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Certificate of Insurance and Policy Schedule form 51 of the Central Motor Vehicle Rules, 1989

Agent/BrokerLicenseCode/Name:-DB-324/05 Subhransu sekhar nayak Agent/Broker :Contact No:-1800266007(mobile or landline)

Certificate & Policy No. I 3379/019221564/000/00 Policy Type Auto Secure Commercial Vehicle Package Policy

Period of Insurance: I From 00:00 Hours on 21/02/2018 Date of Expiry To Midnight of 20/02/2019
Insured Name & Address: Incl. of all tax/cess Rs. 71,069 .00
Name : KIRAN NAIK . Insured Business/Profession : OTHER
Address : AT-BRAHMANITARANG Geographical Area INDIA
. JHARTARANG SHIVA TEMPLE
ROURKELA Registration Authority : Jharsuguda OD-23
RAJAGANGAPUR - 769004
SUNDARGARH, ORISSA HPA/HYP/Lease to: HINDUJA LEYLAND FINANCE

Gross
Public Carrier I
Registration No. Make & Model Body Type " Mfg. Year Vehicle cc Private Carrier
Engine No. Chassis No.
Weight
DYHZ405725 MB1TRPYB7DRY
OD23A 1208 ASH AL4019/1 TRALER 2013 40200 -
. H5499
IDV of non-built-in
Accessorles(Rs.) IDV of Externally Max. Licensed Carrying Total Insured
IDV of Trailer Bi-Fuel/CNG/LPG
IDV of Vehicle (Rs.) Built Body Type Capacity Incl Driver Declared Values
(Rs.) Kit(Rs.) Non-
Electrical (Rs.) Cleaner (Rs.)
Electrical

2,571,292.00 0.00 0.00 0.00 0.00 0.00 3 2 ,571,292 .00

SCHEDULE OF PREMIUM
A . Own Damage B. Llabiliity
Premium on Vehicle and non electrical accessories Rs. 24 ,755.25 Basic Rs. 31,626.00
Cover for lamps,tyres,tubes (IMT ?3) Rs. 3,713.29 Add: Compulsory PA Cover for Owner-Driver Rs.200000 Rs. 100.00
A. TOTAL OWN DAMAGE PREMIUM Rs. 28,468 .54 Liability to Employee Rs. 50.00
C. TOTAL ADD ON PREMIUM Rs. 0.00 B. TOTAL LIABILITY PREMIUM Rs. 31,776 .00
COMPREHENSIVE PREMIUM(A+B+C) Rs. 60,244.54
NET PREMIUM Rs. 60,245.00

IGST @ 18% Rs. 10,844.00

TOTAL PREMIUM Rs. 71,069.00
Drivers Clause : Persons or classes of persons enMled to drive : Any person including the insured: Provided that a person driving holds an effective driving licence at the time of the accident and
is not disqualWied from holding or obtaining such a licence. Provided also that the person holding an effective Leame(s Licence may also drive the vehicle and that such a person satisfies the
requirement.• of Rule 3 of the Central Moler Vehicles Rules, 1989.

Limits of Liability: I/we hereby certify that the Policy to which this Certificate relates as
Under Section 11-1 (i) of the policy (Death of or bodily injury) : Such amount as is necessary to well as this Certificate of Insurance are issued ·in accordance with
meet the requirements of the Motor Vehicles Act, 1986. provisions of Chapter X and XI of Motor Vehicles Act,1968.ln witness
Under Section 11-1 (ii) of the policy (Damage to Third Party Property) Rs. 750,000.00 whereof this Policy has been signed at PENINSULA 9n 19/01/2018
dated ·
Under Section Ill: PA to owner Driver CSI : Rs. 200,000.00 Receipt(s): Receipt Date :
Nominee: Mrs. KIRAN NAIK GSTIN : 27AABCT3516Q1ZW - MAHARASHTRA . SAC - 9971
Nominee Relationship: Father The stamp duty of Rs 0.50/- paid in cash or demand draft or by pay
order,vide ReceipVChallan no:0004119705201718 dated the
Number of claims .covered under Depreciation Reimbursement Cover : O
20/11/2017

This policy does not cover pre-existing damages as per Inspection photographs and Report For Tata AIG General Insurance Company LTD.
Deductible. under Section-I: 1500.00. - (Compulsory Deductible : 1500.00, Voluntary Deductible: 0.00,
Imposed Excess: 0.00) Franchisee: Rs 0

No Claim Bonus: The insured is.entitled for a No Claim Bonus (NCB) on·the own damage section of the
policy, W 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 allowed
rovided the olic is renewed within 90 da s of the ex i date of he revtous lie . Authorized Signatory
Subject to: A) IMT Endorsement No.:
A. Indian Motor Tariff EndorsementNo . IMT 07 23

Policy Servicing Office: A-6,6th Floor, Trade World,Kamal a Mills Compound, Senapati Bapat Marg,Lo-r Parel, Mumbai-400013 Tel No: 022-66382333 ,Fax No: 022-66382390
IN CASE OF AN ACCIDENT TO YOUR VEHICLE PLEASE INTIMATE US IMMEDIATELY FOR SPOT SURVEY FAILING WHICH CLAIM COULD BE PREJUDICED.
IMPORTANT NOTICE
The Insured is not indemnified W 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
Cef!Wicate in order to com wrth t he Moler Vehicles Act, 1988 is recoverable from the Insured. See lhe clause headed •AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY" .
Note :This Schedule . Policy terms and conditions available on company websrte 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 rt may appear. Any amendments/modWica tions/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 .lo 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/alte rattons and records the same through separate
endorsement to be issued by the Company .You are advised to go through the policy schedule cum certiflCale of insurance which is issued based on your declaration and if any error/ discrepancy
is found in respect of vehicle details, No Claim Bonus or any other material information, rt should be brought to our notice wrthin 15 days of receipl of this policy .for necessary correction along wrth
the supporting documents, otherwise rt will be deemed correct. You may visrt company websrte at www.tataaiginsuarance .in for detailed benefits, terms & conditions & exclusions of the policy.
You may also reach us at our 24•7 helpline 1800 266 7780 in case you desire to have a printed copy of policy wording. Our grievance redressal procedure and details about ombudsman is also
available iri our policy wording . Please note that any misrepresentatkm , nondisclosure or wrthholding of material facts will lead to cancellation of policy ab initio with forferture of premium anc non
consideration of claim, if any . We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we receive confirmation that you had lodged claim with
them then we will forfeit all the benefits under section Ii.e. own damage section of the policy. ·

TATA AIG General Insurance Company Limited, Regd. Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400 013 .