4106345001

Ref No.: GEN/WEL/SG/0008.
3/4106345001
Date: 15/01/2025
To,
MR. SHRIPAD BALKRIS
FLAT NO. 23 24 2/C SITAR BUILDING NADBRAHAMA SOCIETY 6TH FLOOR GATE NO. 5 WARJE PUNE
Shyadri - 411058
District: PUNE
MAHARASHTRA, India
Contact Details 9850622552
Policy number: 4106345001

CKYC ID: 40027720157401
Subject: Risk assumption for Car Secure
Dear MR. SHRIPAD BALKRIS,
We thank you for your continued trust in Zurich Kotak General Insurance Company (India) Limited and renewing your policy to cater to your
motor insurance needs.
This is with reference to your above mentioned Policy issued under Car Secure.
Enclosed please find the Policy Schedule outlining the details of your policy. Kindly note that the proposal is underwritten and policy is
issued based on the information submitted to us by you, as well as acceptance of the terms and conditions. Policy schedule must be read
in conjunction with the product brochure and policy wordings. Please visit https://www.zurichkotak.com/customer-
support/downloads or scan above QR code for detailed policy wording.
We request you to carefully go through the same once again and in case of any disagreement, discrepancy or clarifications, please call us
on our toll free number 1800 266 4545 or write to us at care@zurichkotak.com within 15 days from the date of this letter. Alternatively, you
can also write to us at 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), ,Mumbai
– 400063. , Maharashtra, India.
Please note that the information provided by you will be verified at the time of claim and the captioned Policy shall be treated as void in
case of any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any form whatsoever made by you or by
your agent, on your behalf, at any stage.
In case where premium is not received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
As a valued customer, we would like to provide regular updates on your policy through email and SMS. We therefore request you to keep
us updated of any change in your contact details.
Assuring you of our best services at all times.
Thanking you,
Yours sincerely,
For Zurich Kotak General Insurance Company (India) Limited
Authorised Signatory
Zurich Kotak General Insurance Company (India) Limited (Formerly known as Kotak Mahindra General Insurance Company Limited) CIN:U66000MH2014PLC260291. IRDAI Reg. No. 152.
Registered & Corporate Office: 401, 4th Floor, Silver Metropolis, Jai Coach Compound, Off Western Express Highway, Goregaon (East), Mumbai – 400063. Maharashtra, India.
Toll Free: 1800 266 4545 Email:care@zurichkotak.com Website: www.zurichkotak.com
Car Secure UIN:IRDAN152RP0006V04201516;
Car Secure
Comprehensive Policy
Certificate cum Policy Schedule
Policy / Certificate No: 4106345001
For any assistance please call 1800 266 4545 or visit www.zurichkotak.com
INSURED DETAILS POLICY DETAILS
Name: MR. SHRIPAD BALKRIS Policy Issuing Office: Mansurali Tower 1St Floor, Plot No.6 Boat Club
Road Pune Maharashtra 411001.
Address: FLAT NO. 23 24 2/C SITAR BUILDING NADBRAHAMA
SOCIETY 6TH FLOOR GATE NO. 5 WARJE PUNE Period of Insurance:
Shyadri - 411058 District: PUNE MAHARASHTRA(27),
From: 18/01/2025 00:00 to: 17/01/2026Midnight
India
Type Of Vehicle: Private Car
Phone: NA
Policy issued on: 15/01/2025
Mobile: 9850622552
Cover Note No: NA
Email: SHRIPADPINK@GMAIL.COM
Hypothecated to: ICICI BANK LTD
GSTIN:
INTERMEDIARY DETAILS
Intermediary Code 1 1 2 9 0 8 1 7 6 9 Intermediary Name KMBL-1769-PUNE-BRANCH BANKING-051
Intermediary's Mobile Intermediary's Landline

1 8 6 0 2 6 6 2 6 6 6
No. No.
VEHICLE DETAILS

Registration Manufacturer Model Variant Year of RTO Location Engine Vehicle Chassis/ Cubic Fuel Seating
Number Manufacture Number Trailer Chassis No. Capacity/KW Type Capacity
MH 12 PZ HYUNDAI CRETA 1.6 CRDI SX 2018 PUNE D4FBHM MALC381U 1582 DIESEL 5
3892 MOTORS PLUS 490205 LJM360423
Insured Declared Value Non - Electrical Electrical & Electronic Trailer (in ₹) CNG / LPG Kit Total Value of the
(IDV) of the Vehicle Accessories fitted to the Accessories fitted to the (in ₹) Vehicle
(in ₹) Vehicle (in ₹) Vehicle (in ₹) (in ₹)
6,22,586 0 0 0 0 6,22,586
PREMIUM COMPUTATION TABLE (IN ₹)
Section I Section II
Own Damage Liability
Basic Own Damage 4,806.99 Basic TP Including TPPD Premium 7,897.00
Add: Total Liability Premium (B) 7,897.00
Add on Covers Total Premium # 827.25
Less: Section III
No Claim Bonus Percent 50% 2,403.50 Personal Accident
PA Cover for Owner Driver of ₹ 15,00,000 330.00
Unnamed PA Cover for Passenger ₹ 1,00,000/Per Person 250.00
PA Cover for Paid Driver ₹ 1,00,000/Per Person 50.00
Total Own Damage Premium (A) 3,230.74 Total Personal Accident Premium (C) 630.00
Taxable value of Services (A+B+C) 11,757.74
CGST @ 9% 1,058.20
SGST @ 9% 1,058.20
Total Premium (in ₹ ) 13,874.00
Add on Covers Opted For: Key Replacement, Loss of Personal Belongings, Road Side Assistance
# : For the covers opted as shown in Add On Cover Details Table
Compulsory Deductibles
Geographical Area INDIA Additional Excess ₹ 0 2000
₹
Voluntary Deductible ₹ 0 Voluntary Deductible for Depreciation Cover ₹ 0 Total Deductible ₹ 2,000
NOMINEE DETAILS
*Nominee Name *Nominee Age *Relationship *Name of Appointee(if nominee is a minor) Relationship to the
Nominee
SHRADDHA MAHAJAN 35 Wife
SHRADDHA MAHAJAN 35 Wife select
ADD-ON COVER DETAILS
Sr.
Add-On Cover Sum Insured( ) Premium ( ) Remarks
No.
Key Replacement
1 25,000 233.75
UIN:IRDAN152RP0006V04201516/A0026V01201819
Loss of Personal Belongings
2 10,000 93.50
UIN:IRDAN152RP0006V04201516/A0025V01201819
Road Side Assistance
3 NA 500.00
UIN:IRDAN152RP0006V04201516/A0015V02201516
CUSTOMER DECLARATION FOR CNG/ LPG KIT
I/ We agree and undertake to immediately inform the Company in case of change on account of addition of CNG/LPG kit and obtain necessary endorsement in
the Policy.
DISCLAIMER
For complete details on terms and conditions governing the coverage and NCB please read the Policy Wordings. This document is to be read with the Policy
Wordings(which are also available on the Company website i.e. www.zurichkotak.com). Please refer to the claim form for necessary documents to be submitted
for processing the claim.
PUC DECLARATION
This policy has been issued subject to valid Pollution Under Control (PUC) Certificate/Fitness Certificate disclosed to our representative / declared by You prior to
commencement of risk under this policy and further undertaking to renew and maintain a valid PUC throughout the duration of the Policy.
LIMITS OF LIABILITY
Under Section II - 1(i) of the policy -> Death of or bodily injury: Such amounts is necessary to meet their requirements of Motor Vehicles Act, 1988.
Under Section II - 1(ii) of the policy -> Damage to Third Party Property ₹ 7,50,000; PA Cover under Section III: for Owner Driver CSI ₹ 15,00,000
LIMITATIONS AS TO USE
Limitation as to use (Package Policy): 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 trails (g)Use in connection with Motor Trade. Note: In case of vehicles
used for Driving Tuition the words “other than for the purpose of driving tuition” to be read after the words „hire or reward.
DRIVER'S CLAUSES
Any person including the insured: Provided that a person driving hold an effective Driving License at the time of accident and is not disqualified from holding or
obtaining such a license. Provided also that the person holding an effective Learners’ License may also drive the Vehicle and that such a person satisfies the
requirements of Rule 3 of the Central Motor vehicles Rules 1989.
SPECIAL CONDITIONS

1. Previous policy document is required at the time of claim verification.
2. All type of pre – existing damages or cost of repair of such damage will be excluded at the time of claim settlement.
NO CLAIM BONUS SCALE
Number of Claims % of Discount on Own Damage Premium
No claim made or pending during the preceding full year of insurance 20%
No claim made or pending during the preceding 2 consecutive years of insurance 25%
*No Claim Bonus (NCB) is subject to no claim on the previous policy. Benefits under the policy will be forfeited if claim is/was made in previous policy. Please
contact our Customer Care team in case of wrong NCB % mentioned.
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 Policy 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.
Subject to I.M.T. Endt.Nos. & Memorandum 22, 17, 16, GR36A, GR27, 7 Printed/herein/attached hereto Under Hire Purchase Agreement with NA
TAX DETAILS
Service Tax/GST Registration No. 2 7 A A F C K 7 0 1 6 C 1 Z T Category : General Insurance Services
SAC Code 997134 Description Motor Vehicle Insurance Services
Invoice Number 4106345001
DECLARATION
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI
of M.V.Act 1988.
In Witness whereof this Policy has been signed for and behalf of Mansurali Tower 1St Floor, Plot No.6 Boat Club Road Pune Maharashtra 411001. at Mumbai this
15 day of January of 2025
Stamp Duty of 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/ENF-
2/CSD/98/2024/Validity Period Dt. 24/09/2024 To Dt. 31/12/2026 (O/w.No. 4576)/Date: 23/09/2024).
For Zurich Kotak General Insurance Company (India) Limited
Authorised Signatory
This document is digitally signed, hence counter signature / stamp is not required.
CUSTOMER INFORMATION SHEET
This document provides key information about your policy. Please refer to the policy
document for detailed terms and conditions.
Description Policy Clause

Sl NO Title
(Please refer to applicable Policy Clause Number in next column) Number
1 Product Name Car Secure
2 Unique IRDAN152RP0006V04201516
Identification Number
(UIN)
allotted by
IRDAI
3 Structure • State basis of Sum/Limit Insured

• Indemnity
• Fixed Benefit
4 Interests Insured Car Secure is designed to provide insurance cover to Private Car Vehicles
5 Sum Insured / Motor The Insured's Declared Value (IDV) of the vehicle will be deemed to be the 'SUM INSURED' for the
Insured Declared purpose of this policy which is fixed at the commencement of each policy period for the insured vehicle.
Value Scope
The IDV of the vehicle (and accessories if any fitted to the vehicle) is to be fixed on the basis of the
manufacturer's listed selling price of the brand and model as the vehicle insured at the commencement
of insurance/renewal and adjusted for depreciation.
Section Coverage Sum Insured
Section I Loss of Or Damage to The Vehicle Insured Refer below table

Section II Liability to Third Parties As per Court Order
Section III Personal Accident Cover for Owner-Driver INR 15,00,000/-
Insured Declared Value (IDV) of the Vehicle (INR) INR 622586
Non - Electrical Accessories fitted to the vehicle (INR) INR 0
Electrical & Electronic Accessories fitted to the vehicle (INR) INR 0
Trailer (INR) INR 0
CNG / LPG Kit (INR) INR 0
Total Value of the Vehicle (INR) INR 622586
Total Loss/ Constructive Total Loss

The Company may at its own option repair reinstate or replace the vehicle or part thereof and/or its
accessories or may pay in cash the amount of the loss or damage and the liability of the Company
shall not exceed:
a. For total loss / constructive total loss/cash-loss of the vehicle - the Insured's Declared Value (IDV) of the
vehicle (including accessories thereon) as specified in the Schedule less the value of the wreck.
b. For partial losses, i.e. losses other than Total Loss/Constructive Total Loss/cash-loss of the vehicle -
actual and reasonable costs of repair and/or replacement of parts lost/damaged subject to
depreciation as per limits specified.
c. If a damaged motor vehicle is assessed as being unrepairable and hence a wreck i.e. a 'total loss' or
'write-off' the Company shall grant the Policyholder the option to retain the wreck and accept a 'cash
loss' settlement (being the IDV less the assessed value of Salvage based on competitive quotes
procured by the Company including any submitted by or through the insured).
d. In the event of a 'cash-loss' settlement, the Company is entitled to cancel the Own Damage insurance
effective the date of damage. Additionally, the Company can cancel the statutory Motor Third Party
Liability insurance policy after requiring the insured to either cancel the road registration of the wreck
and submit documentary evidence in original thereof or alternatively evidence in original a statutory
Motor Third Party liability insurance policy covering the wreck effective the date of damage.
The insured vehicle shall be treated as a CTL if the aggregate cost of retrieval and / or repair of the
vehicle, subject to terms and conditions of the policy, exceeds 75% of the IDV of the vehicle.
Illustration of IDV Calculation

IDV of the vehicle is calculated on ex-showroom price less depreciation depending on the age of the
vehicle.
Example: Ex-showroom price of the vehicle is INR 10,00,000.
Age of vehicle 1 Year 2 Years 3 Years
Depreciation % 15% 20% 30%
IDV INR 8,50,000 INR 8,00,000 INR 7,00,000
Note: The above Illustration is as per the depreciation slabs mentioned in the policy wording for the age of
the vehicle.
6 Policy Coverage The coverages available under this policy are listed in below and will be applicable as mentioned in the Policy Wordings -
Policy Schedule. Section I, Section II,
Section III
Section I: Loss of Or Damage to The Vehicle Insured
Cover for any Partial or Total Loss or Damage to the vehicle due to natural calamities such as - Fire,
explosion, self-ignition or lightning, earthquake, flood, typhoon, hurricane, storm, tempest, inundation,
cyclone, hailstorm, frost landslide, rockslide etc. Or man - made calamities such as burglary, theft, riot,
strike, malicious act, accidental external means, terrorist activity, any damage in transit by road, rail, inland
waterway, lift elevator or air, etc.
Section II: Liability to Third Parties

Covers legal liability for third party property damage and third-party bodily injury (including death) due to an
accident.
Section III: Personal Accident Cover for Owner-Driver

Personal Accident Cover is provided to the Owner-Driver whilst driving the vehicle including mounting into/
dismounting from or traveling in the insured vehicle as a co-driver. Additionally, other passengers and
paid drivers can also be covered by opting for the same- limited to the carrying capacity of the vehicle,
excluding the driver.
7 Add-on Cover S.No Add-on Name and Description UIN Sum Add-on Wording
Insured
1 Road Side Assistance UIN:IRDAN152RP0006V04201516/A0015V02201516 0

Description: Cover is Provided for
following:
a.Towing due to an accident or
breakdown

b.Battery jump start
c.Arrangement/ Supply of fuel:
d.Emptying of fuel tank
e.Flat Tyre(s)
f.Breakdown support over phone
g.Taxi Benefits
h.Arrangement of keys
i.Message Relay
j.Minor Repairs
2 Loss of Personal Belongings UIN:IRDAN152RP0006V04201516/A0025V01201819 10000

Description: Cover is provided to
pay for the loss or damage to You
and Your Family member's
personal belongings caused by
perils mentioned under section 1
of the Comprehensive policy while
personal belongings are in the
vehicle at the time of loss or
damage to the vehicle.
3 Key Replacement UIN:IRDAN152RP0006V04201516/A0026V01201819 25000

Description: Cover is provided to
indemnify the Insured, the cost of
repair / replacement of Insured
Vehicle key(s), including labor
cost, in case key(s) of Insured
Vehicle are lost / stolen or
damaged.
8 Loss Participation Deductible
Compulsory Deductible: INR 2000
Voluntary Deductible: INR 0
Voluntary Deductible for Depreciation Cover: INR 0
Total Deductible: INR 2000
9 Exclusions GENERAL EXCEPTIONS (Applicable to all Sections of the Policy) Policy Wordings -
The Company shall not be liable under this Policy in respect of General Exclusions
1. Any accidental loss or damage and/or liability caused sustained or incurred outside the (Applicable to all
geographical area; Sections of the Policy)
2. Any claim arising out of any contractual liability;
3. Any accidental loss damage and/or liability caused sustained or incurred whilst the vehicle insured
herein is
a. Being used otherwise than in accordance with the 'Limitations as to Use'. Or

b. Being driven by or is for the purpose of being driven by him/her in the charge of any person other
than a Driver as stated in the Driver's Clause.
4.
a. Any accidental loss or damage to any property whatsoever or any loss or expense whatsoever
resulting or arising there from or any consequential loss
b. Any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising
from ionising radiations or contamination by radioactivity from any nuclear fuel or from any
nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion
shall include any self-sustaining process of nuclear fission.
5. Any accidental loss or damage or liability directly or indirectly caused by or contributed to by or

arising from nuclear weapons material.
6. Any accidental loss damage and/or liability directly or indirectly or proximately or remotely
occasioned by contributed to by or traceable to or arising out of or in connection with war, invasion,
the act of foreign enemies, hostilities or warlike operations (whether before or after declaration of
war) civil war, mutiny rebellion, military or usurped power or by any direct or indirect consequence of
any of the said occurrences and in the event of any claim hereunder the insured shall prove that the
accidental loss damage and/or liability arose independently of and was in no way connected with or
occasioned by or contributed to by or traceable to any of the said occurrences or any consequences
thereof and in default of such proof, the Company shall not be liable to make any payment in respect
of such a claim.
For complete list of exclusions including Section-wise exclusions, refer the policy wordings
10 Special Conditions Special Conditions Policy Wording -

and Warranties (if any) Conditions
•
Explain obligations of the Policyholder

•The insured shall take all reasonable steps to safeguard the vehicle from loss or damage and to
maintain it in efficient condition and the Company shall have at all times free and full access to examine
the vehicle or any part thereof or any driver or employee of the insured. In the event of any accident or
breakdown, the vehicle shall not be left unattended without proper precautions being taken to prevent
further damage or loss and if the vehicle be driven before the necessary repairs are effected any
extension of the damage or any further damage to the vehicle shall be entirely at the insured's own risk.
•The due observance and fulfillment of the terms, conditions and endorsements of this Policy in so far as
they relate to anything to be done or complied with by the insured and the truth of the statements and
answers in the said proposal shall be conditions precedent to any liability of the Company to make any
payment under this Policy.
11 Admissibility of Claim 1. Notice shall be given in writing to the Company immediately upon the occurrence of any accidental Policy Wording -
loss or damage in the event of any claim and thereafter the insured shall give all such information and Conditions
assistance as the Company shall require.
2. No admission offer promise payment or indemnity shall be made or given by or on behalf of the
insured without the written consent of the Company which shall be entitled if it so desires to take over
and conduct in the name of the insured the defence or settlement of any claim or to prosecute in the
name of the insured for its own benefit any claim for indemnity or otherwise and shall have full
discretion in the conduct of any proceedings or in the settlement of any claim and the insured shall
give all such information and assistance as the Company may require.
3. In the event of the death of the sole insured, this policy will not immediately lapse but will remain valid
for a period of three months from the date of the death of insured or until the expiry of this policy
(whichever is earlier).
• Sample claim calculation process
Mr. ABC has Motor OD policy and met with an accident.

The claim amount for this vehicle will be calculated as below:
Details Amount (INR)
Vehicle Repair Cost 50,000
Amount assessed by surveyor 48,000
Depreciation applicable (Part Depreciation: Metal as per
5,000
age, plastic 50%, Glass nil)
Compulsory deductible 1,000
Total Claim payable 42,000
** The above claim calculation is subject to change as per Add on covers opted and policy terms and
conditions
12 Policy Servicing - Toll free / IVRS number of the insurer : 1800 266 4545 (8 AM TO 8 PM)
Claim Intimation and Website / Email: www.zurichkotak.com/ care@zurichkotak.com
Processing Details of designated company officials to be contacted in time of claim:
zkgi.motorclaimservices@zurichkotak.com
Details of procedure to be followed for cashless service (In case of Motor Insurance) as well as for
reimbursement of claim
In case of cashless process, please follow the below mentioned process
• Call our 12 hours helpline with details of accident and policy/cover note number.
• Once the claim is registered, the customer support executive will provide you with a Claim Reference
Number.
• You will need to submit relevant documents to us such as - Driving license, RC copy, Policy copy etc. in
accordance with the Policy terms and conditions.
• We will arrange for an inspection in
- 24 hours, if a claim is reported on a working day
- Next working day, if a claim is reported on Sunday or Public holiday
• On cashless facility confirmation, the vehicle would be repaired at a cashless garage and the payment
would be made directly to the garage.
•You will only have to pay the deductible as mentioned in the policy and the depreciation value, salvage
etc. as informed by the surveyor.
In case of reimbursement process, you will have to submit documents to Zurich Kotak General Insurance
Company Ltd., and we will make the payment within 7 days of completion of documentation. The detailed
list of documents required is mentioned in the claims form which can be downloaded from our website
www.zurichkotak.com.
Turn Around Time (TAT) for claims settlement
Appointment of surveyor Immediate after intimation

Survey report submission 15 days
within 7 days after receipt of final
Claims concluded by the insurer
survey report

Within 7 days after receipt of final
survey report and/or the last relevant
Settlement of claims
and necessary document as the
case may be
Escalation Matrix when TAT is not satisfied
Level 1 regional.motorclaims@zurichkotak.com
Level 2 zonal.motorclaims@zurichkotak.com
Level 3 head.motorclaims@zurichkotak.com
13 Grievance Redressal For resolution of any query or grievance, Insured may contact the respective branch office of the Company Policy Wording -
and Policyholders or may call toll free number 1800 266 4545 or may write an e- mail at care@zurichkotak.com. In case the Grievance Redressal
protection Insured is not satisfied with the response, Insured may contact the Grievance Officer of the Company at
grievanceofficer@zurichkotak.com. In case if the Insured is not satisfied with the solution the Grievance
Officer has provided, Insured can write to seniorgrievanceofficer@zurichkotak.com/
chiefgrievanceofficer@zurichkotak.com.
However, if the resolution provided by us is not satisfactory you may approach Insurance Regulatory and
Development Authority of India (IRDAI) through the Bima Bharosa Portal: https://bimabharosa.irdai.gov.in.
You may also approach Insurance Ombudsman, subject to vested jurisdiction, for the redressal of
grievance.
The details of the Insurance Ombudsman/ complete Grievance Redressal Process is also available at
Company's website: www.zurichkotak.com
14 Obligations of the To disclose all information correctly sought by the insurer at time of filling the proposal form
Policyholder/ In case of any change / modification / addition to the already declared information the same shall be
brought to the notice of the insurer immediately
Non-disclosure of material information may affect the claim settlement.
Disclosure of other material information during the policy period.
("Material Information" for the purpose of this policy shall mean all relevant information sought by the
company in the proposal form and other connected documents to enable it to take informed decision in
the context of underwriting the risk such as Purpose of the Vehicle, Usage of the Vehicle, Claim details
(accident date, spot of accident, damaged parts etc.), details of vehicle, NCB details etc.)
Declaration by the Policy Holder

I have read the above and confirm having noted the details.
Place
Signature of the Policy
Date
Holder
Note:
i. Please visit https://www.zurichkotak.com/documents/customer-support/downloads for product related documents including CIS
ii. In case of any conflict, the terms and conditions mentioned in the policy document shall prevail
Transcript cum Proposal Form - Car Secure
Important Information for the Insured:

1. This is a transcript of the details declared by you on the e-proposal and shall be the basis of underwriting of the policy. Request you to carefully review the
complete information provided under this transcript and get back to us within 15 days of issuance of this document, in case there is any discrepancy found.
2. The policy is subject to receipt of complete premium and the risk under the Policy shall commence only from the date as specified in the policy schedule.
3. This document has to be read in conjunction with the policy schedule/document.
Refund, if any, with regard to the premium paid, would be processed in the same source / account (net banking / credit card / debit card) from where the
4.
premium payment has been originally made subject to policy terms and conditions.
5. The policy is subject to the underwriting guidelines of the Company and the details as declared by the Insured under the e-proposal.
6. Online premium payment should be made by the policyholder himself. No third party payment should be made using this mode of payment.
7. The Policyholder/ Insured has fully understood the terms and conditions of the Policy including all the features available thereunder.
Proposal No : 202501140019675
Proposal for : Renewal Policy
13,874.00 Premium Amount (Inclusive of taxes)
Type of cover: Comprehensive Policy
Vehicle Make/Model/
Registration No. Type of body Cubic Capacity/KW Fuel Type
Variant
HYUNDAI
MH 12 PZ 3892 MOTORS/CRETA/1.6 CRDI SUV 1582 Diesel
SX PLUS

Year of Manufacture Insured Declared Value (IDV) Engine Number Chassis Number
2018 6,22,586 D4FBHM 490205 MALC381U LJM360423
Special conditions :
PROPOSER / OWNER’S DETAILS
1. Title and Name of the Insured: MR. SHRIPAD BALKRIS
FLAT NO 23 24 2C SITAR BUILDING 6TH FLOR 5 NO GATE NADB RAHMA PUNE CITY PUNE PUNE CITY WARJE
2. Insured Permanent Address*
MAHARASHTRA INDIA District: PUNE 411058 MAHARASHTRA(27), India
If Correspondence Address different from FLAT NO. 23 24 2/C SITAR BUILDING NADBRAHAMA SOCIETY 6TH FLOOR GATE NO. 5 WARJE PUNE Shyadri -
Permanent Address,please provide*: 411058 District: PUNE MAHARASHTRA, India
3.Phone 4.Mobile * 9850622552 5.Email ID* SHRIPADPINK@GMAIL.COM
6.Gender 7.Date Of Birth * 8.Nationality Indian Resident
Proposal Date & Time: 14/01/2025 13:40
Policy Start Date: 18/01/2025 00:00
Policy End Date:

17/01/2026 at midnight
(Comprehensive)
Limitation as to use (Private Car): 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 trails (g)Use in connection with Motor Trade. Note: In case of vehicles used
for Driving Tuition the words “other than for the purpose of driving tuition” to be read after the words „hire or reward.
Driver’s Clauses: Any person including insured: Provided that a person driving hold an effective Driving Licence at the time of accident and is not disqualified from
holding or obtaining such a licence. Provided also that the person holding an effective Learners’ Licence may also drive the Vehicle and that such a person satisfies
the requirement of Rule 3 of the Central Motor Vehicle Rules, 1989.
STATUTORY WARNING PROHIBITION OF REBATES (Under Section 41 of Insurance Act 1938)
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
prospectuses or tables of the Insurer.
2) Any person making default in complying with the provisions of this section shall be punishable with fine, which may extend to ₹ 1,000,000/-
VEHICLE DETAILS
Registration Authority and RTO Date of CNG/LPG/Bi Lease / Hire / Hypothecation (Name Color of Seating
Location Registration Fuel and address of concerned parties) Vehicle Capacity
ICICI BANK LTD

PUNE 20/01/2018 DIESEL 5
PUNE, PUNE
*Non - Electrical *Electrical &

*Insured Declared
Accessories Electronic Accessories Trailer *CNG / LPG Kit *Total Value
Value
fitted to the Vehicle fitted to the Vehicle (in INR) (in INR) (in INR)
of the Vehicle (in INR)
(in INR) (in INR)
6,22,586 0 0 0 0 6,22,586
PUC - NO

OPTIONAL ADD-ON COVERS
1. Depreciation Cover# 2. Engine Protect #If Depreciation cover is selected: Voluntary Deductible offered under the
“Depreciation Cover”, which would be applied over and above the Compulsory
3. Return to Invoice 4. Consumable Cover Deductible? No
6. Key Replacement
5. Road Side Assistance
Sum Insured 25000
7. Loss of Personal Belongings
8. Tyre Cover
Sum Insured 10000
9. Daily Car Allowance 10. NCB Protect
11. Meter (Switch On/ Switch Off)
12. Battery Protect Cover
Cover
13. Clutch Protect
RISK INCLUSION / EXCLUSION
*Nominee Name and *Name of Appointee (if Relationship to the

*Relationship
Age nominee is a minor) Nominee

1. *Personal Accident Cover of INR
15,00,000 for the Owner Driver SHRADDHA MAHAJAN 35 Wife select
2. Do you wish to include Personal Name CSI Opted (Rs) *Nominee Name Relationship
Accident cover for the Named passenger?
No
Please give details mentioned aside:
3. Do you wish to include Personal Accident cover for the Un-named Passengers / hirer / pillion No. of Persons
C. S. I. (Per Person)
passenger? Yes As Per Seating Capacity
Please give details mentioned aside: 5 100000
# The maximum CSI available per person is ₹ 2,00,000, each in multiples of ₹ 10,000.
4. Do you wish to restrict Third Party Property Damage of ₹ 7.5 Lakh to the statutory TPPD liability limit of ₹ 6,000/- only? No
5. legal liability against Third Party Risks: A) Owner Driver Yes No Any person other than Paid Driver: No
B) Legal Liability to Employee (IMT 29) Yes No If Yes, no. of Person: 0 C) Unnamed Passengers Yes No If Yes, no. of Person: 5

Compulsory Personal Accident (PA) Cover for owner-driver (PA Cover for Owner –Driver is compulsory for individual vehicle owners). I hereby declare below :
|__| The Owner Driver does not require Compulsory Personal Accident Cover as Owner Driver has a separate existing Personal Accident Cover against Death
and Permanent Disability (Total and Partial) for sum Insured of atleast 15 lacs/ The Vehicle to be insured is not owned by an individual/ The Owner driver does
not have an effective driving license.
PREVIOUS INSURANCE DETAILS
1. Name and address of the previous insurer KOTAK-MANSURALI TOWER,1ST FLOOR, PLOT NO.6,PUNE-411001
2. Previous Policy
ComprehensivePolicy 3. Previous Policy Number 4106345000 4. Existing bonus 50 %
Type
5. Period of Insurance 18/01/2024 To 17/01/2025
6. Details of claims taken in previous policy: No
Whether you are entitled to No Claim Bonus Yes NO
DETAILS OF DEPRECIATION
Table 1:Schedule of depreciation for arriving at IDV:
The Insured's declared value (IDV) of the vehicle will be deemed to be the 'Sum insured' and it will be fixed at commencement of each policy period for
each insured vehicle
Age of The Vehicle % of Depreciation for fixing Age of The Vehicle % of Depreciation for fixing
IDV IDV
Not exceeding 6 Months 5% Exceeding 2 years but not exceeding 3 30%
years
Exceeding 6 months but not exceeding 1 15% Exceeding 3 years but not exceeding 4 40%
year years
Exceeding 1 year but not exceeding 2 20% Exceeding 4 years but not exceeding 5 50%
years years
Note: IDV of obsolete models of vehicles (i.e. Models which the manufacturers have discontinued to manufacture) and vehicles beyond 5 years of age
will be determined on the basis of an understanding between the insurer and the insured.
PAYMENT DETAILS
Payment Mode : PAYMENT AGGREGATOR

Payment Reference No : 22164690194
Payment Amount: 13,874.00
Payment/Transaction Date: 15/01/2025
Bank Details:
I confirm that the premium is paid out of my legitimate sources of fund and the Company has the right to call for documents to establish sources of
funds. The Company has the right to cancel the policy in case I am/have been found guilty by any competent authority or court of law of violating any
law/regulation.
Intermediary Code: 1129081769

As verified using OTP sent on mobile number ending with 2552 on 15/01/2025 or as submitted by you in the physical proposal form.
DECLARATION
PEP :
Are You or any of the proposed applicants or close relatives is/are associated to Politically Exposed Person (PEP ) ? Yes No
AML Declaration :
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. I / We understand that the Company has the right to call for document to establish
sources of funds. 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.
TAX INVOICE
Details of Receiver (Billed To) Details of Supplier (billed by)

Zurich Kotak General Insurance
GSTIN/UIN Name :
Company (India) Limited
Customer ID 1014198409 GSTIN : 27AAFCK7016C1ZT
Customer Name SHRIPAD BALKRIS Pan Number : AAFCK7016C
Email ID SHRIPADPINK@GMAIL.COM CIN: U66000MH2014PLC260291
Mansurali Tower1St Floor, Plot No.6Boat
Contact No 9850622552 Address:
Club RoadPune Maharashtra 411001.
FLAT NO. 23 24 2/C SITAR BUILDING
NADBRAHAMA SOCIETY 6TH FLOOR
Address Date of Invoice 15/01/2025
GATE NO. 5 WARJE PUNE, PUNE,
411058, MAHARASHTRA, India
IMD Code 1129081769 Invoice No 4106345001
Receipt No 1202501738489 Proposal No 202501140019675
Partner Application No Q4C000000159718507
State Code 27 State Code: 27
Place Of Supply Name MAHARASHTRA - 27 State Name MAHARASHTRA
IRN
HSN / SAC Total Value of Supply Taxable value of Supply CGST CGST Amt SGST SGST Amt
HSN/SAC Description
Code (Rs.) (Rs.) Rate (Rs.) Rate (Rs.)
Motor Vehicle Insurance 997134 11757.74 11757.74 9% 1,058.20 9% 1,058.20
Services

Total 11757.74 11757.74 1058.2 1058.2
Total Invoice Value (In
13,874.00
Figure)
Total Invoice Value (In
Thirteen Thousand Eight Hundred Seventy Four
Words)
Whether Tax Payable on a Reverse Basis or Not No
For : Zurich Kotak General Insurance Company (India) Limited
Authorized Signatory
"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."

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Ref No.: GEN/WEL/SG/0008.

Policy number: 4106345001

Subject: Risk assumption for Car Secure

Dear MR. SHRIPAD BALKRIS,

Assuring you of our best services at all times.

For Zurich Kotak General Insurance Company (India) Limited

INSURED DETAILS POLICY DETAILS

Intermediary Code 1 1 2 9 0 8 1 7 6 9 Intermediary Name KMBL-1769-PUNE-BRANCH BANKING-051

Intermediary's Mobile Intermediary's Landline

Car Secure UIN:IRDAN152RP0006V04201516;

PREMIUM COMPUTATION TABLE (IN ₹)

SHRADDHA MAHAJAN 35 Wife

SHRADDHA MAHAJAN 35 Wife select

SHRADDHA MAHAJAN 35 Wife

SHRADDHA MAHAJAN 35 Wife select

SHRADDHA MAHAJAN 35 Wife

SHRADDHA MAHAJAN 35 Wife select

SHRADDHA MAHAJAN 35 Wife

SHRADDHA MAHAJAN 35 Wife select

ADD-ON COVER DETAILS

Car Secure UIN:IRDAN152RP0006V04201516;

Car Secure UIN:IRDAN152RP0006V04201516;

NO CLAIM BONUS SCALE

Number of Claims % of Discount on Own Damage Premium

Service Tax/GST Registration No. 2 7 A A F C K 7 0 1 6 C 1 Z T Category : General Insurance Services

SAC Code 997134 Description Motor Vehicle Insurance Services

Invoice Number 4106345001

For Zurich Kotak General Insurance Company (India) Limited

Car Secure UIN:IRDAN152RP0006V04201516;

Description Policy Clause

1 Product Name Car Secure

3 Structure • State basis of Sum/Limit Insured

Section Coverage Sum Insured

Section I Loss of Or Damage to The Vehicle Insured Refer below table

Car Secure UIN:IRDAN152RP0006V04201516;

Section III Personal Accident Cover for Owner-Driver INR 15,00,000/-

Insured Declared Value (IDV) of the Vehicle (INR) INR 622586

Non - Electrical Accessories fitted to the vehicle (INR) INR 0

Electrical & Electronic Accessories fitted to the vehicle (INR) INR 0

Trailer (INR) INR 0

CNG / LPG Kit (INR) INR 0

Total Value of the Vehicle (INR) INR 622586

Total Loss/ Constructive Total Loss

Illustration of IDV Calculation

Example: Ex-showroom price of the vehicle is INR 10,00,000.

Age of vehicle 1 Year 2 Years 3 Years

Depreciation % 15% 20% 30%

Section II: Liability to Third Parties

Section III: Personal Accident Cover for Owner-Driver

1 Road Side Assistance UIN:IRDAN152RP0006V04201516/A0015V02201516 0

Car Secure UIN:IRDAN152RP0006V04201516;

2 Loss of Personal Belongings UIN:IRDAN152RP0006V04201516/A0025V01201819 10000

3 Key Replacement UIN:IRDAN152RP0006V04201516/A0026V01201819 25000

8 Loss Participation Deductible

Compulsory Deductible: INR 2000

Voluntary Deductible: INR 0

Voluntary Deductible for Depreciation Cover: INR 0

Total Deductible: INR 2000

a. Being used otherwise than in accordance with the 'Limitations as to Use'. Or

5. Any accidental loss or damage or liability directly or indirectly caused by or contributed to by or

Non - Electrical Electrical &

Nominee Name and Name of Appointee (if Relationship to the