sUZUKI
JTI
NCE BROKING
Dedicated
Customer
nis pohcy is
sourted and senviced by Support
Insurance Broking Private Limited
Maruti Suzuki
1, Nelson Mandela Road,
Vasant Kunj, New Delhi -
110 070o
3377 4477/
prefix 011/022/033/044
T h i s is not a part of the policy document. Please Detach Here. se
Bajaj Allianz General Insurance Co. Ltd
BAJAJ|Alllanz IRDAI Regn No 113
CERTIFICATE CUM POLICY SCHEDULE
ORIGINALFOR RECIPIENT/DUPLICATE FOR SUPPLIER
TAX INVOICE/CERTIFICATE CUM POLIGY SCHEDULE
(FORM51 OFTHE CENTRAL MOTOR VEHICLES RULES, 1989)
Bundled Motor Policy- 3 Yr TP+ 1 Yr OD(Private NOO01267703/ 02-FEB-2023 15:48
Proposal No & Date
Policy Type & UIN:
Vehicle) &TROAN113RPO007VO1201819 Own Damage 02-FEB-2023 18:09 to 01-FEB-2024 23:59
Policy No OG-23-9910-1825-00115338 Perlod of Insurance Third Party 02-FEB-2023 18:09 to 01-FEB-2026 23:59
02-FEB-2023 18:09
Policy Issued On
InsuredName Mr. KALAL VISHAL JAGDISH |VehicleIdentiflication No MA3RYHLISPA189206
InvolceNNo NOO01267703 Geographical Area _ India
PLOT NO 63 PITRESHWAR, COLONY SHAHADA ROAD, GT No & State NA Maharashtra
SHIRPUR DIST DHULE SHIRPUR MAHARASHTRA-
Insured Address
425405
Accounting Code of Service 997134
Insured State & GSTUNREGISTERED
Maharashtra-27 Place of Supply Maharashtra GSTIN of Customer
Code
Motor Vehicle Detalls
Maruti SUZUKI_ Seating Capacity
Make SUV PEARL ARCTIC WHITE
Model- Variant NEW BREZZA K15C ISG 6AT ZXI BS6VZA4AZ100 ype of Body | Colour
FuelTy Peurol
Registration No_ |NEW DHULE
Year of Manufacture | 2023 RIO LOcation
Cngunenassis No. K15CN9174075 MA3RYHLISPA189206 Zone_
CUDIC Capacity | 1462 FASTag IOD
Insured Declared Value ()
Vehide 1182275 Non Electrical Accessories Electrical Accessories 0 CNG/ LPG Kit ? 0 Total 1OV |1182275
Schedule of Premlum (Amount In )_
Own Damage Section(A)_ Liability Section(B)
Vehicle 13204 Basic Third Party Liability 10640
13204 Compuisory PA Cover Premium (3 Year] 909
Basic Premlum PA Cover for 5 Person of Rs(100000) each(IMT- 16) 750
Deductlbles Legal Liability (WC) to Driver (IMT-28) 300
Anti-Theft Device
(IMT-10)_ 330
T o t a lDeductib 330 Net Liability Premium (B)_ 12,5
5911 Total Premium (A+8) 36,096
DepreclationShield IRDANI13RPO007V01201819/A0009V01201819)
Engine Protecter(1RDAN113RPO007VO1201819/A0015V01201819)-
vehide Replacement
1773 182
CGST
@9%
SGST @90
R 3,248.64
3,248.64
Advantage(IRDAN113RPO007VO1201819/A001OVO1201819) Gross Premium Paid 342,593
Key and Locks Replacement MY CAR (PUNE) PVT LTD
250 MISP
Cover(1RDAN113RPO007V01201819/A0016V01201819) Notes:
Consumable Expenses(IRDAN113RPO007vo1201819/A0020V01201819) 1182 1. Policy 1ssuance is subject to realisation of premium.
2. Consolidate stamp duty paid to State Exchequer
Roadside Assistance(1RDAN113RPO007v01201819/A0014V01201819) 325 3. Policy is subject to a compulsory Deductible of Rs 1000 (IMT 22)
Net Own DamagePremlum (A)_ 23497 4. Voluntary excess S (0
5. Subject to Endorsements IMT 10,16,28,,
6. This policy provides the benefit of Roadside Assistance" from below vendor:
Vendor Name: Allianz World Partner, Toll Free: 18001035858
Nominee Detalls
Nominee Name: SONALI KALAL Age:!32 Relation: Wife
Financler Details
Financler Type: NonFinance Financier Name: N/A Financler Branch: N/A
Payment Detalls_
Bank Name: ICICI BANK LIMITED
Payment Mode: Credit Card Cheque No/Transactlon No: Amount: 42,593
75201435239
Limitations as to use- The Policy covers use of the vehicle for any purpose other than: a) Hire or Reward, b) Carriage of 9000s (otner than samples or personal luggage), c) Organized
raang, d) Pace making, e) Speed testing, f) Reliablity Trials, 9) Any purpose In connection with Motor Trade.
Driver: Any person induding the insured, Provided that a persan driving holds an effective driving license at the time of the actident andisnotdisaualified rom holdingor obtaining such a
license, Provided also that the person holding an effective learners license may also drive the vehicle and that such a person satisies n e requirements of Rule 3 of the Central Motor Venucles
Rules, 1989
Limts of Uability: under Section I-1 () of the policy Death of or bodily injury Such amount as is necessary to meer thereicau ements of the Motor Vehicles Act, 1988. Under Section
II -1(u) of the Policy Damage to Third Party Property R5.750000 (as per IMT 20)in respect of any one claim or series ot u or one event. Cover for Owner Driver under
sercton 11 (CSI) Rs 1500000 Deductuble under section-I: Rs 1000(Compulsory Deductibie Rs 1000 Imposed Deductible K5. uand vnary Deductible Rs 0)
No Clalm Bonus: The insured is entuded for a No Claim Bonus (NCB) on the Own Damage section of the policy, It no claim a or pending during the preceding year (s), as per the
faliowing The preceding year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%,Precedingoolecuve years/45%, Preceding Five consecutive
yE'/5 o Gairn Bonus wll only be allowed provided the policy is renewed within 90 days of the expiry date of the prevO
MPORTANT NOTCE: The Insured is not indemnifed if the vehide is used or driven otherwise than In accordance witn Y payment made by the Cumpany by reason of
w i d e r t e r S e p p e e n n g in t h e Certuficate in o r d e r t o c o m p l y w i t h t h e M o t o r V e h i c l e Act, 1 9 8 8 is r e c o v e r a b l e f r o m t h e I n s u r e 0 . 3ee c n e d d e d A V O l D A N C E OF CERTAIN TERMS AND
RIGHT OF RECO VERY, For Legal interpretauon, English version will hold g00d.
For intormetion on ombudeman you may vlst webste : htp //wwwgbic.co.n/ombudsman.
W e hereuy eruty Uiet he Policy to which this Ceruficate relates as well as this Certuficale of Insurance are issued in dccOrdanc
htmi
BrOtsians or Chapter X and Chapter Xi of M.V. Act,
988.
FOr Baja Alllanz General InsSurance COmpany
Limted
Autnorised SignaturyY
Pollcy Issuing Office: GE Plaze, Airport Road, Yerwada, Pune - 4 1 1 0 0
6STIN: 27AABCB5730G1Zx, CIN NO: U66010PN2000PLCO15329 State Name : Maharashtra
****wwwww wwYwwwww wwwvww. wwwww w wwwwww Yww *** *
Registered Office: Sr. No. 131, Mumbai-Banglore-Pune-Bypass, Wakad, Pune-411 057. Ph.. 020 39888333/ 64730000 E-mail: mycar.pun.srvi@marutidealers.com
