Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade,Sir Theyagaraya Road, T.

Nagar,

April 09, 2019

Mr.. Vikas Kumar

C/O R.N CHAUDHARY, RD NO 2 Your policy is due
SANJAY GANDHI NAGAR, KALI MANDIR RD, HANUMAN NAGAR, for renewal on
KANKARBAGH
PATNA, BIHAR 07/04/2020
800026
Telephone:
Mobile: 9693855559

Certificate of Insurance and Policy No. Policy Period:

VMPB006702000100 From 00:00:00 hours on 08/04/2019 To 23:59:59 hours on 07/04/2020

Dear Mr.. Vikas Kumar,

Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are
delighted to have you as our customer.

We are enclosing the Certificate of Insurance & Policy Schedule pertaining to the
insurance of your vehicle.

The Certificate of Insurance & Policy Schedule is an important document that you may
be required to produce whilst your vehicle is in use. We request you to verify the above
documents and ensure everything is in order. In case of any discrepancies, please
contact us immediately.

To read the "policy" & "add on" terms, conditions, exceptions and applicable
endorsement, please log on to our website www.royalsundaram.in

Should you have any queries, please contact our Customer Service helpline number
1860-425-0000. You may also write to [email protected]

Assuring you of our best services at all times.

Yours sincerely,

Authorized Signatory

Note:
To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in
Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade,Sir Theyagaraya Road, T.Nagar,

APR 09, 2019

Mr.. Vikas Kumar

FLAT NO A1, 2ND FLOOR, Intermediary Code: OA505227
BOB BUILDING, PATRAKAR NAGAR, K.BAGH
PATNA, BIHAR Intermediary Name: Policybazaar Insurance Web
800020
Telephone :
Aggregator Private Limi
Mobile : 9693855559 Contact: 1800 208 8787

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy

Certificate of Insurance & Policy No. Policy Period: Period Of Insurance

VMPB006702000100 From 00:00:00 hours on 08/04/2019 To 23:59:59 hours on 07/04/2020

INSURED DETAILS
Name of Insured Insured Date of Birth Geographical Area Business/Profession Registration Authority Registration Date
Mr.. Vikas Kumar 27/04/1998 INDIA PATNA 11/04/2015
INSURED’S DECLARED VALUE (IDV) (in Rs.)
Year For the Vehicle For Side-car Non Electrical Accessories Electrical/ Electronic Total IDV
Accessories
4th Year 49,998.00 0.00 0.00 0.00 49,998.00
The Vehicle: any of the following (Two-wheeler shall be deemed to include a sidecar attached to it)
VEHICLE DETAILS
Registration Number BR01CJ9143 Type of Body SOLO
Engine Number JC59AAFGC00446 Cubic Capacity 125
Chassis Number MBLJC59ADFGC00424 Year of Manufacturer 2015
Make of the Vehicle HERO MOTOCORP Seating Capacity (including Driver) 2
Was the Two Wheeler ownership
Model Description IGNITOR DISC SELF-2 SEATER NO
changed in the past 12 months?
Fuel Type PETROL Net Premium (in Rs.) 1,333.00

LIMITATIONS AS TO USE: DRIVER:

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

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.100,000/-

PA. Cover for Owner - Driver under section III (CSI) - Rs.1,00,000/-

Deductible under Section I: Rs.100 in respect of each and every claim.(Compulsory Deductible[100.00], Voluntary Deductible[0.00] and Imposed Deductible[Rs.0]) /- in respect of each
and every claim.

Certificate of insurance & policy schedule continued in Page 2

Document Code:
 CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy

Policy No. VMPB006702000100

A - OWN DAMAGE Premium B - LIABILITY Premium

in Rs. in Rs.
Basic premium on Vehicle and Accessories Basic premium including premium for TPPD
1. Vehicle 653.00 1. Vehicle 720.00
2. TPPD restricted to statutory limit of Rs.6000/- (Endt. IMT.
2. Accessories: 0.00 20) 0.00
3. Electrical & Electronic @ 4% (Endt. IMT. 24) 0.00
ADD: ADD:
4. Loading for Imported Vehicle 0.00 3. Legal Liability To Paid Driver (IMT 28) 0.00
5. Geographical Area Extn.Endt.IMT-1 0.00 4. Geographical Area Extn.Endt.IMT-1 0.00
6. Fibre Glass Tanks 0.00 5. PA to Paid Driver (IMT 17) 0.00
7. Non Electrical Accessories 0.00 6. Legal Liability To Employees (IMT 29) 0.00
7. PA cover for Owner - Driver under Section III (CSI) -
8. Driver Tution fees 0.00 Rs.1,00,000/- 50.00
9. Rally Cover 0.00 8. PA to Unnamed Passengers 0.00
10. Addtional Towing Charges 0.00
LESS:
11. Side Car Discount 0.00
12. Discount for Anti-theft devices (IMT 10) 0.00
13. 50% Discount for Vehicles designed/modifed for
physically/mentally challenged persons. 0.00
14. Voluntary Deductible amount for Rs. 0.00 0.00
15. Automobile Association Discount (IMT 8) 0.00
16. Deduct 45% for NCB 293.00 9. TOTAL LIABILITYPREMIUM (B) 770.00
17. ADD: 0% for Underwriter Loading 0.00 10. ADD: Underwriter Loading % 0.00
11. NET PREMIUM (A+B) 1,130.00
12. Add: IGST 203.00

18. TOTAL OWN DAMAGE PREMIUM (A) 360.00 13. TOTAL PREMIUM PAYABLE 1,333.00
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 year. 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:
Period of Insurance % of NCB on Subject to I.M.T. Endt. Nos & Memorandum 22 (refer Terms & Conditions for relevant wording)
OD Premium
The preceding year 20 Nominee Name Nominee Age Relationship with
INDRA NARAYAN JHA 58 FATHER
Preceding two consecutive years 25 Guardian Name Guardian Age Guardian Relation

Preceding three consecutive years 35

Preceding four consecutive years 45 Date & Signature of Proposal/Renewal notice: 08/04/2018

Preceding five consecutive years 50

In Witness whereof this Policy has been signed at Chennai on 09/04/2019 in lieu of Cover note No. dated Receipt No. IMC0076482. 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

Signature Not
Verified
Digitally signed by
THIRUNAVUKKARASU S
Date: 2018.04.08
13:16:30 IST
Reason: For
A
RouytahlSournizdead Signatory
ram
This document is digitally signed, hence counter signature / sLtoacm
ation : Chenn a i
pisnot required.
Consolidated Stamp Duty Paid to Govt. of Tamil Nadu
GSTIN: 33AABCR7106G1ZQ PAN Number: AABCR7106G
For Legal interpretation, English version will hold good.
GST Invoice

Royal Sundaram General Insurance Co. Limited

No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade

Sir Theyagaraya Road, T.Nagar,

GSTIN : 33AABCR7106G1ZQ

Policy number : VMPB006702000100

Invoice number : VMPB00670200000
Inception Date : 09/04/2019 12:00:00
Policy Posted Date : 08/04/2019 01:16:29

Address of Insured :

c/o r.n chaudhary, Rd no 2

Sanjay gandhi nagar, Kali mandir Rd, hanuman Nagar, Kankarbagh
PATNA
State : Bihar
Pincode : 800026

Accounting code of service : 997134

Description of service : Motor vehicle insurance services

Taxable premium 1,130.00

18%
Add: IGST 203.00

Gross premium 1,333.00

Indication if tax payable under reverse charge - No

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