Signature Not Verified

Digitally signed by
PRASAD BRAHMADEO
NARAYAN
Date: 2015.01.06
12:02:37 IST

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

MOTORISED-TWO WHEELERS PACKAGE POLICY - ZONE A
Policy No

421800/31/2015/5564

Prev Policy No

Cover Note No

Cover Note Dt

Insured's Code

27197338

Issue Office Code :

421800

Insured's Name

SATYA PRAMOD. V.

Issue Office Name :

DO VIII BANGALORE

NO.41, "JYOTHI LAXMI NILAYA", 6TH MAIN Address

ROAD, SRINIVAS NAGAR, BSK 1ST STAGE

Address

421800/31/2014/5208

22 D V G ROAD, V C PLAZA,
BASAVANGUDI,
BANGALORE-560004

BANGALORE KARNATAKA 560050

Tel /Fax /Email

BANGALORE KARNATAKA 560004

9739891909 / /
satyapramodvkatti@gmail.com

Tel /Fax /Email

26621203-4 / 22426890 /
gkantharaju@orientalinsurance.co.in

Agent/Broker Details
Dev.Off.Code

Agent/Broker

NA0000001673 DIRECT

Address

Tel /Fax /Email

////

Period of Insurance :

FROM 00:00 ON 13/01/2015 TO MIDNIGHT OF 12/01/2016

Collection No & Dt

CC 5092008242 - 06/01/2015

Gross Premium

644

Service Tax :

80

INDIA

Geographical Area :

.5

Stamp Duty :

Total :

724

Area Extension :

Particulars of Insured Vehicle:

Registration Mark
& Place
KA 05 EZ 1473
Bangalore South

Engine No. &

Chassis No.
DUFMBJ71033 DUFBMJ32149

Year Of
Manufacture

Make - Model
BAJAJ AUTO LTD-BAJAJ CT 100

2005

Type Of
Body
SOLO

Seating Capacity
(including Driver)
2+0

Cubic
Capacity
100

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 Subsection 3 of Section 66 of the Motor Vehicles Act 1988.
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

Driver :
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.
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.

100000

100000

Insured's Declared Value

For the Vehicle

14,500

Place :

BANGALORE

Date :

06/01/2015

For the Side Car

0

Non Electrical
Accessories

Electrical
Accessories

Value of LPG/CNG

Total Value

14,500

Page 1 of 2

Attached to and forming part of policy number

421800/31/2015/5564
SCHEDULE OF PREMIUM

A. OWN DAMAGE

B. LIABILITY

BASIC OD COVER

259.99

BASIC TP COVER

464.00

MOTOR OD BASIC - NEW

259.99

BASIC TP TOTAL

464.00

BASIC OD TOTAL

259.99

ADD :PA FOR OWNER DRIVER-GR36A

OD TOTAL

260.00

TP TOTAL

514.00

LESS :NO CLAIM BONUS-GR27

130.00

TOTAL PREMIUM

644.00

MOTOR TOTAL OD

130.00

ADD :SERVICE TAX

50.00

80.00
0.50

STAMP DUTY

724.00

TOTAL AMOUNT
* NCB discount - 50 %
Deductibles under Section-I :

COMPULSORY DEDUCTIBLE Rs.100

Subject to IMT Endorsement Printed herein/attached to : IMT-22

(Details of IMT Endorsements and GR also available on internet TAC website www.tac.org.in)

Hypothecation Agreement with:

Hire Purchase/Lessor Agreement with:

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.
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
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 is not admissible if Driving Licence is found fake or is not valid whether or not in the knowledge of the insured.
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 06-JAN-15
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".
For and on behalf of
The Oriental Insurance Company Limited
Entered By

satyapramodvkatti@gmail.com

B N Prasad
General Manager
Authorised Signatory
This is an electronically generated document (Policy Schedule). The Policy document duly stamped will be sent by post.
In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Place :

BANGALORE

Date :

06/01/2015
Page 2 of 2