Policy Number : P0024300002/4103/107063

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149RP0006V02201213

COMMERCIAL VEHICLE CLASS (GCV) PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE /TAX INVOICE
Policy Servicing Office 1ST FLOOR, PALLIPATT ILLOM, NO. 62/6451 B1, KOSHY AVENUE ROAD ,ERNAKULAM -682011 ,KERALA , PH: (1800) 2663202
Policy No P0024300002/4103/107063
Insured Mr ROY
Address ADUMAMKAD HOUSE,CHEMBUKAVU P.O.THRISSUR Period Of Insurance 00:00 Hrs of 15/03/2024
THRISSUR To Midnight of 14/03/2025
KERALA 680020 Agent No.: BRC0000386
Mobile:6282018281
Contact Number 6282018281 Hypothecation with LEASE INDEX INDIA LTD
Email ID:
GST Number
INSURANCEYELLA0@GMAIL.COM
Unregistered 9037939834,7012277602
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & Trolley Chassis Year of
Trolley Serial ID Engine No. Chassis No. Make/Model/Type of Body GVW POLICY CLASS SEATING CAPACITY
No. & RTA Location No. Manufacture
A1 GCV Public
KL 08 AX 8949 / MAHINDRA &
2012 HRC6F31967 MA1FA2HRRC6F12625 1800 Carriers other than 3 2
THRISSUR MAHINDRA MAXXIMO BS4/PICKUP
wheelers
IDV (INSURED'S DECLARED VALUE)
Electrical/electronic
IDV of Chassis IDV of Body Trailers Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
105000 0 0 0 0 0/0 0 105000
OWN DAMAGE(A) LIABILITY(B)

Basic - OD 380.52 Basic - TP 16,049.00

Loss/damage to lamps/tyres/mud guards etc. - IMT-23 57.08 PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s) 450.00
Sub Total 437.60 Under WC act-Driver/cleaner/employees-IMT 28 50.00
Less: Sub Total 16,549.00
No claim bonus 20% 87.52
Sub-Total Deductions 87.52
Total Own Damage Premium(A) 350.00
CGST @ 9% 31.50
SGST @ 9% 31.50
Total Liability Premium(B) 16,549.00
GST on TP Premium
CGST @ 6% 962.94
SGST @ 6% 962.94
GST on Other Liability Premium
CGST @ 9% 45.00
SGST @ 9% 45.00
Premium Computation
Total Package Premium(A+B) 16,899.00
TOTAL CGST 1,039.44
TOTAL SGST 1,039.44
TOTAL 18,978.00

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 entitled to Any person including Insured:
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 effective
Goods carriage 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.
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 effective
Non-transport
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
Vehicles
Rules, 1989.
LIMITS OF LIABILITY
Under Excess in respect of each and every claim under Sec I of motor Under In respect of any one Under Damage to Third Party Property Rs. 750000/- Under PA Owner – Driver as per
Section I policy Section II-I accident -- As per Motor Section II-I in respect of any one claim or series of claims Section III: premium computation table
Compulsory : Rs. 500/- Voluntary : Rs. 0/- Imposed : Rs. 0/- (i) Vehicle Act (ii) arising out of one event.
Total : Rs. 500/-
Subject to I.M.T Endorsement Nos. IMT 7,IMT 21,IMT 23,IMT 28
Pollution Under Control(PUC)
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as applicable, on the date of commencement of the Policy and undertakes to
renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of the Policy. Further, the Company reserves the right to take appropriate action in case of any discrepancy in the PUC
or fitness certificate at the time of issuance of policy.
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship Percentage
MARY 10/03/1971 53 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 Collection Details :- [Collection No - ReceiptDate - Amount] : P/300002/24/101198410- 14/03/2024 , 18978
Premium Amount in Word's ( ) :- Eighteen Thousand Nine Hundred Seventy-Eight Only
In case of Claims, please contact us at 1800 266 3202 For Magma HDI General Insurance Co. Ltd.

Date of Issue : 14/03/2024

Place : Kolkata
Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1879, dated 16.10.2023

GST Number of MHDI - 32AAGCM1685C1ZS

GST Invoice Number - POL3203240002953
Accounting Code for Service - 997134, Motor vehicle insurance services

Place of Supply:KERALA ( 32 )
Authorised Signatory
Whether Tax is payable on Reverse Charge - No
UIN : IRDAN149RP0006V02201213
This is a valid Tax invoice in terms of Sub-rule 2 of Rule 54 of CGST Rule 2017. Further, being an Insurance Company, issuing of e-invoice and QR Code are
not applicable on us in terms of Notification No 13 and 14 of 2020 dated 21st March 2020 issued from Central Board of Indirect Taxes and Customs. I/We
hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified
under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
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. Please note that any