IFFCO Tokio General Insurance Co. Ltd.

Servicing Office of Insurer: 2nd FloorAbove Con Agra Foods, Road No. 31, Lane Opp. DBR
DiagnosticsS.D. Road, Secundrabad, Telangana (State Code:36) -500003, PH-- Website:
www.iffcotokio.co.in
PAN: AAAC17573H . GSTIN: 36AAACI7573H1ZD Insurer's IRDA Registration Number: 106
Tollfree Helpline 040-27718944, 27718945, 277189 Email: CIN : U74899DL2000PLC107621
PRIVATE CAR PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 18144678 Policy Issued On 29-JAN-2022 (12:01)

Insured Name MRS. SAHITHI VITTALA
Own Damage Period 31-JAN-2022(00:00) To 30-JAN-2023(Midnight) Motor Liability Period 31-JAN-2022(00:00) To 30-JAN-2023(Midnight)

Proposal No. & Date PPVBU11350154, 29-JAN-2022 CPA Cover Period 31-JAN-2022(00:00) To 30-JAN-2023(Midnight)
Insured Add. 6104/3,QUTHBULLAPUR, SAI SANKALPA NAGAR,VENNELAGADDA,SUCHITRA MEDCHAL,GSI(SR BANDLAGUDA, HYDERABAD ,
TELANGANA (State Code:36) -500068
Previous Insurer NIA Previous Policy No. 61380231200300000727 31-JAN-2021 To 30-JAN-2022
Broker Details
IRDA Lic. No.: 375, CIN No.: U50300MH1997PLC149349 Broker Category: Composite Broker, Validity: 13-MAY-20 To 12-MAY-23
Name & Add.: TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD, 1ST FLOOR, AFL HOUSE, LOK BHARTI COMPLEX, MAROL MAROSHI ROAD,
ANDHERI (EAST), MUMBAI - 400 059

Make Model Sub Model Cubic Capacity Manufacturing Year Seating capacity

TATA MOTORS TIAGO TIAGO XM 1.2 P 1199 2016 5

Body Type Registration No. RTO Invoice Date Engine No. Chassis No.

HATCHBACK TS 08 FC 5855 HYDERABAD 01-DEC-2016 REVTRN02PTYK33435 MAT626241GKP53388

Vehicle IDV CNG/LPG Kit Elec. Accessories Non-Elec. Accessories Total IDV

243,000 0 0 0 243,000

Schedule of Premium (Amount in Rs.)

Own Damage Premium (A)
Basic Premium Deductibles
Vehicle 2,095 Voluntary Deductibles (0) (IMT-22A) 0
Non-Elec. Accessories 0 Anti Theft Device (IMT-10) 0
Elec. Accessories (IMT-24) 0 AA Membership (IMT-8) 0
CNG/LPG Kit (IMT-25) 0 No Claim Bonus (0%) 0
Sub Total (Basic Premium) 2,095 Handicapped Discount (0%) 0
Geographical Area Extension (IMT-1) 0 Sub Total (Deductibles) 0
IMT 23 Premium 0
Add On Coverages 0
Sub Total-Addition 2095 Net Own Damage Premium (A) 2095
Liability Premium (B)
Basic Third Party Liability 3221 PA Cover For 0 Persons of Rs. 200000 Each (IMT-16) 0
Third Party Liability For Bi-Fuel Kit 0 PA cover for Paid Driver of Rs 2,00,000 (IMT± 0
Third Party Liability For Geographical Area Extension 0 Legal Liability For Paid Driver (IMT-28) 50
PA Cover For Owner Driver Of Rs. 1500000 (IMT- 325 Legal Liability for Employees (for 0 persons) (IMT± 0
15) Net Liability Premium (B) 3596

Note: 1.Warning that in case of dishonour of the premium cheque, this document stands
automatically cancelled 'ab-initio Total Premium (A+B) 5691
.2.Consolidated stamp duty paid to state exchequer. CGST (9%) 513
3.The policy is subject to compulsory deductible of Rs.1000 (IMT-22) SGST (9%) 513

6.The insurance company will display terms & conditions on its website www.iffcotokio.co.in which can
be accessed by you online.
*Subject to IMT Endt. Nos.& Memorandum:7,22,28
EX-SHOWROOM PRICE : 540000
Gross Premium Paid 6,717

Nominee Details
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
SAI KRISHNA K S 37 SPOUSE --N.A-- --N.A--
Payment Details : Cheque No.: 111399895733, Cheque Date: 29-JAN-2022, Bank Name: PAYLINK, Bank City:
Hypothecation Details: STATE BANK OF INDIA - HYDERABAD - HYDERABAD
MISP Name: MALIK CARS, MISP PAN No: AAGCM3282P, MISP Code: TMIBASL/MISP/AAGCM3282P
SAC:997134, Description of Service :Motor Vehicle Insurance Services, Place of Supply :TELANGANA(State Code:36)
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 provisions of Chapter X and Chapter XI of Motor
Vehicle Act, 1988
For & On Behalf of IFFCO Tokio General Insurance Co. Ltd.

Authorized Signatory
In case of any claim or assistance required please contact our help line at 1800 209 0060 and you may also reach us at support@tmibasl.com
 IFFCO Tokio General Insurance Co. Ltd.
Servicing Office of Insurer: 2nd FloorAbove Con Agra Foods, Road No. 31, Lane Opp. DBR
DiagnosticsS.D. Road, Secundrabad, Telangana (State Code:36) -500003, PH-- Website:
www.iffcotokio.co.in
PAN: AAAC17573H . GSTIN: 36AAACI7573H1ZD Insurer's IRDA Registration Number: 106
Tollfree Helpline 040-27718944, 27718945, 277189 Email: CIN : U74899DL2000PLC107621
PRIVATE CAR PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 18144678 Policy Issued On 29-JAN-2022 (12:01)

Insured Name MRS. SAHITHI VITTALA
Own Damage Period 31-JAN-2022(00:00) To 30-JAN-2023(Midnight) Motor Liability Period 31-JAN-2022(00:00) To 30-JAN-2023(Midnight)

Limitations as to use: The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of
goods (other than samples or personal luggage) (3) Organized racing (4) Pace making (5) Speed testing (6) Reliability trials
(7) Any purpose in connection with motor trade.

Driver¶s Clause: Any person including the insured: Provided that the person driving holds an effective driving license at
the time of the accident and is not disqualified from holding or obtaining such license. Provided also that the person holding
an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the
Central Motor Vehicle Rules, 1989.

Limits of Liability Clause: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 Vehicle Act 1988.Under Section II-1 (ii) of the policy-Damage to third party property is
Rs.7.5lakhs PA Cover Under Section III for Owner-Driver is Rs. 1500000

NCB Clause: 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)-20%, preceding two consecutive years-25%, preceding three consecutive
years-35%, preceding four consecutive years-45%, preceding five consecutive years-50% of NCB on OD Premium. NCB is
allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.

Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the
schedule. Any payment made by the company by reasons 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 ³AVOIDANCE OF CERTAIN TERMS
& RIGHT OF RECOVERY´For legal interpretation English version will hold good.

Note: This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or
expression to which a specific meaning has been attached in any part of this policy or of the Schedule shall bear the same
meaning wherever it may appear. Any amendments/modifications/alterations made on this system generated policy
document is not valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes
required to be made in the policy once issued would be valid and effective, only after written request is made to the
Company and Company accepts the requested amendments/modifications/alterations and records the same through separate
endorsement to be issued by the company.
In Witness whereoff this policy has been signed at HYDERABAD on 29-JAN-2022 12:01