National Insurance Company Limited

IRDAI Regn. No. 058. CIN - U10200WB1906GOI001713

CERTIFICATE CUM POLICY SCHEDULE

ORIGINAL FOR RECIPIENT / DUPLICATE FOR SUPPLIER
TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)

Bundled Motor Policy- 3 Yr TP + 1 Yr OD (Private Vehicle) & Proposal No & Date N0005902751 / 07-Nov-2024 18:44
Policy Type & UIN
IRDAN058RP0006V01201819 Own Damage 07-NOV-2024 19:05 to 06-NOV-2025 23:59
Period of Insurance
Policy No 57020031241150648738 Third Party 07-NOV-2024 19:05 to 06-NOV-2027 23:59
Policy Issued On 07-Nov-2024 19:05 Vehicle Identification No. MBJTYKL1SRF253794
Insured Name Mr. Rejimon S Geographical Area India
Invoice No 4131248763422 GST No & State NA | Kerala
CHOORAVILA VEEDU,, THEKKETHERY PO, PATTAZHY,
Insured Address Accounting Code of Service 997134
PATTAZHY, KERALA-691522
Insured State & Code Kerala - 32 Place of Supply Kerala GSTIN of Customer GSTUNREGISTERED
MOTOR VEHICLE DETAILS
Make Maruti Suzuki Seating Capacity 5
MARUTI GRAND VITARA SMART HYBRID Type of Body | Color SUV | PEARL ARCTIC WHITE
Model - Variant ZETA 1.5L 5MT
Registration No NEW Fuel Type Petrol

Year of Manufacture 2024 RTO Location Pathanapuram | KL-80

Engine - Chassis No K15CN7469030 - MBJTYKL1SRF253794 Zone B

Cubic Capacity 1462 FASTag ID

Insured Declared Value(₹)

Vehicle ₹ 1330950 Non Electrical Accessories ₹ 0 Electrical Accessories ₹ 0 CNG/LPG Kit ₹ 0 Total IDV ₹ 1330950
Schedule of Premium(Amount in ₹)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle ₹ 8494 Basic Third Party Liability ₹ 10640
Basic Premium ₹ 8494 Compulsory PA Cover Premium [3 Years],(Sum Insured 15 lakhs) ₹ 825
Deductibles P.A Cover to Unnamed Passengers 5 Person of Rs100000 each (IMT-16) ₹ 750
Anti-Theft Device (IMT-10) ₹ 212 Legal Liability (WC) to Driver (IMT-28) ₹ 150
Sub-Total Deductibles ₹ 212 Net Liability Premium (B) ₹ 12365
NIL DEP PLUS (IRDAN058RP0006V01201819/A0024V01201819) ₹ 5989 Total Premium (A+B) ₹ 28899
Engine Protect Add on (IRDAN058RP0006V01201819/A0025V01201819) ₹ 1198 CGST @9% ₹ 2600.91
Invoice Protect Add on (IRDAN058RP0006V01201819/A0026V01201819) ₹ 1065 SGST @9% ₹ 2600.91
Net own Damage Premium (A) ₹ 16534 Gross Premium Paid ₹ 34101
Point of Sale - NX INDUS MOTOR CO PVT LTD
Notes:-
1. Policy Issuance is subject to realisation of premium.
2. Consolidate stamp duty paid to State Exchequer.
3. Policy is subject to a compulsory Deductible of Rs. 1000 (IMT-22)
4. Voluntary excess Rs. 0
5. Subject to Endorsements IMT 10,16,28
Nominee Details
Nominee Name: MINI P THANKACHAN Age: 46 Relation: Wife
Financier Details
Financier Type: Financed Financier Name: CANARA BANK Financier Branch: MYLOM
Payment Details
Payment Mode: Credit Card Cheque No/Transaction No: 113532142696 Bank Name: HDFC BANK LIMITED. Amount: 34101
Limitations as to use:- The Policy covers use of the vehicle for any purpose other than: a) Hire or Reward, 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 Trade.
Driver:- 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.
Limits of Liability:- Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is necessary to meet there requirements of the Motor Vehicles Act, 1988. Under Section II -1(ii) of the Policy -
Damage to Third Party Property - Rs.750000 - (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Cover for Owner - Driver under section III (CSI) Rs 1500000 - Deductible under
section-I : Rs 1000(Compulsory Deductible Rs 1000 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
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 during the preceding year (s), as per the following: The preceding
year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will only be allowed provided
the policy is renewed within 90 days of the expiry date of the previous policy.
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 """AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY""". For Legal
interpretation, English version will hold good.
For information on ombudsman you may visit website : https://www.cioins.co.in/Ombudsman:- 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 M.V. Act, 1988.

For National Insurance Company Limited

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.

Authorised Signatory

Policy Issuing Office :Thiruvanthapuram Division, Second Floor, St Josephs Press Building, Vazhuthacaud,Thiruvanthapuram, Dist: Thiruvananthapuram, Kerala
GSTIN: 32AAACN9967E1ZC, CIN No: U10200WB1906GOI001713. State Name: Kerala
This Policy is sourced and serviced by Maruti Suzuki Insurance Broking Private Limited
Direct Broker (General) IRDAI License No. 428, valid till 01 February 2027, Mail ID: support@msibpl.co.in, Contact: 33774477 (Prefix 011/022/033/044)
For Policy Terms and Conditions Log on to : www.marutisuzukiinsurance.com, www.nationalinsuranceindia.com
 Original Certificate of Insurance must be carried in your Car
Carry the Original certificate of insurance with the vehicle at all times - this is mandatory and is an evidence of compliance with Motor Vehicle
Act 1988.

Want to change anything in your policy?

Visit your nearest Dealership or get in touch with Maruti Suzuki Insurance Broking at their dedicated customer support - DIAL 3377 4477 (pre-
fix 011 / 022 / 033 / 044) to update your contact details, address, any change in the vehicle ownership, CNG / LPG fitment status, accesso-
ries addition/deletion etc.

Is your policy falling due for Renewal?

To renew your policy you may: 1) Visit www.marutisuzukiinsurance.com 2) Visit Nearest Dealership 3) Call us at 011 3377 4477 4) SMS
RENEW to 9215292152.

What to do if your four wheeler meets with an accident?

Simply inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011 /022 / 033 / 044) or Visit www.marutisuzukiinsurance.com to locate
nearest Dealership. They will assist you with your claim intimation to us and will also help you with other formalities. In case you intend to
make a claim on your policy, please ensure that the claim is intimated to Maruti Suzuki Insurance Broking within 24 hours of accident or on
the next working day.

What should you do if there is a third party injury/death and/ or third party property damage?
Lodge an FIR with the nearest Police station and obtain a copy. Provide a photocopy of your insurance policy to the affected third party. It is not
necessary to compensate the affected third party on the spot. Inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011 /022 / 033 /
044) for further assistance.

Is your Vehicle Stolen?

Lodge an FIR at the nearest Police Station and obtain a copy of the FIR. Inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011/022 /
033 / 044). Maruti Suzuki Insurance Broking will guide you for proper filing of your claim towards a quick settlement.

Total Loss Claim?

As a convention, it is called a total loss when the damages are so severe that claim assessment (Survey) indicates that the vehicle is beyond
repairs OR it shows that the Insurance Co.’s liability is more than 75% of two wheeler’s insured declared value. Visit your nearest Dealership or
just inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011/022/033/044) and you will be guided for a quick claim settlement.

Avoid driving through water log areas!

It can cause damage to your vehicle both internally and externally. Please do not try to start your car in case your vehicle stops by getting
submerged in flood or while crossing a water logged area. This can cause severe damage to the engine which is called Consequential Loss and
is not covered in your policy.

Must to Know
This Policy does not cover damage due to consequential loss, Wear & Tear, Mechanical/Electrical Breakdown, Driving under the influence of liquor or drugs,
Contractual Liability, Driving without valid driving license, Usage outside specified geographical area, Nuclear or War perils. It does not cover Damage to
tyres (unless vehicle is also damaged).

A Compulsory deductible based on Vehicle CC as per India Motor Tariff will apply at the time of every claim.

Depreciation on parts as per India Motor tariff will apply at the time of every claim unless opted for zero depreciation cover.

In case of Zero Depreciation Policy, the benefit of Zero Depreciation would be applicable for specific number of claims as per the Insurance Company's
Terms & Conditions.

AC Gas is fully payable. All Oils/Brake Lining/Glass Sealants/Oil Air Filters are paid @ 50%. Coolant/Fastener are not payable.
Visit Maruti
Visit Maruti SuzukiSuzuki Insurance
Insurance Broking
Broking at www.MarutiInsurance.com
at www.marutisuzukiinsurance.com

Be Safe : Your Safety is Our Concern

Don’t Mix Drinking and Driving Always Keep Your Vehicle In Good Follow Traffic Rule
Condition

Pedestrians Have First Priority on Roads Please Use Child Seats When Children Always Wear Your Seat Belts
are Seated in Front of Airbags