Date : 19/08/2013

Mr.ATUL AGRAWAL Your Policy Details:-

THANEWALA TERRACE, Policy Number:- 0152613796
163 RNT MARG,
Policy Period:- 18/08/2013 To 17/08/2014
MADHUMILAN SQUARE,
Indore 452001, Premium Paid:- Rs.19,442.00
MADHYA PRADESH
0

Dear Mr.ATUL AGRAWAL

Welcome to the Tata AIG family and we thank you for choosing Tata AIG's AutoSecure for your car insurance needs.
As our valued customer, you can now enjoy a host of value added benefits and give the extra protection that your car
needs.

Along with this letter we have enclosed:

Your Policy Schedule / Certificate of Insurance / Premium Payment Receipt

AutoSecure Policy Wordings Booklet
AutoSecure Customer Information Booklet
AutoSecure Car Insurance Document Holder
AutoSecure Policy Card

We assure you of our best services at all times. Happy driving !

Warm Regards,

In select garages across India, Repair cost reimbursed if you go to others garages. 7 working days. Conditions apply.

Insurance
1 is the subjet matter of the soliciation. For more details on risk factors, terms2 and conditions, please
3 read sales brochure
carefully before concluding a sale.Tata AIG General Insurance Company Ltd. Regd. Office: Peninsula Business Park,
Tower A, 15th Floor, Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel,
Mumbai - 400 013 Maharashtra, India

Page 1 of 5
 Date: 02/09/2013

M/s. STATE BANK OF INDIA

Dear Sir,

Sub: Financiers copy of Motor Vehicle Insurance Policy of Mr.ATUL AGRAWAL

Welcome to Tata AIG General Insurance Company Ltd.

Enclosed with this letter do find your copy of the motor vehicle insurance policy, numbered 0152613796 00 of the
hypothecated vehicle of Mr. ATUL AGRAWAL, your client.The registration number, engine number and chassis
number of the said Vehicle HYUNDAI, I 20 SPORTZ 1.4 DSL BSIV (Vehicle make and model) is as below:

Engine number : 259543

Chassis number : 538793
Registration number:

In case you require any further clarifications please do contact us at 1800 266 7780.

It is always our pleasure to be of service to you.

With Warm Regards,

Yours Truly,

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale.Tata AIG General
Insurance Company Ltd. Regd. Office:Peninsula Business Park, Tower A, 15th Floor, Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai - 400 013, Maharashtra, India
Website:www.tataaiginsurance.in 24x7 Tollfree Helpline:1800 266 7780 Email:[email protected]
FL01 Branch: Delhi Financier Copy Page 2 of 5
DE: surebrod TIME STAMP: 18:05:19/08/13 FU: surebrof
 RECEIPT

Receipt No.: W003156022 Receipt Date: 19/08/2013

Received with thanks from M/S KUMAR ENTERPRISES (ID:5005819453)

(Insured: Mr. ATUL AGRAWAL (ID:5005819396))

a sum of Rs. 19,445.00 ( Rupees Nineteen Thousand Four Hundred Fourty Five and
Paise 00 Only )

vide Cheque no. 835598 dated 17/08/2013 drawn on ING VYSYA BANK
LTD.,INDORE branch towards
Sr. No. Policy No. Total Premium (Rs.) Utilised from Receipt (Rs.)
1 0152613796 19,442.00 19,442.00
Excess: 3.00

Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void.
3. Amount received by cheque shall be subject to realisation
4. Any amount received in excess of the premium is being/shall be refunded by the Company
Service Tax Registration No : AABCT3518QST004.
Revenue ( consolidated ) Stamp duty duly paid vide Challan No. MH0002425032 dated 31/03/2013 , for applicable cases
01314E

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale.Tata AIG General
Insurance Co. Ltd. Regd Office:Peninsula Business Park, Tower A, 15th Floor, Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai - 400 013, Maharashtra, India.
Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780 Email: [email protected]
RP01 Branch: Delhi ORIGINAL Page 3 of 5
DE: surebrod TIME STAMP:19/08/2013 FU:surebrof
 Certificate of Insurance and Policy Schedule
Form 51 of the Central Motor Vehicle Rules, 1989
Agent/Broker Producer Name - Landmark Insurance b
Agent/Broker License Code - DB089/03 Agent/Broker Contact No.- 18004194199
Certificate & Policy No. 0152613796 00 Policy Type Auto Secure Private Car Package Policy
Effective time and date of commencement of Insurance From 10:00 Hours on 18/08/2013
Premium (incl.S.Tax) Rs. 19,442.00
Date of Expiry Midnight on 17/08/2014 Insured's Business/Profession SELF-EMPLOYED
Place of Registration INDORE Geographical Area INDIA
Name and address of the Insured Under Hire Purchase/Hypothecation/Lease with
Name: ATUL AGRAWAL STATE BANK OF INDIA
Address : THANEWALA TERRACE,
163 RNT MARG,
MADHUMILAN SQUARE,
Indore 452001,
MADHYA PRADESH

Registration No. Make & Model Body Type Mfg. CC Seating Engine No. Chassis No.
Year Capacity
HYUNDAI I 20 SALOON 2013 1396 5 259543 538793
SPORTZ 1.4 DSL IDV of non-built-in Accessories(Rs.)
Bi-Fuel/CNG/LPG Total Insured Declared
IDV of vehicle(Rs.) IDV of Side Car(Rs.)
Kit(Rs.) Electrical Non-Electrial Value (Rs.)
6,98,000.00 6,98,000.00
SCHEDULE OF PREMIUM
Premium on Vehicle and non electrical accessories Rs. 13,363.91 Basic Rs. 1,110.00

A. TOTAL OWN DAMAGE PREMIUM (rounded off) Rs. 13,364.00 Add: Compulsory PA Cover for Owner-Driver Rs.2,00,000 Rs. 100.00

--------------------------------------------------------------------------- -------------------- Add:Legal Liability to paid driver as per Endt. IMT 28 Rs. 50.00
---

Add: Depreciation Reimbursement (Endt. TA01) Rs. 2,094.00 Add:PA benefits as per Endt.IMT 16 No. of Passengers : 5 Capital
benefits Rs. 40000.00 Rs. 100.00

Add: Loss of personal belongings (Endt. TA09) Rs. 110.00 B. TOTAL LIABILITY PREMIUM Rs. 1,360.00
Sum Assured in INR:Rs.10000.00

Add: Emergency transport and hotel expenses (Endt. TA10) Rs. 110.00 ---------------------------------------------------------------------------------------------------
Any one Accident:Rs.5000.00 Any one Year:Rs.10000.00

Add: Key Replacement (Sum Insured (SI) Rs. 25000.00, per Rs. 265.00 COMPREHENSIVE PREMIUM ( A+B+C) Rs. 17,302.91
occurrence limit 50% of SI) (Endt. TA15)

C. TOTAL ADD ON PREMIUM Rs. 2,579.00 NET PREMIUM Rs. 17,302.91

Add : 12.36% Service Tax Rs. 2,138.64

TOTAL PREMIUM Rs. 19,442.00

Drivers Clause : Persons or classes of persons entitled to drive : Limitations as to use:

Any person including the insured: Provided that a person driving holds an The Policy covers use of the vehicle for any purpose other than :
effective driving licence at the time of the accident and is not disqualified from a) Hire or Reward b) Carriage of goods (other than samples or personal
holding or obtaining such a licence. Provided also that the person holding an luggage) c) Organised racing d) Pace Making e) Speed testing f) Reliability
effective Learner's Licence may also drive the vehicle and that such a person Trials g) Any purpose in connection with Motor Trade.
satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale.Tata AIG General
Insurance Co. Ltd. Regd Office: Peninsula Business Park, Tower A, 15th Floor, Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai - 400 013, Maharashtra, India
Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780 Email: [email protected]

DA17 Branch:Delhi ORIGINAL Page 4 of 5

DE: surebrod TIME STAMP: 18:05:19/08/13 FU: surebrof
 Limits of Liability: Subject to :
Under Section II-1 (i) of the policy (Death of or bodily injury) : Such amount as is necessary to A. Indian Motor Tariff Endorsement No. (IMT)
meet the requirements of the Motor Vehicles Act, 1988.
Under Section II-1 (ii) of the policy (Damage to Third Party Property ) : Rs. 750000.0/- 07,16,22,28
P.A. Cover for Owner - Driver under Section III: CSI : Rs. 200000.0/-
Nominee for P.A. Cover: KHUSHBOO Age: 31 Yrs Relationship: SPOUSE B. TATA AIG Auto Secure Endorsement No. (TA)
Deductible under Section AGRAWAL
-I Compulsory Deductible : Rs. 1000.0/- 01,08,09,10,15
Voluntary Deductible : Rs. 0/-
Imposed Excess : Rs. 0.0/-

Engine Secure(TA 16) - 5% of claim amount in case of repair and 10% of claim amount in For Tata AIG General Insurance Company Ltd.
case of replacement * to be printed when cover is opted on deductible basis
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 XI of Motor Vehicles Act,
1988. In witness whereof this Policy has been signed at MUMBAI on 19/08/2013 in lieu of Cover Note
No WM12401204
Receipt(s): dated 17/08/2013.
W003156022
Service Tax Registration No : AABCT3518QST004.

The stamp duty of Rs. 0.50 /-(Rupees zero and Paise 50 Only) paid in cash or demand draft or by pay
order, vide Receipt/Challan no MH0002425032013 dated the 31/03/2013.

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".
This Schedule, the attached Policy 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 it may appear.
Any amendments/modifications/ 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 to 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/alterations and records the same through separate endorsement to be issued by the Company.

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale.Tata AIG General
Insurance Co. Ltd. Regd Office: Peninsula Business Park, Tower A, 15th Floor, Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai - 400 013, Maharashtra, India
Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780 Email: [email protected]

DA17 Branch:Delhi ORIGINAL Page 5 of 5

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