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- 1. Premium Details Net Premium ServiceTax (12% of Net Premium) Education Cess(2% of Service Tax) Secondary and Higher Education Cess (1% ofService Tax) Total Premium Policy Premium(Including all previous Endorsement/s) 33984.40 4078.13 81.56 40.78 38184.87 Premium relating to this Endorsement 50.00 6.00 0.12 0.06 56.18 Final Premium after Endorsement 34034.40 4084.13 81.68 40.84 38241.05 Reliance Motor GCV A1 - PKG Public Other than 3W Endorsement Schedule Policy Issuing Office: Reliance General Insurance Co. Ltd., 570, Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai – 400031 Policy Servicing Branch Office: Gandhidham,KACHCHH GUJARAT 370201 BBZ, S41, 12B, Above Shikar Puri Street, Main Market Reliance General Insurance Co. Ltd, Name of the Insured Mr JAYDEV B AYACHI Correspondence Address of the Insured GUJARAT - 370140 India VILL SAMAKHIYALI TAL BHACHAU BHACHAU Policy No: 1103542334001520 Policy Period:From 17/06/2014 to 16/06/2015 Endorsement No. 72001 Endorsement Effective Date: 10/10/2014 Type of Endorsement: Additional Service Tax Reg.No. AABCR 6747 BST 001 Category-General Insurance Business Service 00440005 In witness whereof this policy has been signed at BHACHAU on 10/10/2014. For any assistance with claims, please contact us on 1800 3009 (toll free) or email us at services.rgicl@rcap.co.in For and on behalf of Reliance General Insurance Company Limited Authorized Signatory Note: In the event of dishonor of the cheque, this endorsement automatically stands cancelled from inception, irrespective of whether a separate communication is sent or not. Intermediary Name & Code 11A18382 / AMARPREET KAUR SAINI Intermediary Contact No: 9321707654 Not withstanding anything to the contrary contained in the policy, it is hereby declared and agreed that Vehicle has been transferred From Personal Client JIWAN ROADLINES To Personal Client JAYDEV B AYACHI. .All other terms and conditions of the policy remain unchanged. Subject otherwise to terms, exclusions, conditions, limitations and warranties of the Policy. Vehicle Make Vehicle Model Engine No./Chassis No. Registration Number TATA 4018 AL 76563 / 11065 MH06AC4225 Registered Office: Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,Mumbai - 400 001 General Insurance
- 2. Address Of IssuingOffice: Reliance General Insurance Co. Ltd, 570, Rectifier House, Naigaum Cross Road, Wadala (W), Mumbai – 400 031, India Address Of Servicing Branch Office: Gandhidham,KACHCHH GUJARAT 370201 BBZ, S41, 12B, Above Shikar Puri Street, Main Market Reliance General Insurance Co. Ltd, Reliance Motor GCV A1 - PKG Public Other than 3W Policy Schedule Schedule cum Certificate of Insurance Name of the Insured :Mr JAYDEV B AYACHI Business Or Occupation:Business Address of the Insured: VILL SAMAKHIYALI TAL BHACHAU BHACHAU - 370140, GUJARAT India Tel .No .: Res.: Effective date of commencement of insurance of the purpose of Act:Jun 17 2014 12:00AM Period of Insurance: From 10/10/2014Hrs on 17/06/2014 to mid-night on 16/06/2015 Endorsement Effective Date: 10/10/2014 Particilars Of Vehicles Insured : Certificate No. : Name of Registration Authority :PEN Geographical Area: Limitations As To Use Persons or Classes of Persons entitled to drive: The Policy covers use for any purpose other than: a. Hire or Reward 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. b. Carriage of goods (other than samples or personal luggage) c. Organised racing d. Pacemaking e. Speed testing f. Reliability trials g. Any purpose in connection with Motor Trade 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 Rules 3 of the Central Motor Vehicles Rules, 1989. Limits of Liability: As per requirements of Motor Vehicle Act, 1988 a. Under Section II-1 ( i ) of the Policy –Death of or bodily injury such amount as is necessary to meet there requirements of the Motor Vehicle Act, 1988 b. Under Section II (1 ) (ii ) of the Policy-Damage of Third Party Property Rs. 0 Deductible under Section-I - Rs. 1500 Voluntary Deductible under Section-I - Rs. 0 PA Cover for owner-driver under section 3 CSI Rs. 200000 Additional Excess Rs. 0 I/We hereby certify that the Policy to which this 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. *Service Tax Reg.No. AABCR6747BST001 The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in Consolidated stamp duty paid vide Receipt No. MH 00081948420 1415E dated 23/05/2014 ** Not Applicable for the State of Jammu & Kashmir. For claims please contact us on 30338282 or email us at claims.rgi@relianceada.com or visit our website www.reliancegeneral.co.inz 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. “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. Date of issue: 10/10/2014 For Reliance General Insurance Co. Ltd. Duly Constituted Attorney(s) Registered Office: 19,Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai – 400 038, India Registration No. Place of Registration Engine No Chassis No. Make/Model & Variant 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 MH06AC4225 76563 TATA Trailer 2000 2006 3 0.00 900,000.00 PEN 11065 4018 AL Intermediary Name & Code Intermediary Contact No: 11A18382 / AMARPREET KAUR SAINI 9321707654 Registered Office: Reliance Centre, 19, Walchand Hirachand Marg,Ballard Estate ,Mumbai - 400 001 General Insurance