2312201506034801000

HDFC ERGO General Insurance Company Limited

Policy No. 2312 2015 0603 4801 000 Certificate of Insurance cum Policy Schedule

0
Motor Insurance - Two Wheeler Comprehensive Policy

1
Insured Name MR AMITH DEVANDIGA RTO MUMBAI PAN No.
Corr.Address/ C/304 BLDG NO 1 GRIT HEIGHTS LTD VILLAGE BORLA OPP INDIAN OIL
Place of Supply NAGAR GM LINK ROAD CHEMBUR
MUMBAI MAHARASHTRA 400043
Mobile 7738981266 Phone - E Mail devadigaamith@gmail.com Registration No. MH-03-CS-6591
Period of Insurance From Date & Time 24/09/2017 00:01 hrs To Date & Time 23/09/2018 Midnight Policy Issuance Date 23/09/2017
Seats(Incl.
Make Model - Variant Engine No Chassis No Mfg Yr Body Type CC
of side car)
KTM RC-200 690661910 MD2JYC4E4GC054912 2016 2 OPEN 199

Insured's Declared Vehicle (`) Side Car (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Value (IDV) 153,780 0 0 0 0 153,780
Named Persons & Nominee (IMT-15)
Nominee for Owner driver Appointee
Hypothecated(IMT-7) with: BAJAJ AUTO LIMITED
Premium Details (`)
Own Damage Premium (a) Liability Premium (b)
Basic Own Damage: 2,757 Basic Third Party Liability: 887

PA Cover for Owner Driver of `100000 50

Total Basic Premium 2757
PA Cover for un-named persons of `200000 each(for 2 Person) (IMT-16) 280

Sub Total – Addition 1,217

Net Liability Premium (b) 1,217

Add on Coverages Total Package Premium (a+b) 5054

Zero Depreciation 1000
Emergency Assistance 80
Total-Addon 1080 GST 18% : Central Tax 9%( `455.00)+ State Tax 9%( `455.00) 910
Net Own Damage Premium (a) 3837 Total Premium 5,964

Geographical Area India Compulsory Deductible (IMT-22) ` 100 Voluntary Deductible (IMT-22A) ` 0
Fund Transfer No.
Payment Details: Dated : 23/09/2017 Drawn on BizDirect Invoice No.: 201506034801000 HSN Code: 9971
TW1709750289
Previous Policy No. 2312201506034800001 Valid from 24/09/2016 to 23/09/2017 of HDFC ERGO GENERAL INSURANCE CO.LTD. No Claim Bonus 0%
If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.

LIMITATIONS AS TO USE: The Policy covers use of the vehicle 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 or Class 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 when not used
for the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989. Limits of Liability 1. Under Section II-1 (i) of the
policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 100000 3.P.A.
Cover under Section III for Owner - Driver(CSI): ` 100000 Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request & the same is also
available at our website.

I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988. The stamp duty of `0.5 paid
by Demand Draft, vide Receipt/Challan no 2502490201718 dated 14/08/2017 as prescribed in Government Notification Revenue and Forest Department No Mudrank 2004/4125/CR 690/M-1,dated 31/12/2004., dated
,31-12-2004." Goods and Service Tax Registration No: 27AABCL5045N1Z8. 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 Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE
OF CERTAIN TERMS AND RIGHT OF RECOVERY." Disclaimer: The Policy shall be void from inception if the premium cheque is not realized. In the event of misrepresentation, fraud or non-disclosure of material
fact, the Company reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared accordingly. The existing damages to the vehicle as mentioned in the
report shall not be paid by the Company. The policy is issued basis the information provided by you, which is available with the company. In case of discrepancy or non recording of relevant information in the policy,
the insured is requested to bring the same to the notice of the company within 15 days. Goods and Service Tax for this invoice is not payable under reverse charge basis.

Branch : 1ST FLOOR, BLOCK NO.2, BHOOMI SARASWATHI, GANJAWALA LANE, BORIVALI (W), MUMBAI MUMBAI, 400092. Phone No. : +91-22-30092558
Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.

Signature Not Verified *1*

Agent Name: HE DIRECT BORIVALI CHEMBUR KMA Digitally signed by Nagendra Saikumar
Date: 2017.09.23 19:40:07 IST

Agent Code: 201371396470

Reason: I'm the author
Location: India
#1# Duly Constituted Attorney
*$*NAGENDRA_SAI#$#

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Policy Issuing/Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla
Road, Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com CIN : U66030MH2007PLC177117.
IRDAI Reg No. 146. (Formerly HDFC General Insurance Limited from September 14, 2016 and L&T General Insurance Company Limited upto September 13, 2016)
HDFC ERGO General Insurance Company Limited

Frequently Asked Question’s (FAQ’s) - Motor Insurance

WHAT ARE THE MAJOR COVERS UNDER THE POLICY? HOW DO I FILE A CLAIM?
Loss or Damage to the Insured Vehicle caused due to: For Accidental Damage to Insured Vehicle (Own Damage Claims):
a. Fire, explosion, self ignition or lightning. ¡ Mobile App: Simply download HDFC ERGO Mobile App - Insurance Portfolio Organizer
b Burglary, housebreaking or theft from Play Store. Link your policy by providing few simple details and register a claim.
c All act of God perils like earthquake, flood, cyclone etc ¡ Call Toll Free 1800 2700 700 (Accessible from India only) and provide your policy
d Accidental external means, terrorism, riot and strike number for reference and register a claim
Liability to Third Parties:
Provides cover for any legal liability arising out of the use of the vehicle for Please keep the following details handy while intimating a claim
a Accidental death / injury to any third party a. Policy Number
b Any damage to property owned by third party b. Registration Details / RC Copy
Personal Accident Cover: c. Drivers details at the time of accident including driving License Number
The policy provides for a mandatory Personal Accident cover for owner driver and optional d. FIR on a case to case basis
cover for passengers covering accidental death and permanent total disability e. Repair estimate

WHAT ARE THE MAJOR EXCLUSIONS OF THE POLICY? WHAT IS THE CLAIM PROCESS?
a. General aging, wear & tear, mechanical or electrical breakdown, failure, depreciation, 1. If your vehicle can be driven, take it to the nearest dealer / garage.
any consequential loss 2. Get a repair estimate, fill up the claim form and attach a copy of the registration
b. Damage by a person driving without a valid license certificate and driving license of the person driving at the time of the accident.
c. Damage by a person driving under the influence of liquor or drugs 3. If the garage is within our network, you could avail of cashless claim facility. Pay for non
d. Loss/damage attributable to war, mutiny, nuclear risks accident related repairs, depreciation and deductible. We would settle the rest.
e. Damage to tyres and tubes, unless damaged during an accident 4. If the garage is outside our network, you would have to get the claim reimbursed
f. Usage on hire & reward (applicable for all classes except public commercial vehicles) subsequently.
g. Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes,
headlights, paint work (applicable for all commercial vehicles; unless opted CLAIMS DOCUMENTS -
additionally) FOR ACCIDENTAL DAMAGE TO INSURED VEHICLE
h. Loss or damage resulting from overturning arising out of operation as a tool (applicable a. Duly filled and signed claim form & satisfaction voucher
for mobile cranes, drilling rigs, mobile plants, navvies, shovels, grabs, rippers unless b. Registration Certificate (RC)
opted for additionally) c. Driving license of the person driving at the time of the accident
i. Loss of or damage to accessories by burglary housebreaking or theft unless the vehicle d. Policy Copy, original repair estimate, repair invoice
is stolen at the same time (applicable to all commercial vehicles & two wheelers) e. Payment receipt for non-cashless claims
f. Original repair invoice for cashless claims
TRANSFER OF INSURANCE (INCASE VEHICLE IS SOLD) g. AML documents for amount more than `1 lakh (PAN card, 2 passport size photo,
To place your request for Transfer of Insurance, visit Customer Support section on our residence proof)
website www.hdfcergo.com. h. Form 35 & original NOC from financer incase of total loss where payment is made to
insured
WHAT CHANGES CAN BE DONE IN MY POLICY ENDORSEMENT i. A copy of police FIR/panchnama is required for TP injury / death / property damage
To place your request for any ''Changes in Policy', visit Customer Support section on our
Additional documents required for commercial vehicles:
website www.hdfcergo.com. a. Spot survey b. Load challan c. Fitness certificate d. Route permit
CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT WHAT IS NCB?
a. Duly filled and signed claim form & discharge voucher ( after loss settlement ) NO CLAIM BONUS (NCB):
b. Original Registration Certificate (RC) NCB is provided for every claim free year basis the slab as provided by Tariff.
c. Original Policy Copy How can I get No Claim Bonus Reserving Letter?
d. Copy of FIR lodged at the nearest police station NCB Reserving letter can be provided only on Sale of vehicle evidenced by transferred RC
e. All original keys & vehicle invoice copy copy OR Sale Deed and Form 29 & 30. The OD section of the policy needs to be transferred
f. No trace report confirming that the stolen vehicle is not traceable to the new owner or cancelled.
g. Original NOC from financer incase of hypothecation / HPA
h. Intimation to RTO for theft of vehicle HOW DO I RENEW MY POLICY?
i. Duly signed RTO transfer papers (Form 26, 28,29,30,35) a. Visit www.hdfcergo.com to renew c. Visit our nearest branch / your agent
j. RC extract with stolen remark from the concerned RTO after the loss instantly online
k. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence d. Send a copy of the renewal notice along
proof) b. SMS "RENEW <POLICY NO> " to 9999 with premium cheque to our branch
l. Deed of subrogation cum indemnity on judicial stamp paper office /Corporate office
700700
Disclaimer: Where it is brought to the notice of the Company, that vehicle insured
which is not a new vehicle but shown as a new vehicle with a malafide intention, HOW TO CONTACT US?
claims for total loss of such vehicle would not be admissible, if there is a gap of more Visit Customer Support section on our website www.hdfcergo.com and avail host of
than 10 days from date of invoice of vehicle and the proposal date. services online which is easy, instant & convenient

Convenience at your fingertips

On the Customer Support section of our website, you can:
Ver.AUG 17

Get Policy Copy/ Make Changes Track Claim Update Contact

` 80D Tax Certificate on Policy Status Details
This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.