This document is digitally signed

The Oriental Insurance Company Limited

Signer: BALWANT SINGH
Date: Tuesday, December 25, 2018 3:12 PM
Location: Pune

OUR ORIENTAL - MY TVS EMERGENCY

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE ROADSIDE ASSISTANCE SCHEME
Membership No.
PRIVATE CAR-(3 Years) BUNDLED POLICY - ZONE B Policy No. 163300/2739
UIN:IRDAN556RP0003V01201819 Contact 24x7 HelplineNo.1800 425 2002
(BSNL/MTNL Lines) 6000 2002 (prefix state
capital STD code)
Policy No : 163300/31/2019/2739 Prev Policy No : -

Cover Note No : - Cover Note Dt :

Insured's Code : 92021856 Issue Office Code : 163300

Insured's Name : Sanjay Sudam Nimbhore (GSTIN: ) Issue Office Name : DO AHMEDNAGAR (GSTIN:
27AAACT0627R4ZW)

Address : A/P. GHOTAVI, TAL. SHRIGONDA DIST. Address : II FLOOR,AMBER PLAZA , STATION ROAD
NAGAR

Correct IDV & Model is: 752725 & M&M

Bolero zlx power plus Micro Hybrid
AHMEDNAGAR MAHARASHTRA 414001

AHMEDNAGAR MAHARASHTRA 413701

Tel /Fax /Email : 9021626312 / / / [email protected] Tel /Fax /Email : (0241)2451737,2451823 / 0241-2452146 /
[email protected]
Agent/Broker Details
Dev.Off.Code : NE0000000310 ANKUR PATIL
Agent/Broker : BA0000144954 GITANJALI WAGH
Address : ADGAON ROAD, WAGH WASTI, MIRI,,AHMEDNAGAR-
414501,AHMEDNAGAR,MAHARASHTRA,414501
Tel /Fax /Email : //8390114838//[email protected]

Policy Period FROM 15:13 ON 25/12/2018 TO MIDNIGHT OF 24/12/2019

(OWN DAMAGE):
Policy Period FROM 15:13 ON 25/12/2018 TO MIDNIGHT OF 24/12/2021
(LIABILITY) :
Compulsory PA : FROM 15:13 ON 25/12/2018 TO MIDNIGHT OF 24/12/2019
Collection No & Dt : CC 3196006981 - 25/12/2018 GST INVOICE NO :271711169867 UIN :0

Gross Premium : 24,077 GST : 4,334 Stamp Duty : .5 Total : 28,411

Geographical Area : IND Area Extension :

Particulars of Insured Vehicle:

Registration Mark Engine No. & Type Of Body Cubic Year Of Seating Capacity
& Place Chassis No. Make - Model Capacity Manf. (including Driver)

NEW WJJ6K87189 MAHINDRA & OTHERS 1493 2018 6 + 1

MAHINDRA-BOLERO
J6K42580
POWER+ ZLX BS4
Power + BS-IV

Limitations as to use:

1 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) Use in connection with Motor
Trade

Driver :
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.

Limit of Liability:
Under Section II-I(1) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-I(ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000
P.A. Cover under Section III for Registered Owner Cum Driver (CSI) : Rs.

Place : AHMEDNAGAR
Date : 25/12/2018
Page 1 of 3
This document is digitally signed
The Oriental Insurance Company Limited
Signer: BALWANT SINGH
Date: Tuesday, December 25, 2018 3:12 PM
Location: Pune

Attached to and forming part of policy number 163300/31/2019/2739

1500000

Insured's Declared Value

For the Vehicle For Trailers Non Electrical Electrical Value of CNG Total Value
Accessories Accessories LPG Kit

7,41,369 0 11,356 0 0 7,52,725

Nominee Name Age Relationship

SCHEDULE OF PREMIUM

A. OWN DAMAGE B. LIABILITY

BASIC OD COVER 24,019.00 BASIC TP COVER 9,534.00

MOTOR OD BASIC - NEW 24,019.00 BASIC TP TOTAL 9,534.00
BASIC OD TOTAL 24,019.00 ADD :PA FOR OWNER DRIVER-GR36A 750.00
ADD :ADD-ON COVER NIL DEPRECIATION 3,603.00 ADD :PA-UN-NAMED-GR36B2 900.00
POLICY
LESS :Discount 14,411.00 ADD :LL-PAID DRIVER, 150.00
CONDUCTOR,CLEANER-IMT-28
LESS :Motor Add on Cover 468.00 TP TOTAL 11,334.00
Discount(Nil.Depreciation)
OD TOTAL 12,743.00 TOTAL PREMIUM 24,077.00
MOTOR TOTAL OD 12,743.00 STAMP DUTY 0.50
ADD :CGST 2,167.00
ADD :SGST 2,167.00
TOTAL AMOUNT 28,411.00

Deductibles under Section-I : =Compulsory Deductible 1000

Subject to IMT Endorsement Printed herein/attached to : IMT-22 , OIC-1:Nil Depreciation Cover , IMT-20 , IMT-28 , IMT-16

Details of IMT Endorsements are also available on the Company¿s Web Portal www.orientalinsurance.org.in

Hypothecation Agreement with: MAHINDRA & MAHINDRA FIN. SER. LTD., AHMEDNAGAR, AHMEDNAGAR,
MAHARASHTRA, Pin Code - 414001
Hire Purchase/Lessor Agreement with: -

In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured will comply with
the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as well as company's website.
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC endorsements mentioned herein
above which are available on Company's website: www.orientalinsurance.org.in or on demand from the policy issuing office.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void
abinitio (from inception).
Claim is not admissible if Driving License is found fake or is not valid whether or not in the knowledge of the insured.
I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of
Chapter X and Chapter XI of Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at DO AHMEDNAGAR
(GSTIN: 27AAACT0627R4ZW) on 25-DEC-18

Place : AHMEDNAGAR
Date : 25/12/2018
Page 2 of 3
This document is digitally signed
The Oriental Insurance Company Limited
Signer: BALWANT SINGH
Date: Tuesday, December 25, 2018 3:12 PM
Location: Pune

Attached to and forming part of policy number 163300/31/2019/2739

IMPORTANT NOTICE For and on behalf of
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 MVAct, Insurance
The Oriental 1988 is Company Limited
Entered By NE0000000310
: Insured.
recoverable from the See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".
Examined By By
Policy Printed : RAJESH ACCEL
PRTL IP
Policy Printed On 25-DEC-18 15:13:40 MAC Shri. Balwant Singh
General Manager
Authorised Signatory

This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Place : AHMEDNAGAR
Date : 25/12/2018
Page 3 of 3