IRDAI Regn No - 137
Signature Not Verified
This Document is Digitally Signed
Signer : RANJAN KUMAR SAHOO
Date : 8/16/2019 12:24:08 PM
CERTIFICATE CUM POLICY SCHEDULE Reason:Signing Policy For SGI
POS - PRIVATE CAR PACKAGE POLICY - ZONE A
MOTOR PRIVATE CAR (PACKAGE POLICY) - UIN NO. IRDAN137RP0016V01200809 - SAC Code. 997134
CIN No. U66010RJ2006PLC029979
Issue Office: 101047 - Address:- B-08, Unit No.-402 & 403, GD ITL Tower, Netaji Subash Place, Pitampura,8882886219,8010386220-
NEW DELHI NEW DELHI 110034 Tel 7412079647 / 7412079650 / 7412079646 /48
Policy No : 101047/31/20/009305 Prev Policy No - Geographical Area : INDIA
Insured's Code/ Name: 116878295 MR.NARENDER LAKRA
Address: 439/1
: MUNDKA VILLAGE NANGLOI DELHI-DELHI NEW DELHI 110041
Executive: NA0000000203 Agent Details :PS0000016159 SUNITA / / Contact No: 8929028767 PAN No : BKBPS6262E
Period of Insurance : From 00:00 on 14/08/2019 To Midnight of 13/08/2020 Prop No. - Issue date
Gross Premium: 2,874 S Tax: 0 GST:518 Cess : 0 Total: 3,392
Registration Engine No Make - Model Type of Body / Cubic Capacity / Date of Seat Cap
Year of Manf Regn / Delivery
Mark & Place Chassis No Fuel Type (Incl Driver)
DL 9 CQS 2886 830621 MARUTI SUZUKI-800 HATCHBACK 796 16-10-07 3+1
South West Delhi 670407 AC PETROL 2007
IDV For the IDV For Non Electrical Electrical SI for Named CNG/LPG KIT SI Total Value
Vehicle Trailers Accessories Accessories Persons
65,000 0 65,000
A. OWN DAMAGE SCHEDULE OF PREMIUM B. LIABILITY
OD TOTAL 437.00 BASIC TP COVER 2,072.00
TOTAL PREMIUM 2,874.00 ADD :GR36A-PA FOR OWNER DRIVER 315.00
ADD :SGST 9 % 259.00 ADD :IMT28-LL-PAID DRIVER, 50.00
ADD :CGST 9 % 259.00 CONDUCTOR,CLEANER
FINAL PREMIUM 3,392.00 TP TOTAL 2,437.00
* NCB discount - 50 % Previous Policy : 920221823111012165 - Previous Insurer : RELIANCE General Insurance Company
Nominee for PA Owner/Driver : Mrs Narender - Age : 35 - Relationship : SPOUSE - Appointee Name : NA - Appointee Relationship :
NA
ADD-ONS :-
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association, VOluntary Excess, Anti-Theft, Handicap Person, Driver Tuition, Fibre Glass,
CNG/LPG Unit, Geographical Extn, Imported Vehicle etc wherever applicable)
Deductibles under Section-I : COMPULSORY DEDUCTIBLE Rs.1000
Subject to IMT Endorsement Printed herein/attached to : IMT-15,IMT-22,IMT-28
Hypothecation Agreement with:
Hire Purchase/Lease Agreement with: -
Limit of Liability :
Under Section II-1(i) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-1(ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 1500000
Driver's Clause
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 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
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms attached.Warranted that in case of dishonour of premium cheque(s) the Company shall
not be liable under the policy and the policy shall be void abinitio (from inception). I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are
issued in accordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at PITAM PURA
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 MVAct, 1988 is recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".
POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION.
Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.
For instant renewal of your insurance policy, Log on to www.shriramgi.comor contact us at our Head office no. - 0141-3928400
In case of Claims/Grievance, Please contact us at: Toll Free No - 180030030000, 18001033009 Email id - chd@shriramgi.com
For and on behalf of
SHRIRAM GENERAL INSURANCE COMPANY LTD
Place : NEW DELHI
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the expiry date of
your policy. If you do not want us to contact you, kindly send an e-mail for the same on dnd@shriramgi.com
Consolidated stamp Duty paid vide Challan F10(3946)/COSCHQ/CD,stamp date 19/06/2012 to Collector of Stamps(HQ),Govt of N.C.T.,
All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be Authorised Signatory
considered as delayed intimation. ***DIGITALLY SIGNED
GSTIN No. - 07AAKCS2509K1Z5
Page 1 of 1
