CertificateOfInsuranceandPolicyScheduleForm51oftheCentralMotorVehicleRules,1989

Agent/Broker/ProducerName:AMITKAMALKOTHARI
Agent/BrokerLicenseCode:8568606Agent/BrokerContactNo.:9325299195
Certificate&PolicyNo.:
PeriodofInsurance:

015533583701
From00:00Hrson30/06/2016

PolicyType:
DateofExpiry

AutoSecurePrivateCarPackagePolicy
Tomidnightof29/06/2017

InsuredName&Address:
MRSHADABABOOBAKARCHINI
c/oMUSTAQOILMILL
NEARMAHAKALIMANDIR
BABUPETHCHANDRAPUR
CHANDRAPUR442401
CHANDRAPUR
MAHARASHTRA
INDIA

Premium(Incl.ofalltax/cess)
Occupation:
GeographicalArea:
RegistrationAuthority:
HPA/Hyp/Leaseto:

15,677.00
SELFEMPLOYED
India
Chandrapur
N/A

RegistrationNo.

Make&Model

EngineNo.

ChassisNo.

CC

Mfg.Year

BodyType

Seating
Capacity

MH34AM3660

MARUTISWIFTDZIRE
VDI

2373991

532614EE

1248

2014

SALOON

IDVofVehicle
()

IDVofSideCar
()

BiFuel/CNG/LPG
Kit( )

499,158.00

0.00

0.00

IDVofnonbuiltinAccessories( )
Electrical

NonElectrical

0.00

0.00

TotalInsured
Declared
Values(IDV)( )
499,158.00

SCHEDULEOFPREMIUM

A.OWNDAMAGE
PremiumonVehicleandnonelectricalaccessories

B.LIABILITY
10,353.29 Basic

Less:25%forNCB

2,588.32 Add:CompulsoryPACoverforOwnerDriver 2,00,000

A.TOTALOWNDAMAGEPREMIUM

7,764.97 Add:LegalLiabilitytopaiddriverasper(IMT28)

Add:KeyReplacement(SumInsured(SI) 25,000.00peroccurrencelimit
50%ofSI)(TA15)
Add:Depreciationreimbursement(TA01)

PAcovertounnamedpassengers(IMT16)No.ofPassengers:5CSIper
265.00
passenger 100,000.00
2,745.37 B.TOTALLIABILITYPREMIUM

Add:Emergencytransportandhotelexpenses(TA10)
AnyOneAccident: 5000
AnyOneYear: 10000

110.00 NETPREMIUM

Add:LossofPersonalbelonging(TA09)
SumInsured: 10000

110.00 SwachhBharatCess@0.5%

C.TOTALADDONPREMIUM

COMPREHENSIVEPREMIUM(A+B+C)
ServiceTax@14%

3,230.37

2,237.00
100.00
50.00
250.00
2,637.00
13,632.34
13,632.00
1,908.68
68.16

KrishiKalyanCess@0.5%
TOTALPREMIUM

68.16
15,677.00

DriversClause:Personsorclassesofpersonsentitledtodrive:Anypersonincludingtheinsured.Providedthatapersondrivingholdsaneffectivedrivinglicenseatthetime
oftheaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.ProvidedalsothatthepersonholdinganeffectiveLearner'sLicensemayalsodrivethevehicle
andthatsuchapersonsatisfiestherequirementsofRule3oftheCentralMotorVehiclesRules,1989.
LimitationsastoUse:ThePolicycoversuseofthevehicleforanypurposeotherthan:a)HireorRewardb)Carriageofgoods(otherthansamplesorpersonalluggage)c)
Organizedracingd)PaceMakinge)Speedtestingf)ReliabilityTrialsg)AnypurposeinconnectionwithMotorTrade
LimitsofLiability:UnderSectionII1(i)ofpolicy(Deathoforbodilyinjury):Suchamountasis I/weherebycertifythatthePolicytowhichthisCertificaterelatesas
necessarytomeettherequirementsoftheMotorVehiclesAct,1988.
wellasthisCertificateofInsuranceareissuedinaccordancewith
UnderSectionII1(ii)ofpolicy(ThirdPartyPropertyDamage): 7,50,000.00
provisionsofChapterXandXIofMotorVehiclesAct,1988.
UnderSectionIII:PAtoOwnerDriverCSI: 200,000.00
InwitnesswhereofthisPolicyhasbeensignedatCHANDRAPURon
Nominee:MRSCHINIAge:25Relationship:WifeN/AN/A
28/06/2016
DeductibleUnderSectionI: 1,000.00(CompulsoryDeductible: 1,000,VoluntaryDeductible: 0, ReceiptNo.(s):10821100175846028/06/2016
ForTataAIGGeneralInsuranceCompanyLTD.
ImposedExcess: 0)Franchisee:
NoClaimBonus:TheinsuredisentitledforaNoClaimBonus(NCB)ontheowndamagesectionofthe
policy,ifnoclaimismadeorpendingduringtheprecedingyear(s),asfollows:Theprecedingyear
20%,,precedingtwoconsecutiveyears25%,precedingthreeconsecutiveyears35%,precedingfour
consecutiveyears45%,precedingfiveconsecutiveyears50%ofNCBonODPremium.NCBwillonlybe
allowedprovidedthepolicyisrenewedwithin90daysoftheexpirydateofthepreviouspolicy.

Subjectto:A)IMTEndorsementNo.:16,22,28
AtriChakraborty
B.TATAAIGAutoSecureendorsementNo.(TA):01,08,09,10,15
SeniorVicePresidentOperationsandSystems
ServiceTaxRegistrationNo:AABCT3518QST004
StampDuty 0.25paidvideChallanNo:MH001688250201617Edated09/06/2016
PolicyServicingOffice:ROM,3rdfloor,TheOrion,5KoregaonParkRoad,Pune411001,TelNo:02066011111,FaxNo:02066033835.
IMPORTANTNOTICE
TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisSchedule.AnypaymentmadebytheCompanybyreasonofwidertermsappearingintheCertificateinordertocomplywiththeMotor
VehiclesAct,1988isrecoverablefromtheInsured.Seetheclauseheaded"AVOIDANCEOFCERTAINTERMSANDRIGHTOFRECOVERY".
Note:ThisSchedule,theattachedPolicyandEndorsementsmentionedhereinaboveshallreadtogetherandwordorexpressiontowhichaspecificmeaninghasbeenattachedinanypartofthisPolicyoroftheScheduleshallbearthesame
meaningwhereveritmayappear.Anyamendments/modifications/alterationsmadeonthissystemgeneratedpolicydocumentisnotvalidandCompanyshallnotbeliableforanyliabilitywhatsoeverarisingfromsuchchanges.Anychanges
requiredtobemadeinthepolicyonceissued,wouldbevalidandeffective,onlyafterwrittenrequestismadetotheCompanyandCompanyacceptstherequestedamendments/modifications/alterationsandrecordsthesamethroughseparate
endorsementtobeissuedbytheCompany.

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:customersupport@tataaig.com