Auto Secure Private Car Package Policy

NewBusinessDocument-TrackOn-1-5066038

Policy No : 0163546522 00 0 Date : 09/08/2022

Name : Akshay Bhardwaj Your Policy Details
Address : Flat No 2204 Flamingo Bldg Near Cardinal Patlipad Policy Number : 0163546522 00 0
a Than
Thane - 400607 Policy Period : 08/08/2022 to 07/08/2023
Thane - Maharashtra
Premium Paid : ` 12,926.00

Dear Akshay Bhardwaj,

Welcome to Tata AIG General insurance Company Limited family &

We thank you for choosing our Auto Secure Private Car Package
Policy for your vehicle insurance.

We are enclosing Policy schedule cum certificate of insurance of

your vehicle. You are requested to visit our website
www.tataaig.com for policy wording.

We would like to inform you that policy has been issued based on
the information and declaration provided by you. No claim Bonus
(NCB) if shown on your policy schedule has been allowed as
you had not reported any claim in the previous policy.

Kindly go through the enclosed information / declaration provided

by you and in case your policy shows No claim Bonus, for which
you are not entitled as explained above or any other
error/discrepancy then we request you to get in touch with us
within 15 days of receipt of the policy for correction otherwise all
particulars will be deemed to be correct.

You may reach us at our 24*7 helpline 1800 266 7780 for
providing any information or in case you desire to have a printed
copy of policy wording.

We, thank you once again , for choosing Tata AIG General
insurance Company Limited for insuring your vehicle. We assure
you of our best of services at all times. Happy driving!

Regards,

Signature Not Verified

Digitally signed by DS TATA AIG GENERAL INSURANCE COMPANY LTD.
Date: 20220822233138
Reason: Production
Location: Mumbai

Tata AIG General Insurance Company Limited.

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
Page 1 of 5
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, PAN : AABCT3518Q, UIN:IRDAN108P0002V01200001
 Certificate of Insurance and Policy Schedule form 51 of the Central Motor Vehicle Rules,1989
Agent/Broker Name :- Marsh India Insurance Brokers Pvt Ltd
Agent/Broker License Code :- 120 Agent/Broker:Contact No :- 022-66512947
Certificate & Policy No 0163546522 00 0 Policy Type Auto Secure Private Car Package Policy
Period of Insurance From 00:00 Hours on 08/08/2022 Date of Expiry To midnight of 07/08/2023
Insured Name & Address: Premium (Incl. of all applicable taxes) ` 12,926.00
Akshay Bhardwaj Insured Business/Profession OTHER
Flat No 2204 Flamingo Bldg Near Cardinal Patlipada Than India
Thane - 400607 Geographical Area
Thane - Maharashtra Registration Authority MUMBAI CENTRAL

HPA/HYP/Lease to N/A

Lessor GSTIN Number:

Registration Mfg. Seating
Make & Model Engine No. Chassis No. CC Body Type
No. Year Capacity
MH01CP9194 MARUTI BALENO ALPHA K12MN7122662 144187 1197 2017 SALOON 5

IDV of Vehicle (`) IDV of trailers Bi-Fuel/CNG/ IDV of non-built-in Accessories (`) Total Insured
(`) LPG Kit (`) Declared Values
Electrical Non-Electrical IDV- (`)
431,811.00 0.00 0.00 0.00 0.00 431,811.00
SCHEDULE OF PREMIUM
A. Own Damage B.Liability
Premium on Vehicle and non electrical accessories ` 3,544.09 Basic ` 3,416.00
Add: Legal Liability to paid driver as per (IMT 28) ` 50.00
Consumable Expense ` 215.91 Add:One YearCompulsory PA cover for Owner Driver Rs. 1500000 ` 375.00
A. TOTAL OWN DAMAGE PREMIUM ` 3,544.09 PA cover to unnamed passengers (IMT 16) No. of Passengers : 5 CSI per passen
` 350.00
ger Rs.140000
Add: Depreciation reimbursement (TA 01) ` 949.98
B. TOTAL LIABILITY PREMIUM ` 4,191.00
Add: Engine Secure (TA16) ` 647.72 COMPREHENSIVE PREMIUM (A+B+C) ` 10954.13
NET PREMIUM ` 10954
Add: Loss of Personal belonging (TA09)
` 110.00 IGST@18% ` 1,972.00
Sum Insured: Rs 10000 Amount Payable(Inclusive of all applicable taxes) ` 12,926.00
Add: Return of invoice (TA05) ` 1,295.43

C. TOTAL ADDON PREMIUM ` 3,219.04

Drivers Clause : Persons or classes of persons entitled to drive : Any person including the insured: Provided that a person driving holds an effective driving licence at
the time of the accident and is not disqualified from holding or obtaining such a licence. Provided also that the person holding an effective Learner's Licence may also
drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
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.
Limits of Liability:
Under Section II-1 (i) of the policy (Death of or bodily injury) : Such amount as is I/we hereby certify that the Policy to which this Certificate relates as well as
necessary to meet the requirements of the Motor Vehicles Act, 1988. this Certificate of Insurance are issued in accordance with provisions of
Under Section II-1 (ii) of the policy (Damage to Third Party Property) : ` 7,50,000.00 Chapter X and XI of Motor Vehicles Act,1988.In witness whereof this Policy
has been signed at BANGALORE on 09/08/2022
Under Section III: P.A. to owner Driver CSI : ` 15,00,000.00
Nominee: - Relationship: OTHERS Receipt(s): 105001033660925 Date: 05/08/2022

Number of claims covered under Depreciation Reimbursement Cover : 2

Basis of claim settlement for Tyre Secure cover N/A
This
: policy does not cover pre-existing damages as per Inspection photographs and Reports.
Deductible under Section-I: ` 1000.00, - (Compulsory Deductible: ` 1000.00 Voluntary
Deductible: ` 0 Imposed Excess:` 0) Franchisee : NA
Deductible under Engine Secure addon cover 5% of claim amount in case of repair and
: 10% of claim amount in case of
replacement.
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 follows: The preceding year - 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 will only be allowed provided the policy is
renewed within 90 days of the expiry date of the previous policy.

Cover_Level_UIN

Tata AIG General Insurance Company Limited.

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013 Page 2 of 5
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, PAN : AABCT3518Q, UIN:IRDAN108P0002V01200001
Subject to: A) IMT Endorsement No.: 28 , 16 , 22
B. TATA AIG Auto Secure endorsement No.(TA): 09,18,01,16,08,05 Place of Supply : KARNATAKA Supply Code :27
GSTIN: 29AABCT3518Q1ZS - KARNATAKA Service Accounting Code: 997134
Policy Servicing Office: 2ND FLOOR, JP & DEVI JAMBUKESWAR ARCADE, NO.69 MILLERS ROAD, BANGALORE, KARNATAKA, BANGALORE-560052, ,080-66272829

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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed “AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY”.

Note : This Schedule, Policy terms and conditions available on company website 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.
You are advised to go through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim Bonus or any
other material information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. You may visit
company website at www.tataaig.com for detailed benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of policy
wording. Our grievance redressal procedure and details about ombudsman is also available in our policy wording.
Please note that any misrepresentation, non disclosure or withholding of material facts will lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any. We will specifically
seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we receive confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own
damage section of the policy.

For Policy wordings, please scan the below QR code :

Page 3 of 5

Tata AIG General Insurance Company Limited.

 RECEIPT

Receipt No. 105001033660925 Receipt Date : 05/08/2022

Policy No : 0163546522 00

Received with thanks from AKSHAY BHARDWAJ a sum of ` 12926.00 ( Rupees Twelve Thousand Nine Hundred Twenty-Six And Paise Zero Only)vi
de Credit / Debit Card No 9999XXXXXXXX9999 dated 05/08/2022 Name as in credit/debit card - AKSHAY BHARADWAJ drawn on HSBC BANK, branc
h towards

Sl. Policy Total Premium (`) Utilized from the receipt for Balance (`)
No. Number policy (`)
1 0163546522 00 12,926.00 12,926.00 0.00

Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt,all previously issued temporary receipts,if any,related to this Policy shall be considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.

GSTIN: 29AABCT3518Q1ZS - KARNATAKA SAC: 997134.

Revenue (Consolidated) Stamp Duty paid vide challan No. LOA_NO.CSD/270/2022/727 date 10/02/2022 for applicable cases.

Tata AIG General Insurance Company Limited.

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, PAN : AABCT3518Q, UIN:IRDAN108P0002V01200001
Page 4 of 5
 Transcript of Proposal for Auto Secure Private Car Package Policy

1 Name (Registered Owner of the Motor Vehicle)* : Akshay Bhardwaj

2 Address for Communication* : ,Flat No 2204 Flamingo Bldg Near Cardinal Patlipada Than,,,,Thane,Thane,Maharashtra,400607

3 Vehicle Details: Please refer policy schedule cum certificate.

4 Vehicle Purchased is: N/A 5. Vehicle Type : Indigenous

6 Fuel Type: Petrol
7 Insured’s Declared Value - Please refer policy schedule cum certificate.
8 Previous Insurance Particulars*:
Policy Number*: 0162226899 Date of Expiry*: 07/08/2022 Type of Cover : N/A

Name of the Insurer*: TATAAIG

Accident in the previous policy period: NO NCB in previous policy: 0 NCB claimed: N/A

9 Period of Insurance Desired from*: 08/08/2022 to midnight of 07/08/2023

10 Financier’s Details: Please refer policy schedule cum certificate.
11 Extra Benefits opted
Un-Named Persons Personal Accident Cover for seating capacity, including driver: Yes
Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) : Yes
Personal Accident Cover for Owner Driver: YES
Name of the Nominee : - Age : 35 Relationship: OTHERS
Name of Appointee (if Nominee is Minor) N/A Relationship to the Nominee: N/A
12 Restriction of Cover/Discounts/Concessions/Extended Covers

Name of Automobile Association : N/A Membership no : N/A

Third Party Property Damage Cover restricted to ` 6,000/ only : No
Is Voluntary Deductible opted : NO Amount of Deductible opted : N/A
Vehicle is fitted with Anti Theft Device approved by ARAI : N/A
13 Add on covers - Please refer policy schedule cum certificate.
14 Bank Details (Required for Refund / Claims)

Name of the Account Holder: Akshay Bhardwaj

Name of Bank & Branch: N/A Account Number: N/A IFSC Code of Bank: N/A
15. Declaration for No Claim Bonus (If NCB Confirmation is not submitted but NCB claimed)
I/We 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 respect of Section-1 of the Policy
will stand forfeited.

16 I hereby give my consent to receive one page insurance policy.

17 AML Guidelines:

1 I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of
proceeds of crime related to any of the offence listed in Prevention of Money Laundering Act, 2002.

2 I understand that the Company has the right to call for documents to establish sources of funds.

3 The insurance company has right to cancel the insurance contract in case I am/have been found guilty by any competent court of
law under any of the statutes, directly or indirectly governing the prevention of money laundering in India.

18 We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

Tata AIG General Insurance Company Limited.

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
Page 5 of 5
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, PAN : AABCT3518Q, UIN:IRDAN108P0002V01200001