CAR Insurance Policy
CAR Insurance Policy
CAR Insurance Policy
2311201793654805000
Vehicle Details Policy Details
Make MARUTI Policy No. 2311 2017 9365 4805 000
Model DZIRE-VDI(1248 CC) Period of From 30 May, 2022 00:01 hrs
Registration No MP-18-C-8953 Insurance To 29 May, 2023 Midnight
MR MOHD ANARUZZAMAN SHEIKH RTO SHAHDOL Issuance Date 29/05/2022
SHAHDOL C/O- K K JAIN H.N - 89 W.N -18 SHASTRI NAGAR NA Chassis No. MA3CZF03SHE104692 Invoice No. 201793654805000
SHAHDOL Cubic Capacity /Watts 1248 Seats 5
MADHYA PRADESH - 484001 Tel. 9981185391
Year of Manufacture 2017 Body Type SEDAN
Engine No. D13A3071551 EIA No. Not provided
Payment Details : 1122205571860 , Date: 29/05/2022, Bank Name:BizDirect
Email ID : [email protected] GSTIN No :
Insured's Declared Value (IDV) (`)
Vehicle Electrical Accessories Non Electrical Accessories CNG/LPG Kit Trailer Total IDV
428,211 0 0 0 0 428,211
Premium Details (`)
Own Damage Premium(a) (`) Liability Premium(b) (`)
Basic Own Damage: 4551 Basic Third Party Liability: 3221
Total Basic Premium 4551 LL to Paid Driver (IMT-28) 50
Less: No Claim Bonus (45%) 2048 PA Cover for Owner Driver of 1500000 ( CPA Cover Policy Period From Date 30/05/2022 325
To Date 29/05/2023 )
Total - Less 2048 PA Cover for Un-Named Persons of 200000 Each (for 5 Persons) (IMT-16) 500
Net Liability Premium (b) 4096
Total Package Premium (a+b) 6599
Integrated Tax 18% 1188
Net Own Damage Premium (a) 2503 Total Premium 7787
Geographical Area India Compulsory Deductible (IMT-22) 1,000 Voluntary Deductible (IMT-22A) 0
Previous Policy No. 2311201793654804000 Valid 30/05/2021 to 29/05/2022 of HDFC ERGO GENERAL INSURANCE CO.LTD. NCB 35%
If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.
Nominee for
Compulsory Owner
PA cover for driver
owner driver has not been providedMirzufa Yesmin
to the insured spouse
basis his/her declaration of not holding an effectiveAppointee
driving license Or having Alternate PA / Stand alone CPA policy with minimum sum
Hypothecated(IMT-7) with: ORIX AUTO INFRASTRUCTURE SERVICES LIMITED
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 ) Any purpose in connection with Motor Trade. Persons or Class of Persons entitled to drive: 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. Limits of Liability 1. 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. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 750000 3. P. A. Cover under Section III for Owner - Driver(CSI): `
1500000 Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request and the same is also available at our website.
I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988.The stamp duty of 0.50 paid
b y Demand Draft, vide Receipt/Challan no. LOA/CSD/303/2022/1381 dated 29-03-2022 a s prescribed in Government of Maharashtra Order No. Mudrank Mudrank-2017/CR.97/M-1, dated the 09th January
2018,dated 09/01/2018. IMPORTANT NOTICE: The Insured i s 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 i s recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF
RECOVERY". Disclaimer: The Policy shall be void from inception if the premium in full i s not realised by the company. In the event of misrepresentation, fraud or non-disclosure of material fact, the Company
reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared accordingly. The existing damages to the vehicle as mentioned in the report shall not be paid
by the Company. The policy is issued basis the information provided by you, which is available with the company. In case of discrepancy or non recording of relevant information in the policy, the insured is requested
to bring the same to the notice of the company within 15 days. Goods and Service Tax for this invoice is not payable under reverse charge basis.
Branch : LEELA BUSINESS PARK, 6TH FLR, ANDHERI - KURLA RD, MUMBAI, 400059. Phone No. : +91-22-66383600
Goods and Service Tax Registration No: 27AABCL5045N1Z8 HSN Code 997134
BROKER Name : RELIANCE RETAIL INSURANCE BROKING LTD. For HDFC ERGO General Insurance Company Ltd
BROKER Code : 200808970936
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HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : IRDAN125RP0001V02201415. Customer Service Address: D 301, 3rd Floor, Eastern Business District
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : +91
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2311201793654805000
Motor Insurance - Proposal Form cum Transcript Letter For Private Car Package
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : IRDAN125RP0001V02201415. Customer Service Address: D 301, 3rd Floor, Eastern Business District
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Customer Service No : +91
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. 22-62346234/+91-120 6234 6234 | www.hdfcergo.com