its occurrence.
Claim is not admissible if Driving Licence is found fake or is not valid whether or not in the knowledge of the insured.
Hire Purchase/Lessor Agreement with:
-
Page 3 of 3
BANGALORE
19/05/2014
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
Place :
Date :
For and on behalf of
The Oriental Insurance Company Limited
Authorised Signatory
B N Prasad
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485.
This is an electronically generated document (Policy Schedule).
The Policy document duly stamped will be sent by post.
421504/31/2015/1519
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 MVAct, 1988 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".
fabian02gomes@gmail.com Entered By :
Attached to and forming part of policy number
I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in
accordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their
hands at BANGALORE on 19-MAY-14
For and on behalf of
The Oriental Insurance Company Limited
Authorised Signatory
B N Prasad
General Manager