Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade,Sir Theyagaraya Road, T.
Nagar,
September 17, 2018
Ms.. Manish Shah
A/2003, RNA ROYAL PARK, Your policy is due
M.G. ROAD, OFF LINK ROAD. for renewal on
MUMBAI, MAHARASHTRA 19/09/2020
400067
Telephone:
Mobile: 9867270741
Certificate of Insurance and Policy No. Policy Period:
VMPB016389000100 From 00:00:00 hours on 20/09/2019 To 23:59:59 hours on 19/09/2020
Dear Ms.. Manish Shah,
Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are
delighted to have you as our customer.
We are enclosing the Certificate of Insurance & Policy Schedule pertaining to the
insurance of your vehicle.
The Certificate of Insurance & Policy Schedule is an important document that you may
be required to produce whilst your vehicle is in use. We request you to verify the above
documents and ensure everything is in order. In case of any discrepancies, please
contact us immediately.
To read the "policy" & "add on" terms, conditions, exceptions and applicable
endorsement, please log on to our website www.royalsundaram.in
Should you have any queries, please contact our Customer Service helpline number
1860-425-0000. You may also write to customer.services@royalsundaram.in
Assuring you of our best services at all times.
Yours sincerely,
Authorized Signatory
Note:
To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in
Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade,Sir Theyagaraya Road, T.Nagar,
SEP 17, 2018
Ms.. Manish Shah
A/2003, RNA ROYAL PARK, Intermediary Code: OA505227
M.G. ROAD, OFF LINK ROAD.
MUMBAI, MAHARASHTRA Intermediary Name: Policybazaar Insurance Web
400067
Telephone :
Aggregator Private Limi
Mobile : 9867270741 Contact: 1800 208 8787
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy
Certificate of Insurance & Policy No. Policy Period: Period Of Insurance
VMPB016389000100 From 00:00:00 hours on 20/09/2019 To 23:59:59 hours on 19/09/2020
INSURED DETAILS
Name of Insured Insured Date of Birth Geographical Area Business/Profession Registration Authority Registration Date
Ms.. Manish Shah 03/12/1969 INDIA MUMBAI 25/06/2014
INSURED’S DECLARED VALUE (IDV) (in Rs.)
Year For the Vehicle For Side-car Non Electrical Accessories Electrical/ Electronic Total IDV
Accessories
1st Year 100,000.00 0.00 0.00 0.00 100,000.00
The Vehicle: any of the following (Two-wheeler shall be deemed to include a sidecar attached to it)
VEHICLE DETAILS
Registration Number MH02DP0045 Type of Body SOLO
Engine Number 490645650 Cubic Capacity 200
Chassis Number VBKJUC4B1EC014225 Year of Manufacturer 2014
Make of the Vehicle KTM Seating Capacity 2
Was the Two Wheeler ownership
Model Description 200 DUKE-2 SEATER NO
changed in the past 12 months?
Fuel Type PETROL Total Premium (in Rs.) 2,095.00
LIMITATIONS AS TO USE: DRIVER:
The Policy covers use of the vehicle for any purpose other than: Any person including the Insured
a) Hire or Reward • Provided that a person driving holds a valid Driving Licence at the time of
b) Carriage of goods (other than samples or personal luggage) the accident and is not disqualified from holding or obtaining such a
Licence.
c) Organized racing • Provided also that the person holding an effective Learner’s Licence may
d) Pace making also drive the vehicle and that such a person satisfies the requirements of
e) Speed testing Rule 3 of The Central Motor Vehicles Rules, 1989.
f) Reliability Trials
g) Any purpose in connection with Motor Trade
LIMITS OF LIABILITY:
Under Section II-1(i) of the Policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act,1988.
Under Section II-1 (ii) of the Policy - Damage to Third Party Property - Rs.100,000/-
PA. Cover for Owner - Driver under section III (CSI) - Rs.1,00,000/-
Deductible under Section I: Rs.100 in respect of each and every claim.(Compulsory Deductible[100.00], Voluntary Deductible[0.00] and Imposed Deductible[Rs.0]) /- in respect of each
and every claim.
Certificate of insurance & policy schedule continued in Page 2
Document Code:
CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy
Policy No. VMPB016389000100
A - OWN DAMAGE Premium B - LIABILITY Premium
in Rs. in Rs.
Basic premium on Vehicle and Accessories Basic premium including premium for TPPD
1. Vehicle 1,345.00 1. Vehicle 985.00
2. TPPD restricted to statutory limit of Rs.6000/- (Endt. IMT.
2. Accessories: 0.00 20) 0.00
3. Electrical & Electronic @ 4% (Endt. IMT. 24) 0.00
ADD: ADD:
4. Loading for Imported Vehicle 0.00 3. Legal Liability To Paid Driver (IMT 28) 0.00
5. Geographical Area Extn.Endt.IMT-1 0.00 4. Geographical Area Extn.Endt.IMT-1 0.00
6. Fibre Glass Tanks 0.00 5. PA to Paid Driver (IMT 17) 0.00
7. Non Electrical Accessories 0.00 6. Legal Liability To Employees (IMT 29) 0.00
7. PA cover for Owner - Driver under Section III (CSI) -
8. Driver Tution fees 0.00 Rs.1,00,000/- 50.00
9. Rally Cover 0.00 8. PA to Unnamed Passengers 0.00
10. Addtional Towing Charges 0.00
LESS:
11. Side Car Discount 0.00
12. Discount for Anti-theft devices (IMT 10) 0.00
13. 50% Discount for Vehicles designed/modifed for
physically/mentally challenged persons. 0.00
14. Voluntary Deductible amount for Rs. 0.00 0.00
15. Automobile Association Discount (IMT 8) 0.00
16. Deduct 45% for NCB 605.00 9. TOTAL LIABILITYPREMIUM (B) 1,035.00
17. ADD: 0% for Underwriter Loading 0.00 10. ADD: Underwriter Loading % 0.00
11. NET PREMIUM (A+B) 1,775.00
12. Add: IGST 319.00
18. TOTAL OWN DAMAGE PREMIUM (A) 740.00 13. TOTAL PREMIUM PAYABLE 2,095.00
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous year. b) 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 details given below:
Period of Insurance % of NCB on Subject to I.M.T. Endt. Nos & Memorandum 22 (refer Terms & Conditions for relevant wording)
OD Premium
The preceding year 20 Nominee Name Nominee Age Relationship with
ANUJ SHAH 21 SON
Preceding two consecutive years 25 Guardian Name Guardian Age Guardian Relation
Preceding three consecutive years 35
Preceding four consecutive years 45 Date & Signature of Proposal/Renewal notice: 17/09/2018
Preceding five consecutive years 50
In Witness whereof this Policy has been signed at Chennai on 20/09/2018 in lieu of Cover note No. dated Receipt No. IMC0110742. 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 the Motor Vehicles Act, 1988.
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” under Policy Terms and
Conditions.
For Royal Sundaram General Insurance Co. Limited
Signature Not
Verified
Digitally signed by
THIRUNAVUKKARASU S
Date: 2018.09.17
06:35:46 IST
Reason: For
RoyalSundaram
Location: Chennai
Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty Paid to Govt. of Tamil Nadu
GSTIN: 33AABCR7106G1ZQ PAN Number: AABCR7106G
For Legal interpretation, English version will hold good.
GST Invoice
Royal Sundaram General Insurance Co. Limited
No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade
Sir Theyagaraya Road, T.Nagar,
GSTIN : 33AABCR7106G1ZQ
Policy number : VMPB016389000100
Invoice number : VMPB01638900000
Inception Date : 20/09/2018 12:00:00
Policy Posted Date : 17/09/2019 06:35:45
Address of Insured :
A/2003, Rna royal park,
M.g. road, off link road.
MUMBAI
State : Maharashtra
Pincode : 400067
Accounting code of service : 997134
Description of service : Motor vehicle insurance services
Taxable premium 1,775.00
18%
Add: IGST 319.00
Gross premium 2,095.00
Indication if tax payable under reverse charge - No
Note: This document is digitally signed, hence counter signature / stamp is not required.
