Auto Secure Private Car Package Policy

NEWPOLICY-TRACKON-1-33684571
Date : 22/10/2024

Name : MR NAGAKRISHNA YESHWANTH BOBBADI Your Policy Details

Policy Number : 3102332149 00 00
Address : # 1-17/2 BOBBADI PETA NEAR VUDA PHASE -3
Own Damage Policy Period : From 02/11/2024 to. Midnight of
CONTONMENT VIZIANAGARAM
01/11/2025
VIZIANAGARAM
VIZIANAGARAM
ANDHRA PRADESH Liability Policy Period : From 02/11/2024 to. Midnight of
535002 01/11/2025

PA Cover to Owner Driver Policy Period : From 02/11/2024 to.

Midnight of 01/11/2025

Phone : 9989031836 Premium Paid : `12,575.00

Dear MR NAGAKRISHNA YESHWANTH BOBBADI ,

Welcome to Tata AIG General Insurance Company Limited's 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 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 asure you of our best
services at all times.Happy driving!

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, UIN:IRDAN108RP0002V01200001 Page 1 of 6
 Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent Name : CANARA BANK
Agent License Code : CA0045
Agent Contact No : 18004250018
Policy Type: Auto Secure Private Car Package Policy
Policy No: 3102332149 00 00
Cover Note No: Cover Note Issuance Date:
Policy Code : 00/00/3184/02 Period of Insurance
Name & Address of Insured
(Section - I Own Damage) From 00:00
Name : MR NAGAKRISHNA YESHWANTH BOBBADI Hours on 02/11/2024 To Midnight of 01/11/2025 .
Address : # 1-17/2 BOBBADI PETA NEAR VUDA PHASE
-3,CONTONMENT VIZIANAGARAM,, (Section - II Liability) From 00:00
,VIZIANAGARAM,VIZIANAGARAM Hours on 02/11/2024 To Midnight of 01/11/2025 .
ANDHRA PRADESH 535002
Contact Number : 9989031836 (Section - III CPA Cover For Owner Driver) From 02/11/2024 To
Customer Id : 6118138289 Midnight of 01/11/2025
GSTIN :
Place of Supply : ANDHRA PRADESH ZONE : B
Supply Code : 37
Hire Purchase / Hypothecation / Lease With :
RTO LOCATION : ELURU
Geographical Area : India Lessor GSTIN :
Contract/Loan/Reference No:

Licensed
Registration Make / Model / Body Trailer Registration No. carrying
Engine Number Chassis Number Mfg. Year CC/KW
Number Type / Chassis No. Capacity
including driver
MARUTI/ERTIGA
MA3BNC32SMK4
AP 39 LM 9830 SMART HYBRID K15BN9196845 2021 1462 7
00982
ZXI 1.5L MT/MUV
Insured Declared Value (IDV) `
Electrical / Elec
Non Electrical Bifuel / CNG /
Year IDV Of Vehicle tronic Accesso Trailer Side car Total IDV
Accessories LPG Kit
ries
1 787352 0 0 0 0 787352
SCHEDULE OF PREMIUM
Section - I OWN DAMAGE (A) Section - II LIABILITY (B)

Own Damage Premium on Vehicle & Third Party Premium

Accessories Basic TP premium ` 3,416.00
PA Benefits
Basic OD Premium ` 6,281.10
1 Year(s) Compulsory PA cover for Owner Driver ` 375.00
Add: Repair Glass Fiber plastic ` 0.00
TOTAL LIABILITY PREMIUM (B) ` 3,790.90
TOTAL OWN DAMAGE PREMIUM (A) ` 6,281.10
COMPREHENSIVE PREMIUM (A+B+C) ) ` 10,657.00
Section 1 Add On Covers ©
NET PREMIUM ` 10,657.00
Add: Loss of personal belongings (TA 09) Sum
` 135.00 CGST @9% ` 959.00
Insured:10000
Add: Emergency transport and hotel expenses (TA 10) SGST/UGST @9% ` 959.00
` 135.00
Any One Accident : 5000 Any One Year : 10000 TOTAL POLICY PREMIUM ` 12,575.00
Add: Key Replacement (TA 15) Sum Insured: 25000
` 315.00 Road Side Assistance (Inclusive of applicable
per occurrence limit 50% of SI ` 136.88
taxes)
TOTAL ADD ON PREMIUM (C) ` 585.00
Drivers Clause: Persons or classes of persons entitled to drive: 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.

Limitations as to Use: The Policy covers use of the vehicle for any purpose other than : a) Hire or Reward other than for the pAurpose of driving tuitions 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

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
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, UIN:IRDAN108RP0002V01200001
Page 2 of 6
LIMITS OF LIABILITY
Under Such amount Under ` 7,50,000.00 Under Section III ` 15,00,000.00 Number of claims
Section II - as is Section II - 1 : covered under
1 (i) of necessary to (ii) of policy 1 Depreciation
policy meet the (Third Party Year(s) Reimbursement
(Death of or requirements Property Compulsory PA Cover: N/A
bodily Damage) Cover for
of the Motor
injury) OwnerDriver
Vehicles Act, Basis of claim settlement
1988. for Tyre Secure cover :

Deductible
Under UIN Numbers: , IRDAN108RP0002V01200001/A0005V01200910(TA 08),
IRDAN108RP0002V01200001/A0054V01201819(TA 09), IRDAN108RP0002V01200001/A0055V01201819(TA 10),
Section I
IRDAN108RP0002V01200001/A0056V01201819(TA 15), IRDAN108RP0002V01200001/A0022V01201213(TA 19)

Compulsory Deductible : ` 1,000.00

Voluntary Deductible : ` 0.00
Imposed Excess: ` 0.00
Franchisee: ` 0.00

Subject to: A) IMT Endorsement Number : 22

B) TATA AIG Auto Secure Endorsement Number (TA): 10 , 09 , 15 , 08

NOMINATION DETAILS
Name of the Nominee Relationship with insured Name of Appointee (If nominee is minor) Relationship with Nominee
Legal Heir As attached NA NA
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.
In witness whereof this Policy has been signed at MUMBAI on 22/10/2024

Receipt No.(s): 102001087668220 22/10/2024

Stamp Duty of Rs.0.50/ - is paid as provided under Article 47-B of Indian Stamp Act, 1899 and included in Consolidated Stamp Duty Paid to the Government of
Maharashtra Treasury vide Order of Addl. Controller Of Stamps, Mumbai at General Stamp Office, Fort, Mumbai - 400001., vide this Order No.
LOA/ENF1/CSD/55/2024/4453 Validity Period Dt.23/09/2024 To Dt.13/09/2027/4453 Date:06/09/2024

GSTIN :37AABCT3518Q1ZV ANDHRA PRADESH Service Account Code: 997134

Policy Servicing Office : UNIT NO. F5, DOOR NO. 2-2-1/2, 3RD FLOOR,,KOTAGIRIS CITY CENTRE, SEETHAPATHI RAO STREET, SRINAGAR KAKINADA, EAST
GODAVARI, ANDHRA PRADESH, 533003
For Roadside Assistance, Please Contact on 18002679000
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.

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'. This policy does not cover pre existing damages as per Inspection photographs and Report
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.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
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, UIN:IRDAN108RP0002V01200001
Page 3 of 6
For Policy wordings, please scan the below QR code :

Disclaimer:
INSURANCE ACT 1938 Section 41 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 of 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 published prospectus or tables of the Insurer.
2. ANY PERSON MAKING DEFAULT IN COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHED WITH A FINE WHICH MAY EXTEND TO TEN LAKHS RUPEES

For TATA AIG General Insurance Company LTD.

Signature Not Verified

Digitally signed by: Shammi Kapoor
Date: 2024.10.23 12:44:53 +05:30
Location: Mumbai
Authorized Signatory

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
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, UIN:IRDAN108RP0002V01200001
Page 4 of 6
 RECEIPT

Receipt No. 102001087668220 Receipt Date: 22/10/2024

Policy No: 3102332149

Received with thanks from MR NAGAKRISHNA YESHWANTH BOBBADI a sum of 12712 ( Rupees Twelve Thousand Seven Hundred Twel
ve And Paise Zero Only ) vide Credit / Debit Card No 9999XXXXXXXX9999 dated 22/10/2024 Name as in credit/debit card - NAGAKRISHNA
YESHWANTH BOBBADI drawn on HSBC BANK, branch towards

Sl.No. Policy Number Total Premium ` Utilized from the receipt for policy ` Balance `

1 3102332149 12,575.00 12,711.00 1.00

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: 37AABCT3518Q1ZV ANDHRA PRADESH Service Accounting Code: 997134

Revenue (Consolidated) Stamp Duty paid vide challan No. LOA/ENF1/CSD/30/2024/2807 date 09/07/2024 for applicable cases

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
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, UIN:IRDAN108RP0002V01200001
Page 5 of 6
 Auto Secure Private Car Package Policy

1 Name (Registered Owner of the Motor Vehicle)* : MR NAGAKRISHNA YESHWANTH BOBBADI

2 Address For Communication* : # 1-17/2 BOBBADI PETA NEAR VUDA PHASE -3,CONTONMENT VIZIANAGARAM,,,VIZIANAGARAM,
VIZIANAGARAM,ANDHRA PRADESH,535002.

3 Vehicle Details : Please refer policy schedule cum certificate

4 Fuel Type : PETROL
5 Insured’s Declared Value - Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number : 3102070800
Date of inception of TP portion : 02/11/2023
Date of Expiry of TP portion : 01/11/2024
Type of Cover : Package
Name of the Insurer : TATAAIG
OD claim in previous year(YES/NO) : Yes
NCB in previous policy : 0
NCB claimed : 0
7 Own Damage period of insurance desired from* : 02/11/2024 to midnight of 01/11/2025
8 Liability period of insurance desired from* : 02/11/2024 to midnight of 01/11/2025
9 Compulsory PA cover forowner driver period of insurance desired from : 02/11/2024 to midnight of 01/11/2025
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Unnamed Persons Personal Accident Cover for seating capacity, including driver CSI :

Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) :

Compulsory PA Cover for Owner Driver : ` 15,00,000.00 Term : 1 Years

Name of the Nominee : Legal Heir Age : 30 RelationShip : As attached

Name of Appointee (if Nominee is Minor) :NA Relationship to the Nominee : NA
Battery No :
Charger No :

12 Restriction of Cover/Discounts/Concessions/Extended Covers

Automobile association membership opted : No Third Party Property Damage Cover restricted to 6,000/ only : No
Is Voluntary Deductible opted : No Amount of Deductible opted : 0
Vehicle is fitted with Anti Theft Device approved by ARAI : N/A

13 Add on covers : N/A.

14 Bank Details (Required for Refund / Claims)

Name of the Account Holder : Name of Bank & Branch :

Account Number : IFSC Code of Bank :

15 Declaration for No Claim Bonus : N/A .

16 I hereby give my consent toreceive one page insurance policy.

17 AML Guidelines:
1. I/we hereby confirm that all premiums paid / payable in future will be from bonafide sources and not paid out of proceeds of crime and
that such premiums are not disproportionate to my/our income. I / we understand that the Company has the right to call for documents to
establish sources of funds and to cancel the insurance policy in case I / we are found guilty by any competent court of law under any of
the statutes, directly or indirectly governing the prevention of money laundering law in India.

2. I / we are not Politically Exposed Persons * nor are their close relatives / family members / associates. I / we shall keep the company
informed if we subsequently become a Politically Exposed Person / close relative / family member / associate of Politically Exposed Persons.
“Politically Exposed Persons” shall have the meaning assigned to it under Prevention of Money-Laundering (Maintenance of Records)
Amendment Rules, 2023 as amended from time to time.

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

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
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 6 of 6
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001