This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

PRIVATE CAR PACKAGE POLICY - ZONE B
Road Side Assistance included in this policy - Toll free No.18003091209
*Conditions Apply
IRDAN556P0077V01200506

Policy No : 261500/31/2026/2580 Prev Policy No : 332703/31/2025/1363

Cover Note No : - Cover Note Dt :

Insured's Code : 183983056 Issue Office Code : 261500

Insured's Name : Mr. CHANDAN (GSTIN: 0) Issue Office Name : BO RAILWAY ROAD HISAR (GSTIN:
06AAACT0627R1Z3)

Address : S/O SH. MADAN LAL Address : DO HISAR

H.NO. 777, WARD NO. 32 SCO NO. 174-75, RED SQUARE MARKET,
NEAR GURUDWARA, SHIVAJI COLONY , RAILWAY ROAD,
ROHTAK HARYANA 124001
ROHTAK HARYANA 124001 HARYANA 125001

PAN No :
Validated Mobile Tel /Fax /Email : 9953422669 / 01662-235436 /
Number/Email : / / 9034765121 / NA 261500@orientalinsurance.co.in

E-insurance Account
no. :

CKYC No :

Lead/Breakin No : /

Agent/Broker Details
Dev.Off.Code :
Agent/Broker :: LC0000000859 AAPKA POLICYWALA INSURANCE BROKING SERVICES PRIVATE L
Address : Booth No. 13, Anaj Mandi, Bhattu Kalan,, Fatehabad-
125053,Haryana,FATEHABAD,HARYANA,125053
Tel /Fax /Email : ////

Period of Insurance : FROM 00:00 ON 23/08/2025 TO MIDNIGHT OF 22/08/2026

Collection No & Dt : CC 2270002769 - 20/08/2025 GST INVOICE NO :062480072 UIN :0

Gross Premium : 12,163 GST : 2,190 Stamp Duty : .5 Total : 14,353

Geographical Area : INDIA Area Extension :

Particulars of Insured Vehicle:

Registration Mark Engine/Motor Type Of Body Cubic Year Of Seating Capacity
& Place No.&chassis Make - Model Capacity Manf. (including Driver)
no/VIN Type Of Fuel
HR 12 AN 7628 15CR05HYXW14529 TATA MOTORS-TATA OTHERS 1497 2021 4 + 1
NEXON XM DIESEL
RTO Rohtak MAT627241MLH570 DIESEL
70

FASTag ID :

Limitations as to use:--

1 Use only for social,domestic and pleasure purposes and for the insured business or profession.The policy covers use for any
purpose other than -(a)hire or reward.(b) organised racing,or (c) speed testing.

Persons or classes of persons entitled to drive:-- Any person including the insured: PROVIDED that a person driving holds an effective
driving licence at the time of the accident and is not disqualified from holding or obtaining such a licence:PROVIDED ALSO that the person
holding an effective learner's licence may also drive the vehicle and that such a person satisfies the requirements of rule 3 of the Central
Motor Vehicles Rules, 1989.

Limit of Liability:Under Section II-1(i) & (ii) in respect of any one accident: as per Motor Vehicles(Amendment) Act,2019

Place :
Date : 20/08/2025
Page 1 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

P.A. Cover under Section III for Registered Owner Cum Driver (CSI) : Rs. 1500000
*This insurance excludes all pre-existing damages

Insured's Declared Value

IDV of the IDV of Trailer IDV of Non electrical IDV of Electrical IDV of external Any Allied Total Value IDV
Vehicle Accessories Accessories CNG Kit Component/Retrofit

5,46,750 0 5,46,750
Nominee Details :
Nominee Name Age Relationship
SPOUSE Spouse

SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY

BASIC OD COVER 17,447.00 BASIC TP COVER 3,416.00

MOTOR OD BASIC - NEW 17,447.00 BASIC TP TOTAL 3,416.00
BASIC OD TOTAL 3,489.00 ADD :PA FOR OWNER DRIVER-GR36A 320.00
ADD :ADD-ON COVER NIL DEPRECIATION 8,147.00 ADD :LL-PAID DRIVER, 50.00
POLICY CONDUCTOR,CLEANER-IMT-28
LESS :SIP DISCOUNT 13,958.00 TP TOTAL 3,786.00
LESS :Motor Add on Cover 3,259.00 TOTAL PREMIUM 12,163.00
Discount(Nil.Depreciation)
OD TOTAL 8,377.00 STAMP DUTY 0.50
MOTOR TOTAL OD 8,377.00 ADD :SGST 1,095.00
ADD :CGST 1,095.00
TOTAL AMOUNT 14,353.00

Deductibles under Section-I : Compulsory Deductible 1000

Subject to IMT Endorsement Printed herein/attached to : IMT-22 , IMT-29 , IMT-28 , IMT-6

Details of IMT Endorsements are also available on the Company's Web Portal www.orientalinsurance.org.in

Hypothecation Agreement with: HDFC BANK LTD

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 provided by this policy is governed by the terms,conditions,warranties,exclusions,INDIA MOTOR TARIFF(2002)endorsements, and
OIC add-on cover endorsements as outlined in the prospectus and customer information sheet. These details can be found on the company's
website www.orientalinsurance.org.in or requested from the policy issuing office.You can store our policy in Digilocker.The insured is requested
to visit our website or nearest office for policy servicing,claim procedures,and lodging grievances.If not resolved,you may approach the insurance
ombudsman of your region,a list of which is available on our website or at any of our offices.
You may also lodge a complaint at IRDAI:https://bimabharosa.irdai.gov.in/.

This Policy is issued on the condition that the insured vehicle has a valid PUC and FASTag ID(Wherever Applicable)and they must remain valid
throughout the period of this insurance.
In case the Own Damage cover under the Bundled Policy expires and the same is not renewed with Oriental the third party coverage under this
Bundled policy will revert to Standalone Liability Only Policy.

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

Place :
Date : 20/08/2025
Page 2 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

Chapter XI of the Motor Vehicles (Amendment) Act, 2019.The Policy does not cover liability for death,bodily injury or damage as excluded in section
150(2) (ii) and (iii);(b) and (c) of the Motor Vehicles (Amendment) Act,2019.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at BO RAILWAY ROAD
HISAR (GSTIN: 06AAACT0627R1Z3) on 20-AUG-25
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 Vehicles (Amendment) Act,2019 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

Entered By : PRERNA TIWARI

Examined By : PRERNA TIWARI

Policy Printed By : PRTL IP :

Policy Printed On : 20-AUG-25 17:52:26 Authorised Signatory

This is an electronically generated digitally signed document(Policy Schedule). The stamp duty has been centrally deposited with the appropriate
authority or stamp defaced & retained in the office.

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 including Whatsapp (Send "Hi" to 9560711200)

Place :
Date : 20/08/2025
Page 3 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

CUSTOMER INFORMATION SHEET

SI.NO Title Description
1 Product Name Private Car Package Policy
Unique Identification Number (UIN)
2 IRDAN556RP007701200506
allotted by IRDA
The Insured Declared Value (IDV) of the Vehicle will be deemed to be the
3 Structure Basis of Sum Insured (IDV) Sum Insured for the purpose of this policy which is fixed at the
commencement of each policy period for the insured vehicle.
This is an Indemnity based (with deductions for depreciation and policy
excess) package product covering both Accidental Own Damages to the
insured's vehicle & Third Party liability arising out of use of the vehicle. It also
covers personal accident for owner-driver.
The schedule of depreciation for fixing IDV of the vehicle :-

% OF DEPRECIATION
AGE OF VEHICLE
FOR FIXING IDV
Not exceeding 6 months 5%

Exceeding 6 months but not exceeding 1 15%

year
Exceeding 1 year but not exceeding
20%
2 years
Exceeding 2 years but not exceeding
30%
3 years
Exceeding 3 years but not exceeding 4
40%
years
Exceeding 4 years but not exceeding 50%
5 years
IDV of vehicles beyond 5 years of age and of obsolete models of the vehicles
( i.e. models which the manufacturers have discontinued to manufacture) is to
be determined on the basis of an understanding between the insurer and the
insured. IDV shall be treated as the 'Market Value' throughout the policy
period without any further depreciation for the purpose of Total Loss (TL) /
Constructive Total Loss (CTL) claims. The insured vehicle shall be treated as
a CTL if the aggregate cost of retrieval and / or repair of the vehicle, subject to
terms and conditions of the policy, exceeds 75% of the IDV of the vehicle.

1. Indemnity- Repair or TL/CTL basis

2. Benefit basis in case of CPA( only if opted for)

1. Vehicle registered in the name of the insured.

4 Interests Insured 2. Third Party Liability arising out of use of the vehicle.
3. Personal Accident cover for Owner and/or driver and passengers
(only if opted for)

Section I-- LOSS OF OR DAMAGE TO THE VEHICLE INSURED

5 Sum Insured/ Insured
The schedule of age-wise depreciation as shown in above Column no. 3
Declared Value (IDV)
is applicable for the purpose of Total Loss/Constructive Total Loss
(TL/CTL) claims only.

Section II-- LIABILITY TO THIRD PARTIES

Legal Liability to Third parties (TP) for Death, personal injury and property
damage resulting from accident to insured vehicle

Place :
Date : 20/08/2025
Page 4 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

Section - III:
PERSONAL ACCIDENT COVER FOR OWNER-DRIVER
(applicable only when opted for)
Nature of injury/ Scale of compensation
(i) Death 100%
(ii) Loss of two limbs or sight of two eyes or one limb and sight of
one eye 100%
(iii) Loss of one limb or sight of one eye 50%
(iv) Permanent total disablement from injuries other than named
above 100%
The compensation shall be payable under only one of the items (i) to (iv)
above in respect of the accident occurred whilst operation of vehicle by
owner-driver arising out of any one occurrence and the total liability of the
insurer shall not in the aggregate exceed the sum of Rs.15 lakhs during any
one period of insurance.

OD Cover (Section I): The Company will indemnify the insured against loss
Policy Coverage or damage to the vehicle insured hereunder and/or its accessories whilst
6
thereon
i. by fire, explosion, self -ignition or lightning;
ii. by burglary, housebreaking, or theft;
iii. by riot and strike;
iv. by earthquake (fire and shock damage); v. by flood, typhoon, hurricane,
storm, tempest, inundation, cyclone, hailstorm, frost;
vi. by accidental external means;
vii. by malicious act;
viii. by terrorist activity;
ix. whilst in transit by road, rail, inland- waterway lift elevator or air;
x. by landslide, rockslide.

Subject to a deduction for depreciation based on age of the vehicle, at the

rates mentioned below in respect of parts replaced:-

1. For all rubber/ nylon/ plastic parts, tyres and tubes, batteries and air bags -
50%
2. For fiber glass components - 30%
3. For all parts made of glass - Nil
4. Rate of depreciation for all other parts including wooden parts will be
as per the following schedule depending on Age of Vehicle:

No. Age of Vehicle Depreciation rate

i. Not exceeding 6 months NIL
Exceeding 6 months but not
ii. 5%
exceeding 1 year

iii. Exceeding 1 year but not exceeding 2 10%

years
iv. Exceeding 2 years but not exceeding 15%
3 years
v. Exceeding 3 years but not exceeding 4
years 25%

vi. Exceeding 4 years but not exceeding 35%

5 years
vii Exceeding 5 year but not exceeding 10
years 40%

viii Exceeding 10 years 50%

Place :
Date : 20/08/2025
Page 5 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

5. Rate of Depreciation for Painting: In the case of Painting, the depreciation

rate of 50% shall be applied only on the material cost of total painting charges.
In case of a consolidated bill for painting charges, the material component shall
be considered as 25% of total painting charges for the purpose of applying the
depreciation.

Road Side Assistance Cover (Integrated with OD Cover, no extra premium

charged)

TP Cover (Section II): Third party liability arising out of use of the insured
vehicle.

* Nil Depreciation
* Engine Protect
Add-on covers(Available only when
7 * Return to Invoice
opted for & extra applicable
* Loss of Personal Effects
premium is paid)
* Consumables
* Loss of Key
* Tyre and Rim Protector
* EMI protect
* Alternate Car Benefit

8 Loss Participation Deductible applicable

The Company shall not be liable for deductible amount as stated in policy
schedule, in each and every claim under Section - I (loss of or damage to
the vehicle insured) of this Policy.
Refer 'Excess' clause as per policy

The Company shall not be liable to make any payment in respect of :-

9 What are the major
exclusions? (a) consequential loss, depreciation, wear and tear, mechanical or electrical
breakdown, failures or breakages;

(b) Damage to tyres and tubes unless the vehicle is damaged at the same
time in which case the liability of the company shall be limited to 50% of the
cost of replacement. and

(c) Any accidental loss or damage suffered whilst the insured or any person
driving the vehicle with the knowledge and consent of the insured is under
the influence of intoxicating liquor or drugs.
Refer 'Exclusion' clause as per policy

Special Conditions, General Exceptions and warranties are as stated in

policy wordings.
Special Conditions and
10 Warranties In case of Theft of vehicle, immediate notice should be given to insurance
company along-with FIR. Notice should be given to RTO about the theft of
vehicle. Further, insured is advised to follow theft claim guidelines obtained
from claim settling office.
In case of Death of Registered Owner of vehicle, the policy will not lapse
immediately but will remain valid for 3 months from the date of death of
Registered Owner or expiry of the policy whichever is earlier. RC should be
transferred in the name of legal heir within these 3 months or a new policy can
be obtained by the legal heir.

Place :
Date : 20/08/2025
Page 6 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

Claim Intimation and Claim should be notified immediately through online intimation, email to the
11 address mentioned in policy or through any other means.
settlement
Due diligence should be taken by Insured upon occurrence of loss as
mentioned in conditions of the policy.

Claim will be indemnified in any one of the methods;

1) Repair basis -Indemnity with deduction for depreciation /excess applicable-

cashless or reimbursement to Insured
2) Total Loss/CTL basis- Based on the Net of Salvage loss/ Total loss basis
after deduction of Wreck value and Excess.
3) Cash Loss basis

Cashless Claim Process:

* In Cashless settlement, when repair of vehicle is done in authorized
workshop, Insured and Workshop sign the satisfaction note accepting this mode
of settlement. Amount of claim admissible is paid to the workshop and balance
is borne by Insured.
* After completion of repairs, Insurer will give clearance to release
the vehicle from the workshop once all the documents are received
and the liability is admitted.

12 Claim service * In case of claim, please obtain necessary guidance from policy issuing
office regarding designated SVC i.e. claim settling office.
* Surveyor appointment will be done within 24hrs of receiving intimation
* Surveyor / In house Loss Assessor shall reach the place of survey within 24
hours of intimation of claim
* Settlement Advice together with discharge voucher is sent within 7
days from the date of receipt of all documents.

The following are the Basic Claim documents to be submitted by the insured:
Basic Documents:
* Motor Claim Form -claim form may be downloaded from OICL website.
* KYC documents
* Copy of Registration Certificate of the Insured vehicle.
* Copy of Driving License of person driving at the time of loss.
For cashless garage network visit:
https://orientalinsurance.org.in/network-garage . Claimant to be assisted by
the cashless workshop partner to intimate the claim to the claim center.

13 1. Policy can be cancelled by the policyholder any time during the term of the
Cancellation policy.
2. The Company can cancel the policy on grounds of established fraud by
giving a prior notice of 7 days to the policyholder. In this case, no refund of
premium shall be done.
3.The Company will not cancel the Statutory Motor Third Party Policy except in
case of double insurance or total loss of insured vehicle.
4. The Company shall-
i. refund proportionate premium for unexpired policy period, if the term of
the policy is up to one year & no claim(s) is made during the term of the policy.
ii. refund premium for the unexpired policy period, in respect of policy with
the term more than one year and risk coverage for such policy years has not
commenced.

1. Company Officials :
14 Policy Servicing Website: https://orientalinsurance.org.in/
2. Toll Free Number: 1800 11 8485
3. Policy Issuing Office - as mentioned in your Policy Schedule for any
assistance.

Place :
Date : 20/08/2025
Page 7 of 8
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: RAJIV KUMAR GUPTA

Date: Wed, Aug 20, 2025 17:52:27 IST
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261500/31/2026/2580

15 GrievancesComplaints/ www.orientalinsurance.org.in
TAT * E-mail - csd@orientalinsurance.co.in
* IRDAI Integrated Grievance Management System
https://igms/irda.gov/in
* Insurance Ombudsman - Contact details of the Insurance Ombudsman
have been provided in Annexure 1 of the policy document.
* Ombudsman Website -
https://ecoi.co.in/ombudsman.html

TAT: Decision on claim within 7 days of receipt of Survey report.

Surveyor to be appointed within 24 hrs of claim intimation.
Surveyor to submit report within 15 days of appointment.

16 * Insured is at obligation to disclose all material information in the Proposal

form.
Obligations of the Policyholder * In the event of misrepresentation, mis-description or non-disclosure of any
material fact by the Insured, the Policy shall be void
* To intimate any change to the material information affecting the policy.
* Any change in the ownership of the vehicle, any kind of modification in the
vehicle/RC which might enhance the risk is considered as material information
and should be informed to insurance company for necessary endorsement on
policy.
For all above, Insured can contact our policy issuing office, details of which
are mentioned in the policy schedule.

Legal Disclaimer Note: The information must be read in conjunction with the policy document. In case of any conflict between the
CIS and the policy document, the terms and conditions mentioned in the policy document shall prevail.

Declaration by the Policy Holder:

I have read the above and confirm having noted the details.
Place:
Date:

Signature of Policy Holder

Place :
Date : 20/08/2025
Page 8 of 8