Payment Receipt
Payment Receipt
2316207139136700000
LIMITATIONS AS TO USE:The Policy covers use of the vehicle 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 of the vehicle for a ) Organized racing b ) Speed Testing. Persons or Class 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 when not used for the transport of goods at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989. Limits of Liability 1.
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. 2. Under Section II - 1(ii) of the policy -Damage to Third Party
Property - ` 750000 3. P. A. Cover under Section III for Owner - Driver (CSI) : ` 1500000 Terms, Conditions and Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of
cost on request & the same is also available at our website. A personal copy of the same is available free of cost on request & the same is also available at our website.
Insured is carrying on or engaged in the business or occupation of and no other for the purposes of this insurance
I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988.The stamp duty of Rs. 0.5/-
paid vide Order No:(LOA/ENF-1/CSD/64/2024-25/ Validity Period Dt. 15/10/2024 to Dt. 31/12/2028, OW No. 4742 Dt 04/10/2024 GRN NO. MH007778466202425M,Dt. 10/09/2024, SBI Bank & DEFACE No.
0005045616202425,Dt. 03/10/2024) a s prescribed by Government of Maharashtra Notification No. Mudrank 2017/C.R.97/M-1, Dt.09/01/2018. IMPORTANT NOTICE: The Insured is not indemnified if the vehicle is
used o r driven otherwise than in accordance with this Schedule. Any payment made b y 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 'AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY'. Disclaimer: The Policy shall be void from inception if the premium cheque is not realized.
In the event of misrepresentation, fraud o r non-disclosure of material fact, the Company reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared
accordingly. The existing damages to the vehicle as mentioned in the report shall not be paid by the Company. The policy is issued basis the information provided by you, which is available with the company. In case
of discrepancy o r non recording of relevant information in the policy, the insured is requested to bring the same to the notice of the company within 15 days . GST for this invoice is not payable under reverse charge
basis. 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
Goods & Services Tax Registration No: 27AABCL5045N1Z8 SAC Code 997134
Branch :1st fl, 165-166 backbay reclamation h t parekh marg, h t parekh marg, mumbai
For Claim/Policy related queries Please Contact us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register and track claims.
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
Certificate of Insurance cum Policy Schedule 2316207139136700000
2316207139136700000
Agent Name : L&T FINANCE LIMITED For HDFC ERGO General Insurance Company Ltd
Agent Code : 2012288690636965 Tel No. : 91-2262125000
Scan the code for Instant Policy Info, Register/Track Claim, Renewal and Modifications in policy.
"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings "
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2316207139136700000
Motor Insurance - Proposal Form cum Transcript Letter For Miscellaneous Carrying
Comprehensive
Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended) : 1. No person shall allow o r 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 the premium shown on the policy, nor shall any
person taking out o r renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an
insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if
at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees..
I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C:
1 ) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract between me/us and
HDFC ERGO General Insurance Company Limited.
2) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately.
3) I understand that: My premium is derived on the basis of information filled by me, which includes my previous year policy details and No claim Bonus Discount %, if any.
HDFC ERGO General Insurance Company (Company) may verify my previous year policy details and may hold claim settlement process till the time confirmation is received from previous insurer
The Company shall have no liability under this insurance contract if it is found that any of my / our statement on particulars or declaration (other than NCB discount) in this proposal form
or other documents are incorrect and / or untrue / false.
I f any discrepancy found in the information provided for arriving at NCB discount %, Company shall communicated to me via e-mail &/ or letter for payment of the balance premium amount within 20 days from the
date of communication. If the balance amount is not paid by me within 20 days from the date of communication then Claim will be paid proportionately.
4) I/We also shall endeavor to procure the renewal notice and pass on the same to HDFC ERGO General Insurance immediately upon the receipt of such renewal notice.
5) Any person who, knowingly and with intent to defraud the Insurance Company or other persons, files a proposal for insurance containing any false information, or conceals for the purpose of misleading, information
concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a denial of insurance benefits.
GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details provided during policy
issuance. For any subsequent changes or addition (i.e. if GSTIN not entered at the time of policy issuance ) on policy schedule, changes shall be carried out through fresh policy issuance with prospective effect.
6) I understand the Proposal No. 2316207139136700000 is issued to me basis on above information.
7) It has been declared by you that you are not a Politically Exposed Person and the source of funds to purchase this policy are from salary/business income.
Transcript Declaration : In case disagreement or objection or any other changes with respect to information and contents mentioned herein above,please contact our toll free number and register your objections /
changes / disagreement to the content of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days from date of your receipt of this transcript along.
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2316207139136700000
Policy
S.No Title Description (Please refer to applicable Policy Clause Number in next column) Clause
Number
1 Product Name Motor Insurance - Miscellaneous Carrying Comprehensive
Unique Identification
2 Number (UIN) allotted by UIN NO: IRDAN125RP0013V01202122
IRDAI
Section I-
3 Structure Section I: indemnity basis Sum
Insured –
Insured’s
Section II: Legal liability as per M.V act, Workmen compensation act
Declared
Value
Section III : Benefit basis.
(Idv)
4 Interests Insured Motor Vehicle
Sum Insured / Motor Refer
5 Insured Declared Value Section I: 1059 policy
Scope schedule
Section II: Third party Property damage: 7267 Third party liability: As per Motor
Vehicle Act
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2316207139136700000
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2316207139136700000
11 Admissibility of Claim Following are the key parameters leading to admissibility or denial of claims:
-Loss will be admissible only if occured from insured perils mentioned in policy
wordings.
- Report the Loss to Insurance Company without any delay.
- Duty of care & loss minimization post accident.
- Avoid willful Negligence and self-damage to insured vehicle.
- Ensure vehicle is in best running condition
- Drive the vehicle responsibly
- Not to use the vehicle for any other purposes other than what is the vehicle is
registered for.
- Take additonal coverage before planning to take vehicle outside the defined
geographical areas.
Include a sample claim calculation process for retail products
1. Assessed amount by the surveyor is billed in the final invoice.
2. Surveyor processes the bill and calculates the amount payable by Inurance
Company (Sample Calculation Sheet)
3. Parts in bills are categorized as per replacement, repair, labour and paint and
applicable depreciation as per the Indian Motor Tariff is applied.(Parts Depreciation
Sheet)
4. Deductibles as per the policy are deducted from the summary and policy
benefit(Zero Depreciation, Consumables, Return to Invoice, etc) is added and final
Insurance Company payable is calculated.
GENERAL EXCEPTIONS (Applicable to all sections of the Policy) The Company
shall not be liable under this Policy in respect of
1. any accidental loss or damage and/or liability caused sustained or incurred
outside the geographical area;
2. any claim arising out of any contractual liability;
3. any accidental loss damage and/or liability caused sustained or incurred whilst the
vehicle insured herein is a. being used otherwise than in accordance with the ‘
Limitations as to Use’ or b. being driven by or is for the purpose of being driven by
him/her in the charge of any person other than a Driver as stated in the Driver's
Clause
4. i. any accidental loss or damage to any property whatsoever or any loss or
expense whatsoever resulting or arising there from or any consequential loss.
ii. any liability of whatsoever nature directly or indirectly caused by or contributed
to by or arising from ionising radiations or contamination by radioactivity from any
nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the
purpose of this exception combustion shall include any self-sustaining process of
nuclear fission
6. any accidental loss damage and/or liability directly or indirectly or proximately or
remotely occasioned by contributed to by or traceable to or arising out of or in
connection with war, invasion, the act of foreign enemies, hostilities or war like
operations (whether before or after declaration of war) civil war, mutiny rebellion,
military or usurped power or by any direct or indirect consequence of any of the said
occurrences and in the event of any claim hereunder the insured shall prove that the
accidental loss damage and/or liability arose independently of and was in no way
connected with or occasioned by or contributed to by or traceable to any of the said
occurrences or any consequences thereof and in default of such proof, the Company
shall not be liable to make any payment in respect of such a claim.
12 Policy Servicing - Claim 1.Turnaround time for claim settlement including escalation matrix] Input
Intimation and from
Processing Claims
Team
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2316207139136700000
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2316207139136700000
I have read the above and confirm having noted the details.
Place:
Date:
(Signature of the Policyholder)
Note:
i. Insurer shall provide web-link where the product related documents including the Customer Information sheet are available on the w
ii. In case of any conflict, the terms and conditions mentioned in the policy document shall prevail.
iii. Insurer to take confirmation of the Policyholder regarding receiving of the Customer Information Sheet.
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN: IRDAN125RP0013V01202122. Policy Issuing/ Customer Happiness Center: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
Frequently Asked Question’s (FAQ’s) - Motor Insurance
WHAT ARE THE MAJOR COVERS UNDER THE POLICY? HOW DO I FILE A CLAIM?
Loss or Damage to the Insured Vehicle caused due to: For Accidental damage to the insured vehicle (Own Damage Claims):
a. Fire, explosion, self ignition or lightning. ¡ Visit the 'Help' section by clicking https://selfhelp.hdfcergo.com
b Burglary, housebreaking or theft ¡ Send us a "Hi" on our WhatsApp number 8169 500 500
c All act of God perils like earthquake, flood, cyclone etc ¡ Call us on our Customer Service No.: 022-62346234/ 0120-62346234
d Accidental external means, terrorism, riot and strike Please keep the following details handy while intimating a claim:
Liability to Third Parties: a. Policy number
Provides cover for any legal liability arising out of the use of the vehicle for b. Registration details/RC copy
a Accidental death / injury to any third party c. Driver's details at the time of accident including driving license number
b Any damage to property owned by third party d. FIR on a case-to-case basis
Personal Accident Cover: e. Repair estimate
The policy provides for a mandatory Personal Accident cover for owner driver and optional cover for
passengers covering accidental death and permanent total disability
WHAT IS THE CLAIM PROCESS?
WHAT ARE THE MAJOR EXCLUSIONS OF THE POLICY? 1. If your vehicle can be driven, take it to the nearest dealer / garage.
2. Get a repair estimate, fill up the claim form and attach a copy of the registration certificate and
a. General aging, wear & tear, mechanical or electrical breakdown, failure, depreciation, any driving license of the person driving at the time of the accident.
consequential loss 3. If the garage is within our network, you could avail of cashless claim facility. Pay for non accident
b. Damage by a person driving without a valid license related repairs, depreciation and deductible. We would settle the rest.
c. Damage by a person driving under the influence of liquor or drugs 4. If the garage is outside our network, you would have to get the claim reimbursed subsequently.
d. Loss/damage attributable to war, mutiny, nuclear risks 5. The insured should not initiate any repairs or dismantle the vehicle before the survey is completed.
e. Damage to tyres and tubes, unless damaged during an accident CLAIMS DOCUMENTS -
f. Usage on hire & reward (applicable for all classes except public commercial vehicles)
For ACCIDENTAL DAMAGE TO INSURED VEHICLE
g. Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes, headlights, paint
work (applicable for all commercial vehicles; unless opted additionally) a. Duly filled and signed claim form & satisfaction voucher
h. Loss or damage resulting from overturning arising out of operation as a tool (applicable for mobile b. Registration Certificate (RC)
cranes, drilling rigs, mobile plants, navvies, shovels, grabs, rippers unless opted for additionally) c. Driving license of the person driving at the time of the accident
i. Loss of or damage to accessories by burglary housebreaking or theft unless the vehicle is stolen at d. Policy copy , original repair estimate, repair invoice
the same time (applicable to all commercial vehicles & two wheelers) e. Payment receipt for non-cashless claims
f. Original repair invoice for cashless claims
TRANSFER OF INSURANCE (INCASE VEHICLE IS SOLD) g. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence proof)
a. No objection letter from the previous insured h. Form 35 & original NOC from financer incase of total loss where payment is made to insured
b. Form 29/30, Sale Deed OR transferred RC copy. In case of smart card, RTO transfer fee paid i. A copy of police FIR/panchnama is required for TP injury / death / property damage
receipt. Additional documents required for commercial vehicles:
c. Differential Premium if any (NCB recovery, PA to Owner - Driver etc) a. Spot survey b. Load challan c. Fitness certificate d. Route permit
d. NOC from Financier, if applicable.
e. Pre-inspection is must if transfer request date is >14 days from the endorsed RC copy date CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT
f. Break-in loading >45 days ( if applicable) a. Duly filled and signed claim form & discharge voucher ( after loss settlement )
b. Original Registration Certificate (RC)
Additional Documents c. Original policy copy
a. Incase of death of Insured - a. Death Certificate b. Legal heir certificate d. Copy of FIR lodged at the nearest police station
b. Incase of Employer to Employee transfer - a. Letter from Employer e. All original keys & vehicle invoice copy
f. No trace report confirming that the stolen vehicle is not traceable
WHAT CHANGES CAN BE DONE IN MY POLICY ENDORSEMENT g. Original NOC from financer incase of hypothecation / HPA
h. Intimation to RTO for theft of vehicle
For Changes related to registration of vehicle or vehicle details like i. Duly signed RTO transfer papers (Form 26, 28,29,30,35)
a. Correction in registration number/ location / address j. RC extract with stolen remark from the concerned RTO after the loss
b. Correction in vehicle make & model/ cubic capacity/ seating capacity/ engine & chassis k. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence proof)
number/manufacture year l. Deed of subrogation cum indemnity on judicial stamp paper
Disclaimer: Where it is brought to the notice of the Company, that vehicle insured which is not a new vehicle
To make above changes, you need following documents: but shown as a new vehicle with a malafide intention, claims for total loss of such vehicle would not be
a. Request letter for the change admissible, if there is a gap of more than 10 days from date of invoice of vehicle and the proposal date.
b. Policy copy
c. Registration Certificate copy /Invoice Copy for change in vehicle details WHAT IS NCB?
d. Cheque for additional premium if applicable NO CLAIM BONUS (NCB):
NCB is provided for every claim free year basis the slab as provided by Tariff.
For addition of electrical and non electrical accessories, CNG & LPG Kit: How can I get No Claim Bonus Reserving Letter?
a. Request letter for the change NCB Reserving letter can be provided only on Sale of vehicle evidenced by transferred RC copy OR
b. Policy copy Sale Deed and Form 29 & 30. The OD section of the policy needs to be transferred to the new owner or
c. Invoice copy (mandatory where value of accessory exceeds ` 20,000/-) cancelled.
d. Endorsed Registration Certificate Copy (For CNG/LPG kit) HOW DO I RENEW MY POLICY?
e. Cheque for additional premium You can renew your policy via any of the below options:
E-mail or Call us for additional premium details & send relevant documents copy to our customer service a. RENEW ONLINE: Visit "Instant Renewal" section on our website www.hdfcergo.com
office to renew instantly
b. Call on 022 - 62346234 / 0120 - 62346234 and renew instantly
For Change of financier details (Hypothecation/Lease/Hire-Purchase) c. Courier the Cheque / Demand Draft in favor of "HDFC ERGO General Insurance Company Ltd' to
a. Request letter for the change our Customer service office
b. Policy copy d. Email to care@hdfcergo.com
c. Endorsed Registration Certificate copy
d. NOC from financier OR form 35 duly signed and stamped by financier HOW TO CONTACT US?
Customer Service No :022 - 6234 6234 / 0120 - 6234 6234
E-Mail :care@hdfcergo.com
For any endorsments on your policy you can simply place your request on HELP Section of our Write to us at :HDFC ERGO General Insurance Company Limited
website www.hdfcergo.com (Customer service office) D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg,
Bhandup (West). Mumbai - 400078. Maharashtra.