Tata AIG General Insurance Company Ltd.
Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent/Broker Name - Srihari Udupi Raghavendra
Agent/Broker License Code - 9005286 : Agent/Broker:Contact No - 9845378678 (mobile
or landline)
Certificate & Policy No.
Policy Type
AutoSecure Package Policy
0100829465 0100829465 00
Effective time and date of commencement of Insurance
From 13:00 Hours on 30/08/2013
Date of Expiry
Midnight on 29/08/2014
Premium (incl.S.Tax)
Place of Registration
BANGLORE NORTH
Rs. 8626.00
Insured's Business/Profession OTHER
Geographical Area
INDIA
Under Hire Purchase/Hypothecation/Lease with
Name and address of the Insured
SRINIVAS RAO BALLA
Name:
Address : No 104, Indu Arcade
4th Main, Maithri Layout
Kadugodi
Near Hope Farm Junction
BANGALORE 560066
KARNATAKA
Registration No.
KA04MG4671
N/A
Make & Model
Body Type
Mfg. Year
CC
HYUNDAI I 20 ASTA
SALOON
2009
1197
Engine No.
Chassis No.
G4LA9M212676
MALBB51BR9M082997
IDV of non-built-in Accessories(Rs.)
Electrical
Non-Electrial
IDV of vehicle(Rs.) IDV of Side Car(Rs.) Bi-Fuel/CNG/LPG
Kit(Rs.)
3,25,786
Seating Capacity
Total Insured Declared
Value (Rs.)
3,25,786
SCHEDULE OF PREMIUM
Rs.
6,417.33
Basic
Rs.
A. TOTAL OWN DAMAGE PREMIUM (rounded off) Rs.
6,417.00
Add:Legal Liability to paid driver as per Endt. IMT 28
Rs.
50.00
Add: Compulsory PA Cover for Owner-Driver
Rs.2,00,000
Rs.
100.00
Premium on Vehicle and non electrical accessories
C. TOTAL ADD ON PREMIUM
Rs.
Drivers Clause : Persons or classes of persons entitled to drive :
1,110.00
B. TOTAL LIABILITY PREMIUM
Rs.
1,260.00
COMPREHENSIVE PREMIUM(A+B+C)
Rs.
7,677.00
7,677.00
NET PREMIUM
Rs.
Add : 12.36% Service Tax
Rs.
949.00
TOTAL PREMIUM
Rs.
8,626.00
Limitations as to use:
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.
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) Organised racing d) Pace
Making e) Speed testing f) Reliability Trials g) Any purpose in connection with Motor Trade.
Limits of Liability:
Subject to
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. 7,50,000/P.A. Cover for Owner - Driver under Section III: CSI
: Rs. 2,00,000/Deductible under Section - I
: Rs. 1,000/Compulsory Deductible
: Rs. 1,000/Voluntary Deductible
: Rs. /Imposed Excess
: Rs. /-
A. Indian Motor Tariff Endorsement No. (IMT)
22,28
b.TATA AIG Auto Secure endorsement No.TA08
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 Vehicles Act, 1988.
For Tata AIG General Insurance Company Ltd.
In witness whereof this Policy has been signed at Mumbai on 04/09/2013.
Receipt(s): APN05873585
The stamp duty of Rs.0.50/- paid in cash or demand draft or by pay order,vide Receipt/Challan no:
MH000334024201314E
dated the 12/08/2013
Atri Chakraborty
National Head - Operations & Systems
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 Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".
Note: This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been attached in any part of this Policy or of the Schedule
shall bear the same meaning wherever it may appear.
Any amendments/modifications/ alterations made on this system generated policy document is not valid and Company shall not be liable for any liability whatsoever
arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is made to the Company
and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company.
TOLLFREE HELP LINE: 1 800 119966
(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)
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Insured Copy
DA27
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