Service Branch Address: No.

4B, 4th Floor, "" A"" Block, Mena Kampala Arcade ,Sir Theyagaraya Road, T.Nagar,

October 03, 2020

Mr. nirmal jayanth

F-3/6, F TYPE APARTMENTS, Your policy is due
SECTOR 7 , VASHI for renewal on
NAVIMUMBAI, MAHARASHTRA
14/11/2021
400703
Telephone :
Mobile : xxxxxx7241

Certificate of Insurance and Policy No. Policy Period:

VPB0107198000100 From 00:00:00 hours on 15/11/2020 To 23:59:59 hours on 14/11/2021

Dear Mr. nirmal jayanth,

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 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

Please Quote this for quick reference when you call customer care.
Code Description
1 Request for Duplicate Policy Copy
2 Request for Claim Support
3 Request for customer Support

Note:
To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in

0ecf301a36c0fa875c9ccff2684b86d4
 Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade ,Sir Theyagaraya Road, T.Nagar,

October 03, 2020

Mr. nirmal jayanth

MUMBAI Intermediary Code: OA505227
MAHARASHTRA Intermediary Name: Policybazaar Insurance Web
MUMBAI, MAHARASHTRA
400703 Aggregator Private Limi
Telephone :
Mobile : xxxxxx7241
Contact: 1800 208 8787

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Package Policy.
Certificate of Insurance and Policy No. Policy Period: Period Of Insurance
VPB0107198000100 From 00:00:00 hours on 15/11/2020 To 23:59:59 hours on 14/11/2021
INSURED DETAILS
Name of Insured Insured Date of Birth Geographical Area Business/Profession Registration Authority Registration Date

Mr. nirmal jayanth INDIA STUDENT MUMBAI 12/07/2013

INSURED'S DECLARED VALUE (IDV) (in Rs.)
For the Vehicle For Trailers Non Electrical Electrical/Electronic Value of CNG Kit Total IDV Loss Of Baggage For Life Time Invoice Price
Accessories Accessories Road Tax
173356 0 0 0 0.00 Rs. 173356.0 0.00 0.00 0.00
Registration Number MH02CZ1382 Model Description WAGON R DUO LXI LPG - 5 SEATER Gross Vehicle Weight (Kgs)
Engine Number K10BN7258081 Type of Body HATCHBACK Seating Capacity (including Driver) 5
Chassis Number MA3EWDE1S00577037 Cubic Capacity 998
Make of the Vehicle MARUTI UDYOG LTD. Year of Manufacture 2013 Total Premium (in Rs.) 8,802.8

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 the
b) Carriage of goods (other than samples or personal luggage) 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 also
d) Pace making drive the vehicle and that such a person satisfies the requirements of Rule 3 of
e) Speed testing The Central Motor Vehicles Rules, 1989.
f) Reliability Trials
Any purpose in connection with Motor Trade.

LIMITS OF LIABILITY:
Under Section I-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 I-1 (ii) of the Policy - Damage to Third Party Property –Rs.7,50,000 - In respect of any one claim or series of claims arising out of one event/-
Personal Accident cover for Owner - Driver under section III: CSI Rs. 15,00,000

DEDUCTIBLE: Total deductible Rs. 1,000 in respect of each and every claim. (Compulsory Deductible (Rs.1,000),Voluntary Deductible (Rs.0),Imposed Deductible
(Rs.0) and Loss Of Baggage Deductible (Rs.0) )

Certificate of insurance & policy schedule continued in Page 2

Document Code:

0ecf301a36c0fa875c9ccff2684b86d4
 CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Package Policy.
Policy No. VPB0107198000100

Premium Premium
A – OWN DAMAGE B – LIABILITY
in Rs. in Rs.
1. Basic Premium on Vehicle and Non- Electrical 2,846.00 1. Basic Premium including premium for TPPD 2,072.00
Accessories
2. Electrical & Electronic Accessories @ 4% (IMT24) 0.00 2. Less: For restricted TPPD cover for Rs.6000 0.00
(IMT 20)
3. Bi-Fuel Kit (CNG/LPG) @ 4% (IMT 25) 142.30 3. Bi – Fuel Kit (CNG/LPG) 60.00
4. Trailers(IMT 30) 0.00
ADD: ADD:
4. Trailer 0.00 Personal Accident Benefits
5. Geographical Area Extn.Endt.IMT-1 0.00 5. Under section III (Owner Driver) CSI, Rs. 0.00
15,00,000.00*
6. 30% for Imported vehicles without custom duty 0.00 6. Geographical Area Extn (Endt.IMT 1) 0.00
(IMT 19)
7. Fibre Glass Tanks 0.00 7. Named Passengers, CSI Rs.0.00 each as per list 0.00
attached (IMT 15)
8. 60% on OD Premium for Driving Tuition 0.00 8. Unnamed passengers, CSI 0.00 each (IMT16) 0.00

Rs.
9. For any other extra 0.00 9. PA Cover to Paid Driver, CSI Rs. 0.00 (IMT 17) 0.00

10. Additional Towing Charges 0.00

LESS: ADD:
11. Discount for Anti-theft devices (IMT 10) 0.00 Legal Liability:
12. Automobile Association Discount (IMT8) 0.00 10. To Paid Driver (IMT 28) 0.00
13. Voluntary Deductible of 0.00 11. To Paid Employees (IMT 29) 0.00
Rs.0.00(IRDAN102A0006V01200910) (IMT22A)
14. 50% Discount for vehicles specially designed/ 0.00 12. For any other extra 0.00
modified for blind, handicapped and mentally
challenged persons
13. TOTAL LIABILITY PREMIUM (B) 2,132.00
15. DEDUCT: No Claim Bonus (0%) 0.00 14. ADD: Underwriting Loading% 0.00
16. ADD: Underwriting Loading 0.00 15. NET PREMIUM (A+B) 7,460.30
Add: Additional Cover for Package Policies
17. Depreciation Waiver Clause
(IRDAN102A0011V02201213) 2,106.00
18. Windshield Glass Clause
0.00
(IRDAN102A0004V01200910)
19. Facilities in Lieu of Spare Car
0.00
(IRDAN102A0007V01200910)
20. Full Invoice Price Insurance 16. Add: IGST 1,342.80
0.00
(IRDAN102A0008V01200910) (Rs.0.00)
21. LifeTime Road Tax Clause
0.00
(IRDAN102A0005V01200910)
22. Loss of Baggage Clause 0.00
(IRDAN102A0009V01200910) (Rs. 0.00)
23. Engine Protector (IRDAN102A0001V01201314) 234.00
24. NCB Protector Cover
0.00
(IRDAN102A0002V01201314)
25. Key Replacement Cover
0.00
(IRDAN102A0001V01201516)
26. Tyre Cover Clause (IRDAN102A0003V01201718) 0.00
27. TOTAL OWN DAMAGE PREMIUM (A) 5,328.30 17. TOTAL PREMIUM PAYABLE 8,802.80
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 IMT Endt. Nos. & memorandum 22,25, RSMOAC, 001, 009 (refer Terms & Conditions
OD Premium for relevant wording)
The preceding year 20
Nominee Name Nominee Age Relationship with
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: October 03, 2020
Preceding five consecutive years 50

In Witness whereof this Policy has been signed at Chennai on 15/11/2020 in lieu of Cover note No. dated Receipt No. IMC0579819. 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: 2020.10.03
19:35:48 GMT+05:30
Reason: For
RoyalSundaram
Location: Chennai

Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty Paid to Govt. of Tamil Nadu
GSTIN: 33AABCR7106G1ZQ UIN: IRDAN102P0004V02201617 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 : VPB0107198000100

Invoice Number : VPB010719800000
Inception Date : 15/11/2020 - 00:00:00
Policy Posted Date : 03/10/2020 19:35:42

Address of Insured:
F-3/6, F TYPE APARTMENTS,
SECTOR 7 , VASHI
NAVIMUMBAI
MAHARASHTRA
Pincode:400703

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable premium 7,460.30

IGST 18 % 1,342.80

Gross premium 8,802.80

Indication if tax payable under reverse charge - No

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