1. Reliance Two Wheeler Vehicle Certificate cum Package Policy Schedule
Policy / Certificate No. : 1620722312004553
Proposal /Covernote No : 162008032856 Business/Occupation: None
Name of Insured : MR VISHAL DINESHBHAI SHAH Period of Insurance : From 00:00 Hrs on 28/03/2013 to 27/03/2014 on 23:59
Address :
C-1 JAY SOMESHWAR SOCIETY NEAR JAYMALA SOCIETY BUS
STAND RING ROAD ISANPUR AHMADABAD CITY MANINAGAR
AHMADABAD 380008 GUJARAT
Contact details : 9898371572 Hypothecated with :
Email ID : shahvishald@yahoo.com Zone A Geographical Area India
Particulars of vehicle Insured :
Own Damage
Basic OD 386.00
Total Basic Own Damage Premium 386.00
Deduct 50% for NCB -193.22
TOTAL OWN DAMAGE PREMIUM 193.22
Liability
Basic Liability 357.00
Total Basic Liability Premium 357.00
PA Benefits
Compulsory PA cover to Owner Driver of CSI 100000(IMT-15) 50.00
Total PA Premium 50.00
Legal Liability
Total Liability Premium 407.00
Package Premium 600.22
Add:Service Tax (12% of Net Premium) 72.03
Add:Education Cess (2% of Service Tax) 1.44
Add:Secondary & Higher Education Cess(1% of Service Tax) 0.72
FINAL PREMIUM 674.00
Subject to I.M.T. Endt.Nos. & Memorandum printed/herein/attached hereto. IMT22,15 Service Tax Reg.No. AABCR6747BST001
Category-General Insurance Business Service 00440005
The policy has been issued based on the information provided by you and the policy is not valid if any of the information provided is incorrect. Subject otherwise to the terms, conditions and
exclusions of the Reliance Two Wheeler Package Policy. In Witness whereof this Policy has been signed at Mumbai on 04/03/2013 in lieu of Cover Note No:162008032856 dated 02/03/2013
Premium Schedule
Registration Number and
Place
Make / Model Engine / Chassis No.Vehicle Type of body Cubic Capacity Year of
Manufacture
Seating Capacity
of side car (if any)
including driver
Net Premium Rs. IDV (Insured's Declared
Value) Rs
GJ01ER5839
Ahmedabad
BAJAJ
PULSAR 150 DTSI ES
41631
03752
150 2005 2 600.22 21,553.00
Limitations As To Use
The Policy covers use for any purpose other than: a. Hire or Reward, b. Carriage of goods (other than samples or personal luggage), c. Organized racing, d. Pace making, e. Speed testing, f. Reliability trials, g.
Any purpose in connection with Motor Trade
Persons/Classes of Persons entitled to drive :
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.
Limits of Liability :
a. Under Section II-1(i) of the Policy-Death of or bodily injury to any person so far as it is necessary to meet the requirements of the Motor Vehicle Act, 1988. b. Under Section II (1)(ii) of the Policy-Damage to
property other than property belonging to the insured or held in trust or in the custody of control of the insured up to the limits specified Rs.1 lakhs .
Deductible under Section-I
(i)Compulsory deductible Rs. 100/-(ii) Additional compulsory deductible Rs. 0/-(iii) Voluntary deductible Rs. 0 /- (iv) PA Cover for owner-driver under section III CSI Rs. 100000/-
Special Conditions: NA
It is hereby declared and agreed that all pre-existing damages to the vehicle having occurred prior to the commencement of cover are excluded from the scope of the policy.
The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in
Consolidated stamp duty paid vides Receipt No. 33866 dated 07/01/2013 Not applicable for the State of Jammu and Kashmir.
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 M.V. Act, 1988. Note: In the event
of dishonor of cheque, this policy document automatically stands cancelled from inception irrespective of whether a separate communication is sent or not. No Claim Bonus will only be allowed, provided the policy
is renewed within 90 days of the expiry of the previous policy.
Insured's Declared Value
For the Vehicle (Rs) For Trailers (Rs) Non Elec. Accessories
(Rs)
Elec./Electronic Accessories
(Rs)
Value of CNG/LPG Kit
(Rs)
Total IDV (Rs)
21,553.00 0.00 0.00 0.00 0.00 21,553.00
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 appealing in the Certificate in order to comply with the Motor Vehicle Act, 1988 is For Reliance General Insurance Co. Ltd.
recoverable from the Insured.See the clause headed 'AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY'. For legal
interpretation,English version will hold good.NOTE: Kindly acknowledge receipt of this policy. In case you find any variations against your
proposal or anydiscrepancy in the policy,kindly contact us immediately
Reliance General Insurance Co. Ltd. Duly Constituted Attorney(s)
Registered Office: Reliance Centre, 19, Walchand Hirachand Marg, Ballard Estate, Mumbai - 400 001
Policy Issuing Office : 570, Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai - 400 031
Policy servicing office : III Floor Poonam Plaza,Main Rambag Road Maninagar, Ahmedabad,Gujarat
Intermediary CodeName: 16A07643 / PRAPTI NIKHIL CHAUHAN
Intermediary Contact No: 9376933748
Registered Office: Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,Mumbai - 400 001

2. To, Date: 04/03/2013
Reliance General Insurance Company Ltd.
Ahmedabad II
VERNEKAR BUILDING,OPP. HOTEL BARDEZ,
ABOVE DENA,MAPUSA 403507
083226-2303 083226-253401
Dear Sir,
Sub: Confirmation of No Claim Bonus(NCB)Declaration
Insured Name MR VISHAL DINESHBHAI SHAH NCB% applied on the policy 50%
Vehicle Insured BAJAJ
PULSAR 150 DTSI ES
Vehicle Registration Number GJ01ER5839
Type of Cover Package Only policy Your Policy No./Cover Note no. 1620522312000019
Policy Start Date 28/03/2012 Policy End Date 27/03/2013
The proposer has declared that the request was submitted to you for issuance of a NCB Certificate. However, as the proposer is unable to furnish the same issued from
your office as proof of NCB Entitlement that may be availed as per provisions of the India Motor Tariff we have accepted the proposal and permitted the claimed NCB as per
declaration submitted to us by the proposer|
Accordingly, we would request you to:
Confirm that the information mentioned above is correct: Yes/No
If No,please state nature of incorrect information and the actual position thereof:-
State whether any claim under your Policy has been reported(OD/Liability Claim): Yes/No
If Yes,date & amount of claim lodged:
This letter is being sent as per GR 27 of India Motor Tariff.We request you to kindly provide us with the desired information by filling up the same in the original & sending it
to us.
An early response will be highly appreciated. Please not you are required to respond to this lettler within 30 days of receipt of this letter. In case we do not receive a
response from you within this time frame,it shall be deemed that you have confirmed that the information provided by the Proposer(as contained herein) is true and correct.
Yours faithfully,
For Reliance General Insurance Company Limited,
To,
The Manager,
Reliance General Insurance Co.Ltd.
Reference:Our Policy No 1620722312004553
III Floor Poonam Plaza
Main Rambag Road Maninagar
Ahmedabad
Gujarat
We Confirm that the insured is eligible/Not Eligible(Strike Out) for 50% NCB
Authorised Signatory
Registered Office: Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,Mumbai - 400 001