c

1. Authorized Signatory
For THE NEW INDIAASSURANCE CO. LTD.
CERTIFICATECUMPOLICYSCHEDULE
(FORM51 OFTHECENTRALMOTORVEHICLES RULES, 1989)
PolicyType Package Policy( Private Vehicle ) Proposal No. & Date R28586578 / 21-Mar-2017
PolicyNo. & Type 98000031170305120034 Period of Insurance 00:00:00AM25-Apr-2017 to midnight on 24-Apr-2018
PolicyIssuedOn 21-Mar-2017 (00:00) Vehicle IdentificationNo. MA3EWDE1S00718247
InsuredName Mr. NaveenRohira GeographicalArea
InsuredAddress WZ-490 FLATNO-FF-2 GALI NO-16 SADH NAGAR PALAMCOLONY,
NEWDELHI-110045, Delhi
INSURED MOTOR VEHICLEDETAILS INSURED DECLARED VALUE(IDV) (in Rs.)
Make Maruti Vehicle 261040
Model &Variant WagonR New Lxi CNG/MARUTI WAGON R GREEN LXI Non ElectricalAccessories 0
Registration No DL2CAS9152 ElectricalAccessories 0
Year of Manufacture 2014 CNG/ LPGKit 0
Engine- Chassis No 7349767 - 718247 Total IDV 261040
Cubic Capacity 998
Seating Capacity 5
Type Of Body Saloon
RTOLocation DL2CAS9152 / NEWDELHI
Schedule OfPremium(Amount inRs.)
OWN DAMAGESECTION (A) LIABILITYSECTION (B)
Vehicle 4897
Elec.Accessories 0
Non- Elec.Accessories 0
Kit (IMT-25) 0
Extra Premium towards Inbuilt CNG/LPG 245
Basic Premium 4897
GeographicalArea Extn. (IMT-1) NA
Lamp, Tyres etc. (IMT23) 0
Driving Tuition Loading On OD Premium (60%) NA
Sub-Total Additions 0
Deductibles
VoluntaryDeductibles (IMT22A) 0
Anti-Theft Device (IMT-10) 122
AAI Membership (IMT-8) 0
No Claim Bonus (25%) 1194
Discount for vehicles designed for handicapped NA
Sub- Total Deductibles 1316
Add- OnCoverages
Depreciation waiver 2349
Engine Protect 0
Return to Invoice 0
Net ownDamage Premium(A) 6175
Basic Third PartyLiability 2055
Third PartyLiabilityfor Bi-fuel Kit 60
CompulsoryPACover Premium 100
PACover for 0 Person of Rs (0) each (IMT- 16 )
Legal Liability(WC) to Driver (IMT-28) 50
Legal Liabilityto Employees (IMT-29) 0
Legal Liabilityto Passenger (IMT46) 0
Driving Tuition Loading On TPPremium (60%) NA
Net LiabilityPremium(B) 2265
Total Premium(A+B) 8440
Service Tax @14% 1182
SwachhBharat Cess @0.50% 42
Krishi KalyanCess @0.50% 42
Gross PremiumPaid 9706
Note :
1. PolicyIssuance is the subject to the realisation of cheque.
2. Consolidated Stamp Dutypaid via Challan No
3. The Policyis subject to a compulsoryDeductible of Rs 1000 (IMT-22)
4. Voluntaryexcess Rs (0)
5. Subject to Endorsements IMT,7 10, 28,
Nominee Details : Nominee Name VARTIKAROHIRA Age 33 Relation Wife
Payment Detail
Payment Method Cheque No./Transaction No. Bank Name Amount
Auto Debit 17625963 HSBC BANKLTD 9706
Financer Type Financed Financer Name HDFC BANKLIMITED. Financer Branch NEWDELHI
POS Name NA POS ID NA POS PAN No/Aadhar No NA
Limitations as to use: Use onlyfor social domestic and pleasure purposes and for the Insured's business. The Policydoes not cover the use for : (1) Hire or reward (2) Carriage of goods (other than samples or personal
luggage) (3) Organized racing (4) Pace making (5) Speed testing (6) Reliabilitytrials g)Anypurpose in connection with motor trade.
Driver's Clause:Anyperson 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 mayalso drive the vehicle &that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limits of Liability Clause: Under section II-1 (i) of the policy-Death of or bodilyinjury. Such amount as is necessaryto meet there requirements of the motor vehicle act 1988. Under section II-1 (ii) of the policy-Damage to
third partypropertyis Rs.7.5 lakhs P.A. Cover under section III for Owner-Driver is Rs. 2.0 Lakhs
No claimbonus: 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: The preceding year/20%, Preceding
two consecutive years/25%, Preceding three consecutive years/35%, Preceding four consecutive years/45%, Preceding five consecutive years/50%of NCBon OD Premium. No claim bonus onlybe allowed provided the
policyis renewed within 90 days of the expirydate of the previous policy.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule.Anypayment made bythe companybyreasons of wider terms appearing in the certificate
in order to complywith the Motor VehicleAct,1988 is recoverable from the insured. See the clause headed "AVOIDANCEOFCERTAIN TERMSAND RIGHTOFRECOVERY". For legal interpretation, English version will hold
good.
I / We herebycertifythat the policyto which this certificate relates as well as this certificate of insurance are issued in accordance with the provisions of chapter Xand chapter XI of M.V.Act, 1988.