DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

(www.magmahdi.com)
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0006V02201213

Date : 23/03/2020

 
To,  
Mr OGGU RAVI KUMAR
S/O SWAMYELU LATE D.NO.000 ,AGIRIPALLI
KRISHNA
ANDHRA PRADESH 521211
Mobile:8977779975

Agent/ Intermediary Name and Code:CHAGANTIPATI MALLIKARJUNA RAO  POS0004710

Sub: Risk Assumption Letter

Dear Sir /Madam,

T h a n k y o u f o r c h o o s i n g M a g m a- H D I G e n e r a l I n s u r a n c e C o m p a n y L i m i t e d a s y o u r p r e f e r r e d G e n e r a l I n s u r a n c e C o m p a n y . P l e a s e f i n d e n c l o s e d P o l i c y
No. P0020300021/4103/105398, which has been issued based on the details furnished to us as below:
Insured & Vehicle Details

Name of Insured M r  O G G U   R A V I   K U M A R  

Period of Insurance  23/03/2020 TO 22/03/2021  

Vehicle Make/Model  MLR MOTOR PVT LTD / TEJA HANDY
RTO  GUDIVADA / VUYYURU / KRISHNA
Vehicle Registration No.  NEW  
Vehicle Registration Date  23/03/2020 
Engine No.  A8H1230411 
Chassis No.  MBP53CDTKJT002919 

The information received from you are reproduced in the proposal attached with this Risk Assumption Letter and your proposal has been processed accordingly.
Coverage of risk is subject to realisation of the full premium post which, insurance coverage under the policy would commence. In case the premium is not
received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab- initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at customercare@magma-
hdi.co.in or calling our toll free helpline on 1800 266 3202. Absence of any communication from you in this regard within a period of 20 days of date of this
letter, would mean that the issued policy is in order and as per your proposal. The Risk Assumption Letter is to be read in conjunction with the policy and shall
be considered as null and void without the same.
 
Thanking You,
Regards

For Magma HDI General Insurance Co Ltd.

  
Authorised Signatory
  

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149P0006V02201213
 
COMMERCIAL VEHICLE CLASS (PCV) PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office 2ND FLOOR, SURVEY NO. 134/3, PLOT NO. 16 ,TEACHERS'' COLONY, GURUNANAK ROAD,PATAMATA ,KRISHNA -520008 ,ANDHRA PRADESH 
Policy No P0020300021/4103/105398 
Insured Mr OGGU RAVI KUMAR 
Address S/O SWAMYELU LATE D.NO.000 ,AGIRIPALLI  Period Of Insurance 18:06 Hrs of 23/03/2020
KRISHNA  To Midnight of 22/03/2021
ANDHRA PRADESH 521211 CHAGANTIPATI MALLIKARJUNA RAO-POS0004710-
   Agent No.:
Mobile:8977779975  497564591658
Contact Number 8977779975   Agent Contact No.: 9992729993
Email ID:  
GST Number Unregistered  
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & CUBIC PASSENGER
Year of Manufacture Engine No. Chassis No. Make/Model/Type of Body VEHICLE SUB CLASS SEATING CAPACITY
No. & RTA Location CAPACITY CARRYING CAPACITY
NEW  / C1B PCV 3 Wheeler not
MLR MOTOR PVT
GUDIVADA / 2018  A8H1230411  MBP53CDTKJT002919  436/436  exceeding 6 3  4 
LTD TEJA HANDY/RICKSHAW 
VUYYURU / KRISHNA passengers 
IDV (INSURED'S DECLARED VALUE)
Electrical/electronic
IDV of Chassis   IDV of Body   Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
175000  0  0  0  0 / 0  0  175000 
OWN DAMAGE(A)     LIABILITY(B)    
Basic - OD   441.00 Basic - TP   6,318.00
Sub Total   441.00 PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s)   380.00
Add: Under WC act-Driver/cleaner/employees-IMT 28   50.00
Built in CNG - OD loading - OD   22.05 Sub Total   6,748.00
Sub-Total Addition   22.05 Add:
Total Own Damage Premium(A)   463.00 Built in CNG-TP Loading-TP   60.00
Sub-Total Addition   60.00
  Total Liability Premium(B)   6,808.00
 Premium Computation
  Total Package Premium(A+B)   7,271.00
CGST @ 9%   654.39
SGST @ 9%   654.39
TOTAL   8,580.00
 Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :
LIMITATIONS AS TO USE - The Policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor Vehicle's Act
1988.
The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle
(only for Passenger Carrying Vehicles).
Persons or classes of persons
Any person including Insured:
entitled to drive:
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 a license.Provided also that the person holding an
Stage carriage/Contract Carriage/
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
Private Service Vehicle
Motor Vehicles Rules, 1989.
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 a license.Provided also that the person holding an
Non-transport Vehicles 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
Under Excess in respect of each and every claim under Sec I of motor policy Under In respect of any one Under Damage to Third Party Property Rs. 750000/- Under Section PA Owner – Driver as per
Section I Compulsory : Rs. 500/-  Voluntary : Rs. 0/-   Imposed : Rs. 0/- Section II-I accident -- As per Motor Section II-I in respect of any one claim or series of claims III: premium computation table
 Total : Rs. 500/- (i) Vehicle Act (ii) arising out of one event.
Subject to I.M.T Endorsement Nos. IMT 21,IMT 25,IMT 28,IMT 38 
  NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship Percentage
 SUNITHA  13/03/1986  34  WIFE  100
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.

Premium Amount in Word's ( ) :- Eight Thousand Five Hundred Eighty Only

In case of Claims, please contact us at 1800 266 3202 For Magma HDI General Insurance Co. Ltd.

Date of Issue : 23/03/2020

Place            : Kolkata
Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1661 FT, dated 25/09/2019

    
GST Number of MHDI - 37AAGCM1685C1ZI
GST Invoice Number - POL3703200005196
Accounting Code for Service - 997134, Motor vehicle insurance services
Authorised Signatory     
Place of Supply:ANDHRA PRADESH ( 37 )

Whether Tax is payable on Reverse Charge - No

 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 be good.  

For Complete details of coverage , terms, conditions & exclusion please refer the standard policy wording attached with this schedule

IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
 We at MAGMA HDI prefer receiving premium amount through cheque
No. CV/202003230018987
 
   Helpline No : 1800 266 3202    
 
(Information for fields marked with asterisk [*] is mandatory)

Proposal Form for Commercial Vehicles

Customer ID  20005025693  
 *Proposal For:        New Policy        Roll- Over        Renewal        Endorsement

*Coverage        Comprehensive Package Cover        Third Party Liability only Cover        Third Party, fire & theft only Cover
Required:        Third Party and Fire only Cover        Third Party and Theft only Cover  
* Period of Insurance:  23/03/2020  Time:  18:06  ,To  22/03/2021
(Note: Cover shall not commence earlier than the date and time of acceptance of risk and/or issuance of cover note and subsequent to payment of premium)
 Intermediary Code:  POS0004710-497564591658  Intermediary Name:  CHAGANTIPATI MALLIKARJUNA RAO

1. *Proposer Details:
1. Name (Registered Owner of the Vehicle): Mr OGGU RAVI KUMAR 

 
 
 PAN No:    *DOB:  01/01/1982  *Gender:         M          F  *Occupation:    *Marital Status:  Single
Bank Name Branch Name A/c Type-         Saving          Current
Account No.   MICR    IFSC  
2. *Address where Vehicle Registered and Based
S/O SWAMYELU LATE D.NO.000, AGIRIPALLI, KRISHNA, ANDHRA PRADESH 521211, 8977779975 ,Mobile:8977779975 
GST Number Unregistered  
3. *Communication Address (For policy dispatch)
S/O SWAMYELU LATE D.NO.000, AGIRIPALLI, KRISHNA, ANDHRA PRADESH 521211 
GST Number Unregistered  
4. City where the vehicle will primarily be used: KRISHNA 

5. Have you previously insured this vehicle?         Yes          No  Policy No.
If so, are you entitled to No Claim Bonus from your previous Insurer?         Yes          No

If Yes, Kindly indicate the percentage:     20%     25%     35%     45%     50%     55%     65%

I/We hereby declare that the rate of NCB claimed by me/us is correct and that NO CLAIM has arisen in the expiring policy period (Copy of Policy enclosed). I/We further undertake that if this declaration is found incorrect, all benefits
under the Policy in respectof Section1 of the Policy will stand forfeited.

 
Signature of Proposer    
6. About the Motor Vehicle to be Insured
 *Vehicle Type:        2 Wheeler        3 Wheeler        4 Wheeler        More than four wheels  *Vehicle Insured is:        New        Used
*Make  MLR MOTOR PVT LTD *Chassis No  MBP53CDTKJT002919 Speedometer reading as on date  
*Model  TEJA HANDY RTO where vehicle will be registered  GUDIVADA / VUYYURU / KRISHNA *Vehicle IDV  0
*Year of Manufacture OCTOBER  - 2018 Date of Registration /Purchase  23/03/2020 Trailer(s) Identification No.  1_________
*CC/GVW  436 Licensed Carrying Capacity  4    2_________
(No of Passengers Including driver)
*Registration No.  NEW  Â   3_________
Type of Body  RICKSHAW Colour of the vehicle    4_________
*Engine No.  A8H1230411 Vehicle Make (Indigenous or Imported)  TEJA HANDY 
Note: Either Registration no or Engine and Chassis Number is mandatory
*Vehicle Rate Under:                        Zone -A                Zone -B                Zone -C
*Fuel Used:         Petrol         Diesel         Bi Fuel         LPG/CNG         Electric         Hybrid         Others (please specify)
*Purpose of Use:         Good Carrying (Private Carrier)         Passenger Carrying (Private carrier)         Good Carrying (Public Carrier)
          Passenger Carrying (Public Carrier)         Others (Please specify) 
Proposed usage of the vehicle? (Applicable only to passenger carrying vehicles with seating capacity not exceeding 6)
        Driven by the owner(s) only,         Driven by the owner(s) only along with other drivers,         Driven by other drivers,         For rent to tourists,         For rent to individuals for personal use,
        Business purposes by Hotels,         Business purposes by Corporates, Official purposes by foreign embassy/ consulate
*Type of Permit:         Hilly         National/State Highways         City/Town Road         District Roads         Others
* Average Monthly usage :         Less Than 500 Kms;         Between 501 and 2500 Kms;         Between 2501 to 5000 Kms ;         Above 5001 Kms
Whether any modification or conversion has been done in the vehicle from the maker’s standard specification?         Yes         No
If Yes, please give details of such modifications/conversions .............................................
Is the vehicle in good state of repair?         Yes         No  If No, please furnish details ..........................................
 
Nature of Goods carried by vehicle        Hazardous        Non-Hazardous
7. Financier Details:                Hypothecation                Hire Purchase                Lease        Financier Name :  

8. Nominee Details :     Nominee Name:  SUNITHA  DOB  13/03/1986  Relationship  WIFE

   Appointee Name & age    *If Nominee is minor (below 18 yrs) Appointee Name is mandatory.
9. Insured Declared value of the Vehicle:
The IDV of the vehicle will be deemed to be the Sum-Insured for the purpose of the Policy and will be fixed on the basis of the manufacturer’s listed selling price of the brand and model as the vehicle proposed for insurance at the time
of commencement of insurance / renewal and adjusted for depreciation as per the schedule specified below.
Age of the Vehicle % of Depreciation   *Vehicle Chassis Value  175000

Not exceeding 6 months 5%   Vehicle Body Value  

Exceeding 6 months but not exceeding 1 year 15%   Non- Electrical Accessories (Other than factory fitted): Details  

Exceeding 1 year but not exceeding 2 years 20%   Electrical Accessories (Other than factory fitted) Details  

Exceeding 2 years but not exceeding 3 years 30%   Bi- Fuel/ CNG/LPG Kit  

Exceeding 3 years but not exceeding 4 years 40%   Trailer(s)/ Side Car Value (only for 2 wheelers):  

Exceeding 4 years but not exceeding 5 years 50%   Total IDV:  

Note - For vehicles more than 5 years old, please contact the Company for fixing the IDV
 We at MAGMA HDI prefer receiving premium amount through cheque
10.  Extended Covers/ Extra Benefits at Additional Premium:
Extension of Geographical Area: Vehicle is fitted with Fibre Glass Fuel Tank                Yes            No
 
       Bangladesh             Bhutan                Nepal  Vehicle will be used for Driving Tuitions                    Yes            No
 
       Maldives             Pakistan                Sri Lanka  Imported vehicle without payment of customs duty             Yes            No
 
Compulsory Personal Accident (If owner has a valid driving license) Personal Accident Cover ( Max Rs 1 lakh for two-wheelers and Rs 2 Lakh for other class of vehicles each in multiples
          Yes            No of Rs. 10000/- ) for paid driver / cleaner / conductors

No. of Persons.  0 CSI per person   0
Legal liability to paid driver/ conductor/ cleaner employed in operations of vehicle
No of Persons 1
Legal liability to employees travelling in/driving the vehicle other than paid driver.  Legal liability non-fare paying passengers
No. of Persons No. of Persons. ___________________ CSI per person    _______________________

Additional Towing charges:                Amount:  .......... Vehicle used for Private and commercial purposes :                           Yes          No

Cover for overturning of Mobile Cranes, Mechanical Navies, Shovels, Grabs, Rippers and Excavators, Dragline
Do you wish to cover for loss or damage to lamps, tyres, tubes, mudguard, bonnet
Excavators, Mobile Drilling Rigs and Mobile Plants?              
side parts, bumper and paint work? ( Not applicable for taxis )                          Yes          No
            Yes          No
Do you wish to have an enhanced Personal accident cover for Yourself Do you wish to cover Hospital Cash for hospitalisation arising out of accident
Your Driver / unnamed occupants of the vehicle ?                         for Yourself / Your Driver / Unnamed occupants of the vehicle?     
       Yes            No        Yes            No
If Yes, please provide the Sum Insured per person
11.  Add On Coverage at additional :
NOT APPLICABLE

12.  Restrictions of Cover/ Discounts:
Vehicle fitted with Anti-theft device approved by ARAI :             Yes            No Is the vehicle specially designed for the use by a handicapped person and/ or owned by an institution
exclusively engaged in service of the blind, handicapped and mentally regarded children or adults?
Vehicle will be used within own premises :                               Yes            No
                                       Yes            No
Third Party Property Damage cover restricted to 6000                Yes            No

 *Voluntary Deductible :                                                           Yes             No

                                                                                                   Amount:   ..........
  Signature of Proposer       
13.  Previous Insurance Details:
Previous Insurer Name:     Type of cover:   
Policy/ Cover note number:     Period of Insurance: From  To 
Has any Insurance Company ever: Claims reported in last 5 years
1) Declined the proposal Year 1  2  3  4  5 
2) Cancelled & Refused to renew
3) Required an increase in Premium Type of Claims
         
4) Imposed special conditions or excess (OD/TP)
No. of Claims          
Amount          

14.  Driver Details:  
a. Age & Date of Birth of the Owner                                            :              Age:_______ Yrs  DOB:_____/_____/_____
b. Age & Date of Birth of the Driver                                             :              Age:_______ Yrs  DOB:_____/_____/_____
c. Does the driver suffer from defective
   vision or hearing or any physical infirmity?                                                       Yes            No
   lf YES, please give details of such infirmity                                  :
d. Has the driver ever been involved/convicted
for causing any-accident of loss?                                                                          Yes            No

lf YES, give details as under including the pending prosecutions:

  -Driver's Name :
  -Date of Accident:
  -Loss / Cost ( Rs.)
  -Circumstances of Accident / Loss                                                                         

15.  Premium Details

Total Premium (Including GST):   8,580.00  Payment Mode :    Cash            Cheque                  DD       

Cheque/DD, Cheque No     Bank/Branch    Date.  

Declaration: I/We hereby declare that the statements made by me/us in this Proposal Form are true to the best of my / our knowledge and belief and I/We hereby agree that this declaration shall form thebasis of the contract between
me/us and the Magma HDI General Insurance Co. Ltd.
I/We also declare that any additions or alterations carried out after the submission of this Proposal Form would be conveyed to Magma HDI General Insurance Co. Ltd immediately.
I/We hereby agree to receive a One Page Motor Insurance Policy in Physical Form, to be read along with the detailed Terms and Conditions available on the website www.magmahdi.com
         Yes           No   
I/We further confirm that the existing damages as per the pre inspection report, if any, have duly been shared with me & my consent has been obtained for the same.
I/We hereby declare and undertake that the amount paid by me/us as premium for the aforementioned vehicle is out of my/our lawful and declared source of Income.

 
 
__________________________________ 
Place:   Kolkata                Date:  23/03/2020 Signature of Proposer       
INSURANCE ACT 1938, SECTION 41 â€“ PROHIBITION OF REBATES
1.No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind or risk relating to lives or property in India, any rebate of the whole
or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy, accept any rebate except such rebate as may be allowed in accordance with the
prospectus or tables of the Insurer
2. Any person making default in complying with the provisions of this section shall be punishable with fine, which may extend to Ten Lakhs Rupees.

Signed by : Magma HDI General Insurance Company limited

Time & Date : 23-Mar-2020 18:08:07 IST