ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Stand-alone OD Policy ( Private Vehicle ) Proposal No. & Date SR10549438 / 06-Oct-2022
Policy No. & Type 21182936 Period of Insurance 10-Oct-2022 to 09-Oct-2023
Policy Issued On 06-Oct-2022 (00:00) Vehicle Identification No. MB8DP12DKM8896252
Insured Name Mr. Anmol Burman Geographical Area INDIA
Invoice No SR10549438 Accounting Code of Service 997134
Insured Address HOUSE NUMBER 112 ADARSH NAGAR NARMADAROAD GWARIGHAT JABALPUR,
JABALPUR-482001, Madhya Pradesh
Insured State & Code Madhya Pradesh-23 Place of Supply Madhya Pradesh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Suzuki Vehicle 70882
Model & Variant ACCESS DISC CBS SE BT BS6 UZNEWM/ACCESS Non Electrical Accessories 0
Registration No MP20SZ2693 Electrical Accessories 0
Year of Manufacture 2021 CNG/ LPG Kit 0
Engine- Chassis No AF212672274 - MB8DP12DKM8896252 Total IDV 70882
Cubic Capacity 124
Seating Capacity 2
Type Of Body Solo With Pillion
RTO Location MP20SZ2693 / JABALPUR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) Pre-Existing Third Party Policy Details.
Vehicle 951 Insurance Company Name IFFCO TOKIO GENERAL INSURANCE COMPANY LIMITED
Elec. Accessories 0 Policy No. 21152097
Non- Elec. Accessories 0 Risk Inception Date 10-Oct-2021
Kit (IMT-25) 0 Risk Expiry Date 09-Oct-2026
Extra Premium towards Inbuilt CNG/LPG NA
MISP - Khatwani Sales & Services Pvt. Ltd., JABALPUR
Basic Premium 951
Geographical Area Extn. (IMT-1) NA
Lamp, Tyres etc. (IMT 23) 0 Notes : ( For Stand-alone OD Policy )
Driving Tuition Loading On OD Premium (60%) NA 1. Policy Issuance is the subject to the realisation of cheque.
Fiber Glass Tank 0 2. Consolidate stamp duty paid to State Exchequer
3. The Policy is subject to a compulsory Deductible of Rs 100 (IMT -22)
Sub-Total Additions 0 4. Voluntary excess Rs (0)
Deductibles 5. Subject to Endorsements IMT ,7
Voluntary Deductibles (IMT 22A) 0 6. As per your declaration to opt out of Compulsory PACover due to no valid Driving Licence with the
Owner-Driver / Alternate PA/Stand-alone CPApolicy with minimum Sum Insured of 15 Lakhs , the PA
Anti-Theft Device (IMT-10) 0 cover will not be applicable under this policy.
AAI Membership (IMT-8) 0 7. The Coverage under this policy is only for Own Damage and no other liability in connection with
No Claim Bonus (20%) 190 the vehicle.
Discount for vehicles designed for handicapped NA 8. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from NCB to
Non-NCB, the recoverable amount may be more than the NCB amount.
Sub - Total Deductibles 190
Add - On Coverages
DEPRECIATION WAIVER 319
Engine And Gear Box Protection Cover 0
New Vehicle Replacement 0
Net own Damage Premium (A) 1080
IGST@18% 194.40
Total OD Premium 1274
Nominee Details : Nominee Name VIJAY PRASAD BURMAN Age 52 Relation Father
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 48840667 HSBC BANK LTD 1717
Financier Type Financed Financier Name HINDUJALEYLAND FINANCE LTD Financier Branch JABALPUR
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.
Driver: 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.
Deductibles: Deductible under section-I : Rs 100(Compulsory Deductible Rs 100 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
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 per the following: The preceding year/20%,
Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will only be allowed provided the policy
is renewed within 90 days of the expiry date of the previous policy.
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 hold good.
For information on ombudsman you may visit website : https://www.cioins.co.in/Ombudsman
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.
For IFFCO TOKIO GENERAL INSURANCE COMPANY
LIMITED

Authorized Signatory
Policy Issuing Office:-IFFCO Tower II Plot No. 3 Sector 29 Gurgaon Haryana 122001
GSTIN: 06AAACI7573H1ZG, CIN No.:U74899DL2000PLC107621
State Name : Haryana