SBI General Insurance Company Limited.

Servicing Office : /D[PL'DUVKDQ%XLOGLQJQG)ORRU*65RDG2SS%RUD6HUYLFH6WDWLRQ8OXEDUL*8:$+$7,$66$0 6WDWH

Code:18) -781007
Private Car Insurance Policy - Package UIN --IRDAN144RP0005V03201112
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AAMCS8857L GSTIN: 18AAMCS8857L1ZB CIN :U66000MH2009PLC190546 IRDAI Reg:144

Policy No: HYNDAIHIIB/1416417 Proposal No. & Date: HIIB15273727, 28-APR-2025

Policy Issued On: 28-Apr-2025 18:43 HRS Previous Policy No.: 3408/00352011/000/00
Insured Name: MR. JANJIT BHUYAN Previous Insurer: Cholamandalam MS General Insurance Co. Ltd.
Period of Own Damage : 29-APR-2025 (00:00) To 28-APR-2026 (1 YEAR)
GERELUACHUK NANDIKESWAR JAMUGURIHAT, ASSAM , ASSAM Period of Liability Cover: 29-APR-2025 (00:00) To 28-APR-2026 (1 YEAR)
Insured Address:
(State Code:18) -784180
Period of Compulsory 29-APR-2025 (00:00) To 28-APR-2026 (1 YEAR)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX8864H NA RAJASHREE BARUAH 40 SPOUSE

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI GRAND I10 NIOS 1.2MT KAPPA SPORTZ DT 1197 2022 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
HATCHBACK AS 32 A 1707 BISWANATH YES PETROL MALB351CLNM293475
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
476,190 0 0 0 476,190 G4LAMM952493

Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)

Basic Own Damage Premium Basic Third Party Liability Premium 3,416
Vehicle 3,799 Bi-Fuel Kit 0
Non-Elec. Accessories (IMT-24) 0 Geographical Area Extension (IMT-1) 0
Elec. Accessories (IMT-24) 0 Sub Total (Third Party Liability) 3,416
Bi-Fuel Kit (IMT-25) 0 Personal Accident (PA) Cover
Geographical Area Extension (IMT-1) 0 Compulsory PA Cover for Owner Driver Rs 1500000 (IMT-15) 325
IMT 23 Premium 0 PA Cover for 0 Unnamed Passengers Rs 0 Each (IMT-16) 0
Sub Total (Basic Premium) 3,799 PA cover for Paid Driver of Rs 2 Lac (IMT-17) 0
Discount/Deductibles Sub Total PA Cover 325
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 0 Paid Driver (IMT-28) 50
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT-29) 0

No Claim Bonus (35%) 1,330 Sub Total (Legal Liability) 50

Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 3,791

Sub Total (Deductibles) 1,330 Total Premium (A+B) 9,931
Total Own Damage Premium 2,469 SGST(9%) 894
Add On Coverages ( ZD,KP ) 3671 CGST(9%) 894
Net Own Damage Premium (A) 6,140 Gross Premium Paid 11,719
Add-on Cover Opted in the Policy: Depreciation Reimbursement(IRDAN144RP0005V03201112/A0007V02201314), Cover for Key replacement(IRDAN144RP0005V03201112/A0007V01202122)

Notes: 1. Consolidated Stamp duty paid to state exchequer

2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of
commencement of the Policy. The insured undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, 3.Geographical Area Ext. extended to (IMT-1): NA
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1,000 (IMT-
4. Policy issuance is subject to realization of cheque if premium is paid by cheque 22) & Voluntary Deductible of INR 0 .
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer website http://www.sbigeneral.in

*Hypothecation Details: SBI - SONITPUR - SONITPUR Payment Mode: Online

Limitations as to use:The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace
making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
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 learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Limits of Liability Clause: 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 Vehicle Act 1988.Under Section II-1 (ii) of
the policy-Damage to third party property is INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 15 Lakhs.
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) - 20%, preceding
two consecutive years - 25%, preceding three consecutive years - 35%, preceding four consecutive years - 45%, preceding five consecutive years - 50% of NCB on OD Premium.
NCB is allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Declaration on Tax Invoice 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.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT
OF RECOVERY" For legal interruption, English version will hold good.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.sbigeneral.in/portal/grievance-redressal or connect with the respective servicing
office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General Insurance
Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : ASSAM(State Code : 18), Insurer Invoice Number : 0000001416417
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 XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, Scan for Renewal SBI General Insurance Company Limited.
Haryana 122001 (Valid from 90 Days Prior to
Expiry)

Broker Code: 822 (Valid UPTO:30/05/2028) MISP NAME-TRYST AUTO PRIVATE

CIN No.: U67200HR2021PTC098982 LIMITED
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0185
Email ID: connect@hiib.in DP NAME-DEVSAGAR BHUYAN
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (TRYST AUTO PRIVATE LIMITED) at +91-7399916311