This Document is Digitally Signed
The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA
Date: Tue, Dec 3, 2024 12:11:33 IST
Reason: Signing Policy for OICL
MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE
STANDALONE OWN DAMAGE(OD)-PRIVATE CAR POLICY - ZONE A
UIN: IRDAN556RP0001V01201920
Road Side Assistance included in this policy - Toll free No.18003091209 *Conditions Apply
Policy No : 421902/31/2025/4377 Prev Policy No : 421902/31/2024/4616
Cover Note No : - Cover Note Dt :
Insured's Code : 174595985 Issue Office Code : 421902
Insured's Name : MR. SAMPATH KUMAR N (GSTIN: 0) Issue Office Name : BO SHESHADRIPURAM BENGALURU
(GSTIN: 29AAACT0627R4ZS)
Address : NO 39 ANNA STREET ALUTHUPALAYAM Address : 401/2 SWASTIK MANANDI ARCADE, SC
MODAKKURICHI ,ERODE , TAMIL NADU ROAD, SHESHADRIPURAM
(State Code:33) -638104
BANGALORE KARNATAKA 560020
ERODE TAMIL NADU 638104
Tel /Fax /Email : 9606482955 / / 9606482955 / Tel /Fax /Email : 080-23460196 / 080-23462430 /
sampathcute@gmail.com 421902@orientalinsurance.co.in
Lead\Breakin No :
Agent/Broker Details
Dev.Off.Code :
Agent/Broker :: LC0000000010 IDEAL INSURANCE BROKERS PVT LTD
Address : 23, TOWNSHEND ROAD KOLKATTA 700025 WEST BENGAL, KOLKATTA 700025
WEST BENGAL,MOB NO 9830762288 9619001166, 9830883728,CALCUTTA,WEST
BENGAL,700001
Tel /Fax /Email : 033-22481949/9619001166//info@idealinsurance.in
Period of Insurance : FROM 00:00 ON 05/12/2024 TO MIDNIGHT OF 21/11/2025
Collection No & Dt : DC_I_IND 5097005879 - 03/12/2024 GST INVOICE NO :2923352520 UIN :0
Gross Premium : 4,369 GST : 786 Stamp Duty : .5 Total : 5,155
Geographical Area : INDIA Area Extension :
Particulars of Insured Vehicle:
Registration Mark Engine No. & Type Of Body Cubic Year Of Seating Capacity
& Place Chassis No. Make - Model Capacity Manf. (including Driver)
Type of Fuel
TN 33 BT 4534 KM56529 FORD-ECOSPORT OTHERS 1498 2019 4 + 1
1.5L DIESEL
Erode MAJAXXMRKAKM56 DIESEL
TITANIUM MT BS-IV
529
Limitations as to use: C.P.A Cover Owner Driver(CSI):Rs 0
1 The policy covers use of the vehicle for any purpose other than hire or reward ,tuition,organized racing,pace making,reliability
trial,speed testing,carriage of goods(other than samples or personal luggage) or use for any purpose in connection with Motor Trade.
Limit of Liability: As per policy terms/conditions
Details of TP insurance
Name of Insurer & Address Policy No Period of Insurance
NIACL 71050031212060049223 22/11/2022 TO MIDNIGHT OF 21/11/2025
Place : BANGALORE
Date : 03/12/2024
Page 1 of 3
This Document is Digitally Signed
The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA
Date: Tue, Dec 3, 2024 12:11:33 IST
Reason: Signing Policy for OICL
Attached to and forming part of policy number 421902/31/2025/4377
If the TP Insurance declaration provided above by the Insured is found incorrect/or the policy does not exist/ lapsed/Cancelled due to any
reason, then subject policy becomes Null and Void from the date TP coverage has ceased to exist.
*This insurance excludes any loss/liability arising out of Third Party or personal accident.
*This insurance excludes all pre-existing damages
Insured's Declared Value
For the Vehicle For Trailers Non Electrical Electrical Value of CNG Total Value
Accessories Accessories LPG Kit
6,50,000 0 0 0 6,50,000
SCHEDULE OF PREMIUM
BASIC OD COVER 22,406.00 TOTAL PREMIUM 4,369.00
BASIC OD TOTAL 4,481.00 ADD :IGST 786.00
LESS :SIP DISCOUNT 17,925.00 STAMP DUTY 0.50
LESS :ANTI-THEFT DISCOUNT-GR-30 112.03 TOTAL AMOUNT 5,155.00
OD TOTAL 4,369.00
MOTOR TOTAL OD 4,369.00
Please note the coverage under this policy is restricted to Own Damage section only and no other liability in connection with the
vehicle
Deductibles under Section-I : Compulsory Deductible 1000
Subject to IMT Endorsement Printed herein/attached to : IMT-10 , IMT-20 , IMT-22
Details of IMT Endorsements are also available on the Company¿s Web Portal www.orientalinsurance.org.in
Hypothecation Agreement with: -
Hire Purchase/Lessor Agreement with: -
In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured will comply with
the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as well as company's website.
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC endorsements mentioned herein
above which are available on Company's website: www.orientalinsurance.org.in or on demand from the policy issuing office.
Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void
abinitio (from inception).
Claim is not admissible if Driving License is found fake or is not valid whether or not in the knowledge of the insured.
I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of
Chapter X and Chapter XI of Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at BO
SHESHADRIPURAM BENGALURU (GSTIN: 29AAACT0627R4ZS) on 03-DEC-24
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 MVAct, 1988 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".
Entered By : Ms C S HARINI
Examined By : Ramayanam Praneeth
Digitally Signed
Policy Printed By : 464601 IP : By
Policy Printed On : 03-DEC-24 12:11:32 Authorised Signatory
This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.
Place : BANGALORE
Date : 03/12/2024
Page 2 of 3
This Document is Digitally Signed
The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA
Date: Tue, Dec 3, 2024 12:11:33 IST
Reason: Signing Policy for OICL
Attached to and forming part of policy number 421902/31/2025/4377
This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.
In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
IRDA Regn. No. 556-Now you can buy and renew selected policies online at www.orientalinsurance.org.in
and through other digital platforms Whatsapp (Send "Hi" to 9560711200)
Place : BANGALORE
Date : 03/12/2024
Page 3 of 3
