6

Poiicy Schedule of Four Wheeler

Four Wheeler Package Pchcy

CSETIFICATE CUT{ POLTCY SCTiEf]ULE
Certif icate Cum Policy No. : 43005i50725068ru0/C00

Policy lssuing Noida / B-77, Sector 5, Noida - 201301

Office
o Zone lB
lnsurance Midnight CEds
lnsured Name VIJAY KUMAR
2B-18-A-98 DLD TEJAE [4ILL NEW CoverNole Number
DELHT - 11000fi
Registratiofi Make & Model Type Ot Body CC Mfg Year seat Cap Chassis Number Engine Nurnber
Numb€r &
226 & TATA NANO LX 624 AUG -2010 4 22248
SCUTH DELHI
SOUTH SHEIKH
SARAI
Side Car Electricat I CNG I LPG Ufi.t Tofal Value
Ae*
0 0

Own Amount
I Easic
B rc
Damage 4,1

Teta!
,

Cover For Owner - Driver 550"00

Sub Total Additions

O$rn ium 1,1

Total um +

Total Policy - levai Loading

Net Premium 2
Service Tax lncl Edu

raph a : lndia
are

LIMITS OF LIABILITY :
Setion ll * '1 (i) of the poiicy
(a) Under + Death ot or bodily injury : Such amount as is n@essary to rn*l there requiremeils of lie Motor Vehicle Act, '1988.

making, Spead tesling, Reliabiiity lails, Any purpos in trnffition with Moior trade.

Subject to IMT Endorsement Nos & Memorandurn Printed herein I attached hereto : 7.?2,28
Premlum Coltection Details + i Collslion No /AtrounllReceipt Date j 10103353710IRs.9,635.00 r 0511012017

ServicE Tax Regi$trat'ron No. : GIS / MUMBAI - I I 1547 12017

ln cas6 ot any claim, please call us at our 24 Hour Call Centre Numbers

Ahura Cenlre, O Fl@r, 82 MahairaliCaves Rc.l, Ardheri (E). Mumbai - 400093

Regd Oifie: Peni$ula Corpwate Park. Nicholas Piranal Tov€r.,9!' Floor. Ganpairao Kadam Marg l-ils Parei, Murnbai 400013
Visit us at Erflai, 6 al us on our 24 hsr the
Mumba,; 022$6939500 Delhir O1 1-66603500 Ahmedabad;g7+666'1 020 i9
Ban$alqe: 080-66500001 Hyderabalt: 040-666?9232 Chennai: 044-66841 050
Pune: 020550'1 41 56 Jaipur: 0141-51 01234

. This is a computer generated stalement. htrce tequire no signalure sr $eal.

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