ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Stand-alone OD Policy ( Private Vehicle ) Proposal No. & Date SR3457989 / 01-Jan-0001
Policy No. & Type M10133180 Period of Insurance 06-Dec-2020 to 05-Dec-2021
Policy Issued On 02-Dec-2020 (00:00) Vehicle Identification No. MA3NYFB1SKL603663
Insured Name Mr K Niranjan Chowdary Geographical Area INDIA
Invoice No M101331800000 Accounting Code of Service 997134
Insured Address S/O MR K RAMANJINEYULU,RSI B18 QUATER'S, KONDAPUR POLICE LANE,KNDAPUR,RAGHAVENDER COLONY, 8897848789, ,
RANGAREDDY-500084, Telangana
Insured State & Code Telangana-36 Place of Supply Telangana GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 680390
Model & Variant VITARABREZZAVDI/MARUTI VITARABREZZAVDI Non Electrical Accessories 0
Registration No TS07HA3627 Electrical Accessories 0
Year of Manufacture 2019 CNG/ LPG Kit 0
Engine- Chassis No 3571164 - MA3NYFB1SKL603663 Total IDV 680390
Cubic Capacity 1248
Seating Capacity 5
Type Of Body Saloon
RTO Location TS07HA3627 / RANGAREDDY
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) Pre-Existing Third Party Policy Details.
Vehicle 4776 Insurance Company Name ROYAL SUNDARAM GENERAL INSURANCE CO. LIMITED
Elec. Accessories 0 Policy No. MOBL202442
Non- Elec. Accessories 0 Risk Inception Date 06-Dec-2019
Kit (IMT-25) 0 Risk Expiry Date 05-Dec-2022
Extra Premium towards Inbuilt CNG/LPG NA
Basic Premium 4776 MISP - Jayabheri Automotives Pvt Ltd, HYDERABAD
Geographical Area Extn. (IMT-1) NA
Lamp, Tyres etc. (IMT 23) 0 Notes : ( For Stand-alone OD Policy )
Driving Tuition Loading On OD Premium (60%) NA
1. Policy Issuance is the subject to the realisation of cheque.
Fiber Glass Tank 0 2. Consolidate stamp duty paid to State Exchequer
Sub-Total Additions 0 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Deductibles 4. Voluntary excess Rs (0)
Voluntary Deductibles (IMT 22A) 0 5. Subject to Endorsements IMT ,7 10,
6. UIN : IRDAN108RP0001V01201920
Anti-Theft Device (IMT-10) 119 7. The Coverage under this policy is only for Own Damage and no other liability in connection with
AAI Membership (IMT-8) 0 the vehicle.
No Claim Bonus (20%) 931
Discount for vehicles designed for handicapped NA
Sub - Total Deductibles 1050
Add - On Coverages
Depreciation Re-imbursement 4082
Engine Secure 1361
Return To Invoice 1361
Net own Damage Premium (A) 10530
CGST@9% 947.70
SGST@9% 947.70
Total OD Premium 12425
Nominee Details : Nominee Name K RAMANJINEYULU Age 50 Relation Father
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Visa Credit Card 109028001361 ELECTRONIC PAYMENT 12425
Financier Type Financed Financier Name HDFC BANK LIMITED. Financier Branch BANJARAHILLS
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.
Driver: 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.
Deductibles: Deductible under section-I : Rs 1000(Compulsory Deductible Rs 1000 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
No Claim Bonus: 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 following: The preceding year/20%,
Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will only be 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 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". For Legal interpretation, English
version will hold good.
For information on ombudsman you may visit website : http://www.gbic.co.in/ombudsman.html
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 M.V. Act, 1988.
For Tata AIG General Insurance Company Limited

Authorized Signatory
Policy Issuing Office:-5th and 6th Floor, Imperial Towers, H.No 7-1-6-617/A, GHMC no - 615,616, Ameerpet, Hyderabad
GSTIN: 36AABCT3518Q1ZX, CIN No.:U85110MH2000PLC128425
State Name : Telangana