Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent/Broker/Producer Name: DIRECT Agent/Broker License Code: 2; Agent/Broker Contact No.: 24*7 Tollfree Helpline 1800-266-7780 / 1800-11-9966* (* Tollfree from MTNL/BSNL lines only) Certificate & Policy No.: Period of Insurance:
0100838334 00 From 00:00 Hrs on 29/09/2015
Policy Type: Date of Expiry
Auto Secure - Private Car Package Policy To midnight of 28/09/2016
Insured Name & Address: MR SANDEEP SURESH BORSE 1003 STEEPES VASANT , PLAWANS OFF, EE HIGHWAY THANE - 400601 MAHARASHTRA
Prem Premiu ium m (Inc (Incl. l. S. Tax) Tax) Occupation: Ge o og graphica l Ar ea ea: Regi Regist stra rati tion on Auth Author orit ity: y: HPA HPA / Hyp Hyp / Leas Lease e to: to:
Registration No.
Make & Model
MH 15 CT 1340
SKODA LAURA - 1.8 TSI AMBIENTE AMBIENTE
IDV of Vehicle ( )
IDV of Side Car ( )
659,478.00
0.00
Engine No. CDA147232 Bi-Fuel/CNG/LPG Kit( ) 0.00
Chassis No. TMBLKJ1Z1AA154920
CC
15,3 15,359 59.0 .00 0 OTHER India Nash Nashik ik HDFC HDFC BANK BANK LTD LTD Mfg. Year
1798
2010
IDV of non-built-in Accessories( ) Electrical
Non-Electrical
0.00
0.00
Body Type
Seating Capacity
SALOON
5
Total Insured Declared Values(IDV) - ( ) 659,478.00
SCHEDULE OF PREMIUM
A. OWN DAMAGE DAMAGE Premium on Ve hi hicle and non e le le ccttrical acce ss sso ri rie s Less : 25% for NCB A. TOTAL OWN DAMAGE PREMIUM C. TOTAL ADD ON PREMIUM
B. LIABILITY 11,023.17 Basic
4,931.00
2,755.79 Add: C ompulsory PA Cover for Owner-Driver 2,00,000
100.00
8,267.38 Add: Legal Liability to paid driver as per (IMT 28)
50.00
0.00 PA cover to unnamed passengers (IMT 16) No. of Passengers : 5 CSI per passenger 50,000.00 B. TOTAL LIABILITY PREMIUM
125.00 5,206.00
COMPREHENSIVE PREMIUM(A+B+C)
13,473.38
NET PREMIUM
13,473.00
Add : 14% Service Tax TOTAL PREMIUM
1,886.00 15,359.00
Drivers Clause: Clause: Persons or classes of persons entitled to drive: Any person including the 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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989. Limitations as to Use: Use: 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) Organized racing d) Pace Making e) Speed testing f) Reliability Trials g) Any purpose in connection with Motor Trade Limits of Liability: Under Section II-1 (i) of policy (Death of or bodily injury): Such amount as is I/we hereby certify that the Policy to which this Certificate relates as necessary to meet the requirements of the Motor Vehicles Act, 1988. well as this Certificate of Insurance are issued in accordance with Under Section II-1 (ii) of (ii) of policy (Third Party Property Damage): 7,50,000.00 provisions of Chapter X and XI of Motor Vehicles Act,1988. Under Section III : PA to Owner Driver CSI: 200,000.00 In witness whereof this Policy has been signed at MUMBAI on Nominee:PRANALI Nominee:PRANALI Age:41 Relationship:Wife 25/09/2015 Deductible Under Section - I : 2,000.00 - (Compulsory Deductible : 2,000, Voluntary Deductible: Deductible: 0, For Tata AIG General Insurance Company LTD. Imposed Excess: 0) Franchisee: 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 follows: 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. NCB will only be Atri Chakraborty allowed provided the policy is renewed within 90 days of the expiry date of the previous policy. National Head - Operations & Systems Subject to: A) IMT Endorsement No.: 07,16,22,28 No.: 07,16,22,28 B. TATA AIG Auto Secure endorsement No.(TA): 08 Service Tax Registration No : AABCT3518QST004 Stamp Duty 0.25 0.25 paid vide Challan No: dated Policy Servicing Office : Mumbai, : Mumbai, A-6, 6th Floor, Trade World,Kamala Mills Compound, Senapati Bapat Marg,Lower Parel, Mumbai-400013, Tel No:022-66382333, Fax No:022-66382390 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". RECOVERY". Note: 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.
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions, please read sales brochure carefully before concluding a sale. TATA AIG General Insurance Company Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai- 400 013. IRDA Registration No.108, CIN No : U85110MH2000PLC128425 U85110MH2000PLC128425 Website: www.tataaiginsurance.in www.tataaiginsurance.in 24X7 Tollfree Helpline 1800-266-7780 E-mail:
[email protected] [email protected]
