Auto Secure - Liability Only Policy

Name : Mr V Raju | +91 9705324268 |

TP Cover Period 22/12/2024

Address : 19-17-24,NELLIMUKKU PEDAGANTYADA, PEDAGANTYADA

Dear Mr. A Ramu

Welcome to Tata AIG General Insurance Company Limited family & we thank you for choosing our policy for your motor vehicle insurance. Your Policy No. 3749320520 has
been issued based on the information and declaration provided by you. You are requested to visit our website www.tataaig.com for full policy wordings

Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Policy Details Vehicle Details

Policy No & Certificate No : 3749320520 - 00 Registration no : AP31CE8060
Insured Name : Mr. V Raju Registration Authority : Visakhapatnam AP-31
Address : 19-17-24,NELLIMUKKU PEDAGANTYADA, PEDAGANTYADA Visakhapatnam ,
Make/Model : Honda/CB Shine
Andhra Pradesh 530044
Fuel Type : PETROL
TP cover period : 22/12/2024 to 21/12/2025 (Midnight)
Variant : Electric Start Drum Brake Alloy Wheels (125 cc)
Policy Issuance Date : 21/12/2024
Engine Number/Battery Number : JC36E77836693/
Customer / Lessor GSTIN : NA
Chassis number : ME4JC36JHD7558884
Customer ID : NA
Engine/Battery Capacity (CC/ KW) : 125
Customer contact number : 9705324268
Seating Capacity (including driver) : 2
Proposal No : PR/24/6100012348
Mfg Year : 2013
Covernote no / Issuance date : NA/21/12/2024
Date of Registration : 18/12/2013
Alternate Policy No : NA Body Type : MOTORCYCLE
Trailer Regn No. / Chassis No. : NA
HP/HYP/Lease : NA
Zone :
Geographical Area : India

Insured Declared Value (IDV)

Vehicle IDV (₹) Electrical Accessories (₹) Non Electrical Accessories-Vehicle IDV (₹) Bi-Fuel/CNG/LPG Kit (₹) Trailer/Side car IDV (₹) Total IDV (₹)

0 0.00 0.00 0.00 0.00 0

Schedule Of Premium

Section II Liability (B)

Third Party Premium

₹ 714.00
₹ 714.00
₹ 714.00

₹ 129.00

Total Policy Premium

Agent Name : POLICYBAZAAR

Agent License Code : 742 • Agent Contact No. : 18002585970(or landline)
INSURANCE BROKERS PRIVATE LIMITED
 Auto Secure - Liability Only Policy

Drivers Clause : Persons or classes of persons entitled to drive : 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 other than for the purpose of driving tuitions 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 Tr ade

Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate, as applicable, on the date of commencement of the
Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certifitate, as applicable, during the s ubsistence of the Policy.

Limits of Liability :Under Section II-1 (i) of 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 policy (Third Party Property Damage) : ₹ 100,000.00 • Under Section III : PA to Owner Driver CSI : ₹ 1,500,000.00

Nominee details :
Name of the Nominee : Not Applicable • Nominee Age : 30 • Relationship of the Nominee with the Insured : Others

Number of claims covered under Depreciation Reimbursement Cover : 2, Number of claims covered under Depreciation Allowance Battery Cover : 0

Deductible under Section - I : ₹ 100.00 (Compulsory Deductible ₹ 100.00, Voluntary Deductible : 0.00, Imposed Excess : 0.00) Franchisee :NA , Depreciation Allowance
Battery Deductible - 5 % of the claim amount subject to minimum of Rs. 500

Add-On Cover :

No Claim Bonus : 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 du ring the preceding
year(s), as follows : The preceding year 20%, preceding two consecutive years 25%, preceding three consecutive years 35%, preceding four consecutiv e years 45%,
preceding five consecutive years 50% of NCB on OD Premium. NCB will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous
policy.

Subject to : (A) IMT Endorsement No. : IMT 15, IMT 22

GSTIN : 27AABCT3518Q1ZW - MAHARASHTRA Service Accounting Code : 997134
TATA AIG Auto Secure endorsement No. (TA) : TA 16,

I/We hereby certify that the Policy to which this Certificate relates as well as this
For & On Behalf of Tata AIG General Insurance Company Ltd.
Certificate of Insurance are issued in accordance with provisions of Chapter X
and XI of Motor Vehicles Act, 1988. Digitally Signed by: Malpa Devi Maharana
In witness whereof this Policy has been signed at Mumbai on : Receipt (s) : Date: 21/12/2024
PB113010172 21/12/2024 Location: Mumbai

For stamp duty of ₹ 0.25 paid. In cash or demand draft or by pay order, vide
Receipt/ Challan no : MH0101010112345 dated the 01/09/2099

Policy Number : 3749320520/00/00 • GSTN Number :27AABCT3518Q1ZW

Policy Servicing Office : A-501, Building no-4 IT Infinity Park , MALAD EAST , MAHARASHTRA , 400097 • Tel. No : - phone

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”.

Note : You are advised to go through the policy schedule cum certificate of insurance which is issued based on information and declaration provided by you. Transcript of
Information & Declaration is also provided herewith to enable you to go through the same again and if any error/ discrepancy is found in respect of vehicle details, No Claim
Bonus or any other information provided by you, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting
documents, otherwise it will be deemed to be correct. You may visit the company website at www.tataaig.com for detailed benefits, terms & conditions and exclusions of the
policy issued and held by you. You may also reach us at our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of policy wording. Our grievance redressal
procedure and details about ombudsman are available at the company website www.tataaig.com. You may also reach us at our 24*7 helpline 1800 266 7780 for grievance
redressal procedure and details about ombudsman. Please note that any mis-representation, fraud, non-disclosure of material facts or non-cooperation of the insured will
lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any. We will specifica lly seek confirmation on No Claim Bonus availed by
you from your previous insurer. In case we receive confirmation that you had lodged claim with them then we will intimate you to pay the No claim Bonus Amount within 20
days. In case we don’t receive the No Claim Bonus recovery then it will be adjusted against claim amount payable to you if any. This Schedule, Policy terms and conditions
available on the company website and Endorsements mentioned herein above shall be read together and any word or expression to which a specific meaning has been
attached to/in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any amendments/modifications/alterations made on this system
generated policy document is not valid and the Company shall not be liable for any liability whatsoever arising from such cha nges unless written request is made to the
Company and the Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement.

Receipt No. : Receipt Date : 21/12/2024 Policy No. : 3749320520 00 00

Utilized from the receipt for Policy (₹)

3749320520 00 00

:
:

GSTIN : 27AABCT3518Q1ZW MAHARASHTRA Service Accounting Code : 997134.

 Auto Secure - Liability Only Policy

Transcript of Information/Declaration

Insured and Vehicle Details

1. Name (Registered Owner of the Motor Vehicle) : Mr. A Ramu

2. Vehicle Details : Honda CB Shine
3. Address for Communication :19-17-24,NELLIMUKKU PEDAGANTYADA, PEDAGANTYADA Visakhapatnam , Andhra Pradesh 530044
4. Vehicle Type : MOTORCYCLE
5. Fuel Type : PETROL
6. Battery number :
7. Charger number :
8. No. of batteries :
9. Cost of battery :
10. No. of Chargers :
11. Is Battery provided by manufacturer:
12. Name of batter manufacturer :
13. Is battery a part of Ex-showroom price of the vehicle:
14. Insured’s Declared Value : ₹ 0
15. Date of Registration : 18/12/2013
16. Proposed Period of Insurance
TP cover period : 22/12/2024 to 21/12/2025 (Midnight)
Previous Insurance Details
1. Policy Number : NA
2. Date of expiry : NA
3. Type of cover : NA
4. Name & address if the Insurer : 19-17-24,NELLIMUKKU PEDAGANTYADA, PEDAGANTYADA Visakhapatnam , Andhra Pradesh 530044
5. Claim in Previous Policy Period : No
6. NCB in previous policy : NA
7. NCB Claimed : NA
8. Period of insurance
OD cover period NA: to NA
Nominee Details
1. Name of Nominee : Not Applicable
2. Age of Nominee : 30
3. Relationship : Others
4. Name of Appointee (if Nominee is minor) : NA
Restriction of Cover / Discounts / Concessions / Extended Covers
1. ARAI Membership Number : NA
2. Third Party Property Damage Cover restricted to ₹ 6,000/ only : No
3. Is Voluntary Deductible opted : No
4. Amount of Deductible opted : NA
5. Vehicle is fitted with Anti Theft Device approved by ARAI : No
6. Add-on Covers opted : No
7. PUC Certificate Number and PUC Expiry Date : NA -

Declaration for No Claim Bonus (If NCB Confirmation is not submitted but NCB claimed)

AML Guidelines :

Disclaimer : Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms & conditions, please refer sales brochure/ policy
wordings on www.tataaig.com carefully, before concluding a sale. Purchase of Tata AIG General Insurance Company Limited products are purely on voluntary basis.
#Add On covers can only be purchased with the base product and on payment of an additional premium

Prohibition of Rebates : - Section 41 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015. 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 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 prospectus or tables of the insurer. 2. Any person making default in
complying with the provisions of this section shall be liable for penalty which may extend to ten lakhs.

Grievance Redressal Procedure : As per Regulation 17 of IRDA of India (Protection of Policyholders Interests) Regulation, 2017.

Section 64 VB of the Insurance Act 1938 :Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company
Limited.

Auto Secure - Liability Only Policy - UIN : IRDAN152RP0002V02201516 • Depreciation Reimbursement - UIN : IRDAN152RP0002V02201516/A0043V01201819

Tata AIG General Insurance Company Limited

Registered Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013, Maharashtra, India • 24x7 Toll Free No: 1800 266 7780 • Email :
customersupport@tataaig.com • website : www.tataaig.com • IRDA of India Registration No: 108 • CIN: U85110MH2000PLC128425 • Company PAN No. : AABCT3518Q

TAGIC/PS/MRTW/Feb 22/05 Ver1/All 2547