Tata AIG General Insurance Co. Ltd.

Registered Office : 15th floor,Tower A,,Peninsula Business Park,Ganpatrao Kadam Marg,Opp. Senapati Bapat Marg,

Lower Parel,Mumbai , Maharashtra-400013, PH--1800119966

IRDA Registration No : 108

TWO WHEELER PACKAGE POLICY
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Proposal No. & Date
P49195, 27-Aug-2014

Policy No

064001/0120003011/000000/00

Policy Issued On

27-Aug-2014 (19:23)

Period of Insurance

27-Aug-2014(19:23) to 26-Aug-2015(Midnight)

Insured Name

MR. RAPOLU SIVA NAGA RAJU

Previous Policy No.

NA

Insured Add.

S/O SRINIVASA RAO,DNO:6-28, IPPATAM(P),

TADEPALLI(M), GUNTUR DT.,, GUNTUR ,
ANDHRA PRADESH-522302

Previous Insurer

NA

Product Type : ADDON

Make

Model

Sub Model

Cubic Capacity

Manufacturing Year

YAMAHA

FZ (FZ 16)

21CK

153

2014

Seating capacity
2

Body Type

Registration No.

RTO

Hypothecation/Lease*

Fuel Type

Chassis No.

SOLO

New

GUNTUR

No

PETROL

ME121C0K6E2023865

Engine No.

Invoice Date

Vehicle IDV

Elec. Accessories

Non-Elec. Accessories

Total IDV

21CK023767

27-Aug-2014

68,940

68,940

Schedule of Premium (Amount in Rs.)

Own Damage Premium (A)

Liability Premium (B)

Basic Premium

Basic Third Party Liability (Including TPPD)

Vehicle
Non-Elec. Accessories (IMT-24)

0 PA Cover For Owner Driver Of Rs. 1 Lakh (IMT-15)

Elec. Accessories (IMT-24)

0 PA Cover ( 100000 Per Person) for 0 Persons(IMT-16)

Sub Total (Basic Premium)

462
50
0

1,214
0 Sub Total (PA Cover)

IMT 33
Add On Coverages Nil Depreciation

50

207 Net Liability Premium (B)

Geographical Area Extension (IMT-1)

512

0 Total Premium (A+B)

Sub Total-Addition

1,933

1,421 Service Tax @ 12.36%

Deductibles

239

Gross Premium Paid

2,172

Voluntary Deductibles (0) (IMT-22A)

0 Note: 1.Policy issuance is subject to realization of cheque

Anti Theft Device (IMT-10)

0 2.Consolidated stamp duty paid to state exchequer

AA Membership (IMT-8)

0 3.The policy is subject to compulsory deductible of Rs.100 (IMT-22)

No Claim Bonus (0%)

Sub Total (Deductibles)

Net Own Damage Premium (A)

Nominee Details
Name of Nominee
SRINIVASA RAO

462

1,214 Sub Total (Third Party Liability)

4.Geographical Area-India
*Subject to IMT Endt. Nos.& Memorandum:22

1,421

Age
50

Relationship with Insured

FATHER

Name of Appointee
--N.A--

Relationship with Nominee

--N.A--

Limitations as to use: The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4)
Pace making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Drivers Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining
such license. Provided also that the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle
Rules, 1989.
Limits of Liability Clause: 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 Vehicle Act 1988.Under Section II-1
(ii) of the policy-Damage to third party property is Rs.1 lakhs PA Cover Under Section III for Owner-Driver is Rs. 1.0lakhs.
Grievance Clause: For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call at( 18002667780) or may write an email at
(customersupport@tata-aig.com). In case the insured is not satisfied with the response of the office, insured may contact the Grievance Officer of the Company at (customersupport@tata-aig.com).In
the event of unsatisfactory response from the Grievance Office, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of Insurance
Ombudsman offices are available at IRDA website:www.irdaindia.org , or on the website of General Insurance Council: www.generalinsurancecouncil.org.in or on the company website
(www.tataaiginsurance.in).
The Policy wording is available on request at free of cost. The Same can be downloaded from our Website (www.tataaiginsurance.in).
Hypothecation Details: ----NA---Important Notice: The insured is not indemnified, if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT OF
RECOVERYFor legal interpretation, English version will hold good.
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 Chapter XI of Motor Vehicle
Act, 1988

For & On Behalf of Tata AIG General Insurance Co. Ltd.

Dealer Code : 14020
Authorized Signatory
Brokers Name & Add.: Toyota Tsusho Insurance Broker India Pvt. Ltd. , New No.56, Old No.44 Anjeneya Apartments, C1, First Floor, Thirumalai Pillai Road, T.Nagar,Chennai-600017
Brokers Code - DB-403/08
For Renewal/Claims assistance - please contact Ins.Co. & Broker through : Annapurna Auto GUNTUR at 0863-2272700