ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Commercial Vehicle - Passenger Carrying ) Proposal No. & Date R123750256 / 01-Jan-0001
Policy No. & Type 55130231201345747646 Period of Insurance 14-Dec-2020 to 13-Dec-2021
Policy Issued On 28-Nov-2020 (00:00) Vehicle Identification No. MA3CZF03SKK601235
Insured Name Mr. Mogilipalem Ganesh Geographical Area INDIA
Invoice No 4131204454611 Accounting Code of Service 997134
Insured Address 4-1-785/2.anisha Nagar, Bodhan.nizamabad BODHAN (V&M), ,
NIZAMABAD-503185, Telangana
Insured State & Code Telangana-36 Place of Supply Telangana GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 595227
Model & Variant NEW DZIRE VDI BS- IV/MARUTI DZIRE VDI Non Electrical Accessories 0
Registration No TS16UC2710 Electrical Accessories 0
Year of Manufacture 2019 CNG/ LPG Kit 0
Engine- Chassis No 3550435 - MA3CZF03SKK601235 Total IDV 595227
Cubic Capacity 1248
Seating Capacity 5
Type Of Body Saloon
RTO Location TS16UC2710 / NIZAMABAD
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 7577 Basic Third Party Liability 11320
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [1 Year] 275
PACover for Paid Driver of Rs (200000) each (IMT- 17 ) 120
Kit (IMT-25) 0
Legal Liability (WC) to Driver (IMT-28) 50
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Basic Premium 7577 Legal Liability to Employees (IMT-37) 0
Geographical Area Extn. (IMT-1) NA Legal Liability to Passenger (IMT 46) 0
Lamp, Tyres etc. (IMT 23) 0 Driving Tuition Loading On TP Premium (60%) NA
Net Liability Premium (B) 11765
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 21058
Fiber Glass Tank 0 CGST @9% 1895.22
Sub-Total Additions 0 SGST @9% 1895.22
Deductibles Gross Premium Paid 24848
Voluntary Deductibles (IMT 22A) 0 MISP - VARUN MOTORS PVT LTD, NIZAMABAD
Anti-Theft Device (IMT-10) 189
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus 0 0
Discount for vehicles designed for handicapped NA 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 189 3. The Policy is subject to a compulsory Deductible of Rs 500 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10, 28, 17,
Nil Depreciation Plus 1905
Engine Protect 0
Invoice Protect 0
Net own Damage Premium (A) 9293
Nominee Details : Nominee Name MR gummadilli rajitha Age 24 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Electronic Payment 109024911457 ELECTRONIC PAYMENT 24848
Financier Type Financed Financier Name CHOLAMANDALAM INVESTMENT AND FINANCE CO LTD Financier Branch NIZAMABAD BRANCH
Persons or Classes of Persons entitled to drive : Any person including 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 passengers at the time of the accident 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 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 for: (1) Organised racing, (2) Pace Making (3) Reliability Trials, (4) Speed Testing (5) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled mechanically
propelled vehicle.
LIMITS OF LIABILITY: 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. Under Section II -1(ii) of the Policy - Damage
to Third Party Property - Rs. 7.5 lakhs (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Personal Accident cover for Owner - Driver under section IV: Capital Sum Insured (CSI) - Rs.
1500000 Deductible under Section-I: 500 (Compulsory Deductible Rs. 500 and Imposed 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: The preceding year/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. 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 http://www.gbic.co.in/ombudsman.html
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 M.V. Act, 1988.
For National Insurance Company Limited

Authorized Signatory
Policy Issuing Office:-Nizamabad Branch, First Floor, 4-8-799/2, Lakshmiraj Complex, Jawahar Road, Nizamabad, Andhra Pradesh
GSTIN: 36AAACN9967E6ZZ, CIN No.:U10200WB1906GOI001713
State Name : Telangana