Dear MR.

AJITHKUMAR P,

Greetings from Mahindra Insurance Brokers!!!

We welcome you to the Ensure by Mahindra family and thank you for choosing our Insurance Program.
Ensure by Mahindra is a specially designed Insurance Program to give you a delightful ownership experience of the Mahindra
vehicle by giving a smooth hassle free experience on your Vehicle Insurance. The Insurance is provided by the Insurance
companies with whom MIBL is associated for selling its products.

The key benefits will be as follows:

‡ Near Cashless facility
‡ Standard and faster Claim settlement
‡ Hassle -free Renewal
‡ Range of Add-on Covers

Your satisfaction is our first priority. Please find enclosed:

‡ Certificate of Insurance (insurance policy)
‡ Policy wordings providing Terms & Conditions

All the above benefits will be available to you at Mahindra Dealer Service Centres. In the unfortunate event of damage to your
Vehicle all you need to do is to get in touch with the Dealer Service Centre or the Insurance Company by dialling on the toll free
number 18002004030

We once again thank you for choosing Ensure by Mahindra.

Best Wishes
Mahindra Insurance Brokers
 Universal Sompo General Insurance Co. Ltd.
MOTOR GOODS CARRYING VEHICLE (2315) CUM RECEIPT
UIN:IRDAN134RP0009V02200809
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Servicing Office of Insurer: G-1, NO 6, CATHEDRAL , GARDEN ROAD, NUNGAMBAKKAM, CHENNAI , TAMIL
NADU-600034 State Code-33
PAN: 897kkkla GSTIN: 33AAACU8917F1ZD Toll Free: 18002004030
Policy No & Policy Issued On 2315/73398559/00/000 , 13 Apr 2024 4:27PM Period of Own Damage Cover 13 Apr 2024 4:27PM to 12 Apr 2025 11:59PM (Midnight)
Proposal No. & Date P22152081, 13 Apr 2024 Period of Liability Cover 13 Apr 2024 4:27PM to 12 Apr 2025 11:59PM (Midnight)
Insured Name MR. AJITHKUMAR P Period of CPA Cover 13 Apr 2024 4:27PM to 12 Apr 2025 11:59PM (Midnight)
NO : 224/2, MELA STREET, MADATHUPATTI, NORTH
Previous Policy No NA
Insured Add. ACHAMPATTI, TALUK: SANKARANKOVIL, , TENKASI
Previous Insurer NA
, TAMIL NADU-627951
Insured Contact No XXXXXX3525 Nominee Name PERUMALSAMY Age 52 Relation FATHER

Make Model Variant Cubic Capacity/GVW/Kw Seating capacity

MAHINDRA & MAHINDRA MAXX BOL MAXX PUP CITY 1.4 VXID 3171 3
Vehicle Type Vehicle Sub Class Carrier Type Fuel Type Engine No. Chassis No./VIN
GOODS CARRYING Truck Goods PUBLIC DIESEL TUR4A17815 MA1RB2TUKR6A34394
Manufacturing Year RTO Registration No. Registration Date CNG/LPG Kit Trailer Chassis No/VIN
2024 Sankarankovil-TN79 New 0
Vehicle IDV Body IDV Trailer IDV Non-Elec. Accessories IDV Elec. Accessories IDV Total IDV
847400 118750 0 0 0 966150
Schedule of Premium (Amount in Rs.)
Own Damage Premium (A) Liability Premium (B)
Basic Premium Basic Third Party Liability (including TPPD) 16,049
Vehicle 7,506 Third Party Liability For Bi-Fuel Kit 0
Trailer (IMT - 30) 0 Trailer (IMT - 30) 0
Legal liability to Driver (0) / Cleaner (0) / Helper (0) /
Non-Elec. Accessories 0
Conductor (0) (IMT - 28)
0
Elec. Accessories (IMT-24) 0 PA Cover For Owner Driver (1500000) 225
PA Cover (200000 per person) for Driver(1) /Cleaner(1)
CNG/LPG Kit (IMT - 25) 0 240
/Helper(0) /Conductor(0) (IMT-17)
PA Cover (200000 Per Person) for 0 Unnamed Persons
Sub Total (Basic Premium) 7,506 0
(IMT-16)
Geographical Area Extension (IMT-1) 0 Legal liability to NFPP (0) (IMT- 37) 0
IMT - 34 0 Geographical Areas Extention (IMT - 1) 0
Lamp,Tyre Mudguards (IMT - 23) 1126 IMT - 34 TP 0
Legal liability to Employee (0)(IMT - 29) 0
Net Liability Premium (B) 16514
Add On (Consumables,Depreciation Waiver,Towing) 4607 Total Premium (A+B) 29,753
CGST(9.00%)
1234
Sub Total-Addition 13,239 TP CGST(6.00%)
963
SGST(9.00%) 1234
Deductibles TP SGST(6.00%) 963

Voluntary Deductibles (0) (IMT-22A) 0 Gross Premium Paid 34,147

Anti Theft Device (IMT-10) 0 Note: 1.Policy issuance is subject to realization of cheque
AA Membership (IMT-8) 0 2.Consolidated stamp duty paid to state exchequer
No Claim Bonus (0%) 0 3.The policy is subject to compulsory deductible of Rs.500 (IMT-21)
Sub Total (Deductibles) 0 4.Geographical Area-India
Net Own Damage Premium (A) 13,239 *Subject to IMT Endt. Nos.& Memorandum:17,23,21
Hypothecation Details: Hypothecation, EQUITAS SMALL FINANCE BANK LTD, - CHENNAI
MISP Details: Name: DERIK MOTORS P LTD Code: MIBL/M&M/AACCD2601H/000 Receipt No: 33MB240038716 Payment Mode: ONLINE Reference code: D010531DRK1
Addon Cover(s) UIN: 1) , ,
Limitations as to use: The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor
Vehicle¶s Act 1988.The Policy does not cover use for a)Organised racing b) Pace Making c)Reliability Trials d)Speed Testing
Limits of Liability: (a) Under Section II-I(i) of the policy: Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act,1988. (b) Under Section
II-I(ii) of the policy: Damage to Third Party Property ` 750000/-; PA Cover for Owner-Driver under Section III: CSI ` 1500000/-.
Driver¶s Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or
obtaining such license. Provided also that the person holding an effective learner's license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central
Motor Vehicle Rules, 1989.
Grievance Clause: For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call at 18002004030 or may write an email at . In case
the insured is not satisfied with the response of the office, insured may contact the Grievance Officer of the Company at .In the event of unsatisfactory response from the Grievance Office,
he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of Insurance Ombudsman offices are available at IRDAI
website:www.irdaindia.org , or on the website of General Insurance Council: www.gicouncil.in or on the company website https://universalsompo.com.
The Policy wording is available on request at free of cost. The Same can be downloaded from our Website https://universalsompo.com.

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 ³AVOIDANCE OF CERTAIN TERMS AND
RIGHT OF RECOVERY´For legal interpretation, English version will hold good.
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 Motor
Vehicle Act, 1988
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.
HSN : 997134 Description of Service: Motor vehicle Insurance Place of Supply : TAMIL NADU(State Code : 33) Invoice Number : 33MB240038716
UIN: IRDAN134RP0009V02200809 For & On Behalf of Universal Sompo General Insurance Co. Ltd.
 Authorized Signatory
Broker Name & Corporate Add: Mahindra Insurance Brokers Limited , Ground Floor, Sadhana House, Behind Mahindra Towers, 570 P.B.Marg, Worli, Mumbai-400018
Email id: insurance.care@mahindra.com Toll Free No: 1800 266 2626 , Mon to Sat from 10.00 AM
License Code No: 261 & Validity: 17-05-2025 CIN:U65990MH1987PLC042609