Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21
21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611
CIN

Service Branch Address:

NO:30 3rd Flr, JNR City Centre ,Rajaram Mohan Roy Road ,Sampangirama Nagar ,BENGALURU - 560 027.

AUG 25 2019

M/R ANJANEYULU PAGADALA

S/O SUUBARAIDU
IDUPUR MARKAPURAM
MARKAPURAM
PRAKASAM
ANDHRA PRADESH

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Passenger Carrying Vehicle Policy
Certificate of Insurance and Policy No. Policy Period:Period ofinsuranceFrom11:55:20hourson
From11:55:20hourson 25/08/2019
VPV0428853106333 To Midnighto 24/08/2020
INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date

M/S ANJANEYULU PAGADALA India PRAKASAM 04/04/2012

INSURED'S DECLARED VALUE (IDV) (in Rs.)

For the For Value of Total
Non Electrical Accessories Electrical / Electronic Accessories
Vehicle Trailers CNG Kit IDV
70,000 0 0 0 0 70,000
VEHICLE DETAILS
Registration Number AP27TU3577 Type of Body MONOCOQUE
Engine Number BAMBUL42476 Cubic Capacity 447
Chassis Number MD2AABAZZUWL41947 Year of Manufacture 02/2012
Make of the Vehicle BAJAJ AUTO LTD Gross Vehicle Weight (Kgs) 500
Model Description RE 445 DIESEL BS111 Maximum Licensed carrying capacity
4
including driver
Net Premium (in Rs.) 8,860
LIMITATIONS AS TO USE: Persons or Classes of Persons entitled to Drive:
The Policy covers use only under a Permit within the meaning of the Any person including the Insured
Motor Vehicles Act, 1988 or such a carriage falling under Sub Sub-section 3 • Provided that a person driving holds an effective driving licence at
of Section 66 of the Motor Vehicles Act, 1988. the time of the accident and is not disqualified from holding or
The Policy does not cover use for obtaining such a License.
a) Organised racing
b) Pace Making
• Provided also that the person holding an effective Learner's Licence
may also drive the vehicle and that such a person satisfies the
c) Reliability Trials
requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.
d) Speed testing
e) Use whilst drawing a trailer except the towing (other than for reward)
of any one disabled mechanically propelled vehicle.
LIMITS OF LIABILITY:
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 6000 (as per IMT 20) - In respect of any one claim or series of claims
arising out of one event.
Personal Accident cover for Owner - Driver under section IV: CSI - Rs.2,00,000/-
Deductible under Section -II : Rs.500 in respect of each and every claim.(Compulsory Deductible[Rs.500] and Imposed Deductible[Rs.0])

Document Code: Certificate of insurance & policy schedule continued in Page 2

9999000909

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:customer.services@royalsundaram.in
Mail:customer.services@royalsundaram.in www.royalsundaram.in
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Passenger Carrying Vehicle Policy
Policy No. VPV0428853106333
Premium in Premium in
A - OWN DAMAGE B - LIABILITY
Rs. Rs.
1.Basic premium on Vehicle and Non-Electrical Accessories 892.00 1.Basic premium including premium for TPPD 6,218.00
2.Electrical & Electronic accessories @ 4%(IMT 24) 0.00 2.Discount for Statutory TPPD 150.00
3.Bi-Fuel kit (CNG/LPG) @ 4% (IMT 25) 0.00 3. Passenger Liability Premium 2,183.00
4. Bi-fuel Kit (CNG) @ 4% / Inbuilt CNG Kit -Endt. IMT-25 0.00
5. Hire or Reward Endt. IMT-44 0.00
ADD: ADD:
4. Trailer 0.00 6. Personal Accident Benefits Under Section IV 100.00
5. Loading for Imported Vehicle - 30% of OD 0.00 7. PA to Paid Driver/ Cleaners Endt. IMT-17 0.00
6. Geographical Area Extn.Endt.IMT-1 0.00 8. Geographical Area Extn.Endt.IMT-1 0.00
7. Driving Tution - 60% of OD 0.00
8. Fibre Glass Tanks 0.00 Legal Liability:
9. Addl Pre-Tyre & Mudguards-15% of OD 0.00 9. To Paid Driver/ Cleaner/ Coolies Endt. IMT-40 0.00
10. Additional Towing Charges. Rs.0 0.00 10. NFPP - Employees Endt. IMT-37 0.00
11. For any Other extra 0.00 11. NFPP Other than Employees Endt. IMT-37A 0.00
Less: 12. For any other extra 0.00
12. Discount for Anti-theft Devices Endt. IMT-10 0.00
13. 50% Discount for vehicles specially designed/modified 0.00
13. TOTAL LIABILITY PREMIUM (B) 6,651.00
for physically and mentally challenged persons
14. Deduct 0% NCB 0.00
15.Add: % Underwriting Loading 0.00 14. Add: %Underwriter Loading
15. NET PREMIUM (A + B) 6,651.00
Add: Additional Cover for Package Policies
16. Depreciation Waiver Clause (RSMOAC501) 0.00 ADD: IGST 2,209.00
17. Windshield Glass (RSMOAC502) 0.00

21.TOTAL OWN DAMAGE PREMIUM (A) 892.00 16.TOTAL PREMIUM PAYABLE 8,860.00
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy. b) 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 per the details given below:
Subject to IMT. Endt. Nos. & Memorandum 20,7,22,38(refer Terms & Conditions for
Period of Insurance % of NCB on OD Premium relevant wording)Under Hire Purchase/Lease Agreement/Hypothecated with SHRIRAM
TRANSPORT FIN CO LTD, ONGOLE
The preceding year 20

Preceding two consecutive years 25

Nominee Name Nominee Age Relationship with
Preceding three consecutive years 35 0
Guardian Name Guardian Age Guardian Relation
Preceding four consecutive years 45
0
Preceding five consecutive years 50
Date and Signature of Proposal/Renewal notice

In Witness whereof this Policy has been signed at Chennai on in lieu of Cover note No. dated Receipt No. CBCMOR3243564. 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 the Motor Vehicles Act, 1988.
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" under Policy Terms and Conditions.

For Royal Sundaram General Insurance Co. Limited

Consolidated Stamp Duty Paid to Govt of TamilNadu Authorised Signatory

This document is digitally signed, hence counter signature / stamp is not required.

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:customer.services@royalsundaram.in www.royalsundaram.in