Dear Sir/Madam,

Greetings From SUPERNOVA AUTOMOBILES PVT LTD

It’s our privilege to have you as a customer of “KIA Safety” and thank you for insuring your KIA CARENS CARENS G1.5 IMT
LUXURYPLUS7 as per below summary (kindly refer to policy schedule for details):

Policy No.: 3001/O/KA-19532509/00/000 Insurer Name: ICICI Lombard General Insurance Co. Ltd.

Vehicle Registration: GJ 01 WM 7282 Vehicle IDV: Rs.1425520 CNG/LPG IDV: 0

Electrical Accessories IDV: 0 Non Electrical Accessories IDV: 0 Total IDV: Rs.1425520

Compulsory Deductible: Rs.1000 Policy Start Date Policy End Date

NCB % (as declared/eligible): 20% Own Damage: 19-Sep-2024(00:00:00) Own Damage: 18-Sep-2025(Midnight)
Coverage: Stand-Alone Own Damage *Period of Third Party Liability: 19-Sep- *Period of Third Party Liablity: 18-Sep-
Private Car insurance Policy 2023(00:00:00) 2026(Midnight)
Add on Cover(s) opted: Zero Depreciation, Consumable, Engine Protect Plus Cover, Key Protect Cover, Road Side Assistance **
**For Roadside Assistance, please contact the below mentioned toll free number : 18003093965
* As per long term Third Party Liability Policy No. 3001/KA-18468116/00/000 Insurer Name ICICI Lombard General Insurance Co.
Ltd.

As KIA Safety customer, you’ll benefit with a bouquet of feature and services to ensure that ownership of your KIA CARENS and
the insurance policy provides convenience and satisfaction in the event of an unforeseen event.

You benefit with instant insurance coverage of the vehicle as per policy conditions*, a wide range of Motor Insurance Add-on
Covers* with unique features (for more details pls. enquire details from Dealer Designated Person) and access to cashless claims*
settlement across all KIA Motor Dealer Workshops/Service Centres across India.

Renewal* of insurance policies can be at KIA Safety Call Centre or at any KIA MISP Dealer partners with facility of online premium
payment at the convenience from your home, office or while on the move.

In the event should you require assistance on your motor insurance policy, you have access to exclusive and dedicated call centre
(Toll free No. 1800 2666 9666) & helpdesk (contact email - support@kiasafety.com) to assist with your queries and extend support.

We always look forward to your continued patronage and assure our best services.

Best wishes for miles of safe and enjoyable driving and a wonderful ownership experience.

Best regards,
Team KIA Safety

*Subject to Terms and Conditions of insurers & payment of insurance premium. Admissibility of claims at the sole discretion of
respective insurance company. For details please refer to insurers policy terms & conditions
FOR RENEWALS, ENDORSEMENTS, NCB CERTIFICATE, CANCELLATION & REFUND :KINDLY CONTACT SUPERNOVA
AUTOMOBILES PVT LTD at 7043722722

BROKERS DETAILS:
SMC Insurance Brokers Pvt. Ltd.
IRDA – DIRECT BROKER LICENSE NO: DB 272/04 /289
VALID UPTO : 27 Jan 2026
CIN NO.: U66000DL1995PTC172311
Corporate Office: Parsavnath Metro Mall, Pratap Nagar, New Delhi-110007.
Email ID: support@kiasafety.com
Toll Free No: 1800-2666-9666
 ICICI Lombard General Insurance Co. Ltd.
Third Floor, Zodiac Square, S G road, Ahmedabad, Gujarat 380054AHMEDABAD ,
GUJARAT-380054
Help Desk No. : 18002666 IRDA Reg No. : 115 CIN No. : L67200MH2000PLC129408
Servicing Branch GSTIN No. : 24AAACI7904G1ZT PAN No.: AAACI7904G

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE

Policy No.
3001/O/KA-19532509/00/000 Stand-Alone Own Damage Private Car insurance Policy UIN: IRDAN115RP0001V01201920 issued at 05-Sep-2024 (14:27:00)
Proposal No. & Date : PRDKIA10512734, 05-Sep-2024 Period of Own Damage : From19-Sep-2024(00:00:00) To 18-Sep-2025(Midnight)
Insured's Name : MR. AYUDH SARAN Period of Third Party Liability : From 19-Sep-2023 (00:00:00) To 18-Sep-2026 (Midnight)
Insured Type : INDIVIDUAL
PAN Card : CYGPS7559J Previous OD Policy No. : 3001/KA-18468116/00/000
Customer GSTIN : NA Previous OD Insurer : ICICI Lombard General Insurance Co. Ltd.
Insured's Address : C 204, SANGATH 2, MOTERA STADIUM MOTERA ROAD, Previous TP Policy No. : 3001/KA-18468116/00/000
SABARMATI, , AHMEDABAD , GUJARAT-380005 Previous TP Insurer : ICICI Lombard General Insurance Co. Ltd.
Vehicle Details
Registration No. Registration Authority Chassis No. Engine No. CC/KW
GJ 01 WM 7282 AHMEDABAD MZBGC815LPN117224 G4LHPM574976 1497
Variant
Make Model Fuel Type Year of Manufacture
CARENS G1.5 IMT
KIA CARENS PETROL 2023
LUXURYPLUS7
Seating Capacity Vehicle Class Invoice Date Geographical Area Geographical Area Ext.
7 Private 19-Sep-2023 INDIA NO
INSURED'S DECLARED VALUE (Rs.)
YEAR Vehicle Electrical Accessories Non Electrical Accessories CNG/LPG Total IDV
1 1425520 0 0 0 1,425,520
SCHEDULE OF PREMIUM
Own Damage (OD) Premium Amount (Rs.) Amount (Rs.)
Basic Premium Discounts
Vehicle 7,020 Voluntary Deductibles (0) (IMT-22A) 0
Non-Electrical Accessories 0 Anti Theft Device (IMT-10) 0
Electrical Accessories (IMT-24) 0 AA Membership (IMT-8) 0
Bi Fuel Kit (IMT-25) 0 Handicap Discount 0
Sub Total (Basic Premium) 7,020 No Claim Bonus (20%) 1,404
Geographical Area Extension (IMT-1) 0 Sub Total (Discounts) 1,404
Add On (Zero Depreciation, Consumable, Engine Protect Plus Cover, Key
Protect Cover, Road Side Assistance **
Lamp,Tyre Mudguards (IMT - 23) 0 11,491
**For Roadside Assistance, please contact the below mentioned toll free
number : 18003093965)
Sub Total 7,020 Net Own Damage Premium 17,107
Total Premium 17,107
SGST(9.00%) 1540
CGST(9.00%) 1540
Gross Premium Paid 20,187
Note: - 1. Issue of Policy is subject to realisation of cheque if premium is paid by cheque. 2.CONSOLIDATED STAMP DUTY PAID VIDE LETTER OF AUTHORIZATION NO. CSD0220242018
DATED 10 APR 2024 & NOT APPLICABLE FOR THE STATE OF JAMMU & KASHMIR. 3. The policy is subject to compulsory deductible of Rs.1000 (IMT-22). 4. Add on Cover(s) : Zero
Depreciation UIN: IRDAN115RP0001V01201920/A0035V01201819, Consumable UIN: IRDAN115RP0001V01201920/A0008V01201920, Engine Protect Plus Cover UIN:
IRDAN115RP0001V01201920/A0009V01201920, Key Protect Cover UIN: IRDAN115RP0001V01201920/A0010V01201920, Road Side Assistance UIN:
IRDAN115RP0017V01200102/A0027V01201213. Geographical Extension Area : NA.
HSN :997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : GUJARAT(State Code : 24), Invoice Number :18092443287
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 learner’s license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Own Damage Cover is subject to a valid Third Party Policy.
This policy covers damages to vehicle only and not the Third Party losses. Third Party cover is taken by the customer in previous policy, details of which are as per the customer declaration only.
Customer needs to ensure that there is a valid Third Party Insurance Cover at all times.
This Policy covers only Own Damage Risk with no other liability in connection with Stand-Alone Own Damage Private Car insurance Policy vehicle including third party cover and is issued basis the
following : Third party Policy no. 3001/KA-18468116/00/000 , valid from 19-Sep-2023 to 18-Sep-2026 (Midnight), Issued by ICICI Lombard General Insurance Co. Ltd.
Subject to IMT Endt. Nos.& Memorandum:7,22
Hypothecation Details: HDFC BANK LTD. , - AHMEDABAD
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 “AVOIDANCE OF CERTAIN TERMS & RIGHT OF RECOVERY”. For legal
interpretation, English version will hold good.
Grievance Clause: For resolution of any query or grievance, Insured may contact the respective branch office of the Company or may call at (18002666) or may write an email at
(customersupport@icicilombard.com). In case the insured is not satisfied with the response of the office, insured may contact the Nodal Grievance Officer of the Company at
(https://www.icicilombard.com/grievance-redressal). In the event of unsatisfactory response from the Nodal Grievance Officer, insured may email to Head Grievance Officer at (gro@icicilombard.com).
In the event of unsatisfactory response from the Head Grievance Officer, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of Insurance
Ombudsman are available at IRDAI website www.irda.gov.in or on company website www.icicilombard.com or on www.gbic.co.in
The Company reserves the right to cancel this Policy immediately upon becoming aware of any mis-representation, fraud, non-disclosure of material facts or non-cooperation by or on behalf of the
Insured; the Company is not obliged to refund the premium paid under this Policy.
Please visit https://www.icicilombard.com/customer-testimonials/downloads for the policy wordings for complete details on Terms and Conditions.
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
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.
Broker Name : SMC Insurance Brokers Pvt. Ltd. MISP Name : SUPERNOVA AUTOMOBILES For & On Behalf of
IRDA – DIRECT BROKER LICENSE NO :DB 272/04 /289 PVT
MISPLTDCode : 191000372 ICICI Lombard General Insurance Co. Ltd.
(Valid up to 27 Jan 2026) Designated Person Name : KAVITA PATWA
CIN : U66000DL1995PTC172311 MISP Contact No: 7043722722
Email ID : support@kiasafety.com MISP Email: Authorized Signature
Toll Free No. : 1800-2666-9666 insurance1@supernovakia.com
For Renewal, Please Contact:SUPERNOVA AUTOMOBILES PVT LTD | SHOWROOM NO 1,2,3,4 SURYAM TRADE CENTRE, OPP GALAXY HEIGHT, NEAR TORRENT SUBSTATION,
NIKOL, AHMEDABAD AHMEDABAD , GUJARAT- 382350 - CONTACT NO.: 7043722722 OR SMC Insurance Brokers Pvt. Ltd. - Toll Free No. : 1800-2666-9666
Registered & Corporate Office Address:ICICI Lombard House , 414, P Balu Marg,Off Veer Savarkar Marg, Nr Siddhivinayak Temple, Prabhadevi , Mumbai - 400025