Policy Number : P0019000100/4102/723360

MAGMA HOUSE, 24 Park Street , Kolkata -700016

(www.magma-hdi.co.in)
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800-3002-3202

Date : 04/09/2018

To,
DEEPAK S
5/157-1,PEECHAPALAYAM,MANIYANO OR P.O ,PARAMATHI VELUR TK ,NAMAKKAL DT
NAMAKKAL
TAMILNADU - 637201
Mobile No: 9578969195

Agent/ Intermediary Name and Code: POLICYBAZAAR INSURANCE WEB AGGREGATOR PRIVATE LIMITED WAG0000001

Sub: Risk Assumption Letter

Dear Sir /Madam,

Thank you for choosing Magma-HDI General Insurance Company Limited as your preferred General Insurance Company. Please
find enclosed Policy No. . P 0 0 1 9 0 0 0 1 0 0 / 4 1 0 2 / 7 2 3 3 6 0 , w h i c h h a s b e e n i s s u e d b a s e d o n t h e d e t a i l s f u r n i s h e d t o u s a s b e l o w :

Insured & Vehicle Details

Name of Insured Deepak S
Period of Insurance 04/09/2018 TO 03/09/2019
Vehicle Make/Model TVS/APACHE RTR Fi
RTO Thiruvannamalai
Vehicle Registration No. TN25K6646
Vehicle Registration Date 10/07/2008
Engine No. 0E4F82093041
Chassis No. MD634KE4382F91929
Previous Policy Details
Previous Policy No. N/A
Previous Policy Period N/A
Previous Year NCB% N/A
Previous Insurer Name N/A
Previous Policy Type N/A

The information provided above is based on the information received from you and accordingly, the proposal has been processed.
Coverage of risk is subject to realisation of the full premium post which, insurance coverage under the policy would commence. In case the
premium is not received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at
[email protected] or calling our toll free helpline on 1800-3002-3202. Absence of any communication from you in this regard
within a period of 20 days of date of this letter, would mean that the issued policy is in order and as per your proposal.The Risk Assumption
Letter is to be read in conjunction with the policy and shall be considered as null and void without the same.

Thanking You,
Regards

For Magma HDI General Insurance Co Ltd.

Authorised Signatory

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 Policy Number : P0019000100/4102/723360

MAGMA HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800-3002-3202
TWO WHEELER PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office : Navin's Presidium, 7A, B Wing,3rd Floor, New No 17-19 Old No 103, Nelson Manickam Road,Aminjikarai,Chennai 600029

Policy No P0019000100/4102/723360 Period Of 00:01 Hrs of 04/09/2018

Insured DEEPAK S Insurance To Midnight of 03/09/2019
Address 5/157-1,PEECHAPALAYAM,MANIYANO OR P.O Agent No. : WAG0000001
,PARAMATHI VELUR TK ,NAMAKKAL DT Agent Contact : 1800-258-5970
NAMAKKAL PG/IR No.
TAMILNADU
637201
Contact Number 9578969195 Lease agreement
with
Email Address [email protected]
GST Number Unregistered

INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION

Registration No. & Year of
Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
RTA Location Manufacture
TN25K6646 /
2008 0E4F82093041 MD634KE4382F91929 TVS APACHE RTR Fi 160 2
TN25

IDV (INSURED'S DECLARED VALUE)

IDV of Vehicle ₹ Non Electrical Accessories ₹ Electrical/electronic Accessories ₹ Bi-Fuel kit(LPG/CNG) ₹ Other accessories ₹ Total Value ₹
17040 0 0 0 0 17040
OWN DAMAGE(A) ₹ LIABILITY(B) ₹
Basic - OD 221 Basic - TP 985
Non Electrical Acessories 0 PA Owner Driver -SI Rs.100000 50
Electrical or Electronic Accessories 0 Sub Total 1035
Sub Total 221 Add:
Add Driving Tution TP 0
Zero Dep - OD 0 Geographical Extension TP 0
Sub-Total Addition 0 Sub-Total Addition 0
Less Less:
No claim bonus 0 % 0 TPPD Discount 0
Sub-Total Deductions 0 Sub-Total Deductions 0
Total Own Damage Premium(A) 221
Total Liability Premium(B) 1035

Premium Computation

Total Package Premium(A+B) 1256

IGST @ 18% 226.00
CGST @ 9% 0.00
SGST @ 9% 0.00
Total 1482

Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :I/2017/10029846768

LIMITATIONS AS TO USE - 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

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
Driver
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
Clause :
Rule 3 of the Central Motor Vehicles Rules, 1989.

LIMITS OF LIABILITY
Damage to Third Party
Excess in respect of each and every Property Rs. 100000/-
Under Under In respect of any one Under Under
claim under Sec I of motor policy in respect of any one PA Owner – Driver as per
Section Section accident -- As per Motor Section Section
Compulsory : Rs. 100/- Voluntary : Rs. claim or series of claims premium computation table
I II-I (i) Vehicle Act II-I (ii) III:
0/- Imposed : Rs. 0/- Total : Rs. 100/- arising out of one
event.
Subject to I.M.T Endorsement Nos. IMT 7,IMT 15,IMT 16,IMT 22,IMT 28

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 Policy Number : P0019000100/4102/723360

NOMINATION DETAILS

Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship With Insured Percentage
Vijaya 37 Mother 100

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 M.V. Act, 1988.

Premium Amount in Word's ( ₹ ) :- One Thousand Four Hundred Eighty Two only
In case of Claims, please contact us at 1800 - 3002 - 3202 For Magma HDI General Insurance Co. Ltd.

Date of Issue :04/09/2018

Place : Kolkata

Authorised Signatory
Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 928-F.T, dated
01/06/2017
GST Number of MHDI - 33AAGCM1685C1ZQ
GST Invoice Number - POL3309190001618
Accounting Code for Service - 997134, Motor vehicle insurance services

Place of Supply:TAMILNADU ( 33 )

Whether Tax is payable on Reverse Charge - No

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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN
TERMS AND RIGHT OF RECOVERY". For legal interpretation English version will be good.

For Complete details of coverage , terms, conditions & exclusion please refer the standard policy wording attached with this schedule

IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.

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