Auto Secure - Liability Only Policy

Date:21/12/2023

Your Policy Details:

Name: Mr MD ALAMGIR
Policy Number: 6301181896 00 00
Address: SANJOAL RANIKUTHI,
Policy Period: From 00:00 Hours on 22/12/2023 to Midnight of
KHARAGPUR,
21/12/2024
PASCHIM MEDINIPUR,
721301, Premium Paid: ₹ 39,669.00
KHARAGPUR,
WEST BENGAL

Dear Mr MD ALAMGIR,

Welcome to Tata AIG General Insurance Company Limited family & we thank you for choosing our policy for your motor vehicle insurance.

We are enclosing Policy schedule cum certificate of insurance of your vehicle. You are requested to visit our website www.tataaig.com for policy
wording.

Your policy has been issued based on the information and declaration provided by you, No Claim Bonus (NCB) if shown on your policy schedule
has been allowed as you had not reported any claim in the previous policy.

Kindly go through the enclosed information/declaration provided by you and in case your policy shows No Claim Bonus, for which you are not
entitled as explained above or any other error/discrepancy then we request you to get in touch with us within 15 days of receipt of the policy for
correction otherwise all particulars will be deemed to be correct.

You may also reach us at our 24*7 helpline 1800 266 7780 for providing any information or in case you desire to have a printed copy of policy
wording.

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

Sincerely,
For Tata AIG General Insurance Company Limited

Authorized Signatory

Tata AIG General Insurance Co. Ltd.,

7th and 8th Floor, Romell Tech Park,
Cama Industrial Estate, Western Express
Highway, Goregaon(E), Mumbai,
Maharashtra 400063

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 Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN : IRDAN108RP0008V01200001
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 Auto Secure - Liability Only Policy

Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Agent Name: SUMIT MUKHERJEE

Agent License Code: POSP5248Q Agent Contact No.: 8145601203
POSP Name: SUMIT MUKHERJEE POSP Code: 0041564000 POSP PAN No.: DBQPM5248Q POSP Contact Number: 8145601203
POSP Aadhar No: ********9514
Policy Number: 6301181896 00 00 Policy Type : Auto Secure - Liability Commercial Class: Goods Carrying
Policy Code: 00/00/3189/02 Only Policy Vehicle
Alternate Policy No: N/A Covernote No: N/A Covernote Issuance Date: N/A
Name & Address of Insured Period of Insurance
Name: Mr MD ALAMGIR (Section-I Liability) From 00:00 Hours on 22/12/2023 To Midnight of
Address: SANJOAL RANIKUTHI, KHARAGPUR, PASCHIM MEDINIPUR, 721301, 21/12/2024
KHARAGPUR, WEST BENGAL, INDIA
Contact Number: 8101008139
Customer ID:
GSTIN:
Place of Supply: WEST BENGAL
State Code: 19
RTO Location: MIDNAPUR Zone: C Geographical Area: INDIA Hire Purchase / Hypothecation /
Lease With :
Contract/Loan/Reference No:

Licensed
Public Carrying
Registration Make / Model / Body Type/
Engine Number Chassis Number Mfg. Year GVW Carrier/Private CC/KW Capacity
Number Segment
Carrier Including
Driver
A1 GCV Public
TATA MOTORS/LPT
WB338410 20K62242290 388002KXZ120557 2002 16200 carriers other 5883 5
1613/DIESEL/CLOSED/TRUCK
than 3 wheelers

Insured Declared Value (IDV) ₹

Electrical
Non Electrical Bi-Fuel / CNG
Vehicle IDV Body IDV Chassis IDV /Electronic Trailer IDV Total IDV
Accessories IDV /LPG Kit
Accessories
0 0 0 0 0 0 0 0

SCHEDULE OF PREMIUM
Section - I LIABILITY (B)
Third Party Premium Premium Amount
Basic TP premium ₹ 35313.00
Legal Liability
Add: Legal liability to paid driver - IMT 28 Number of persons:2 ₹ 100.00
TOTAL LIABILITY PREMIUM ₹ 35413.00
Net basic Liability Premium (B) ₹ 35313.00
GST on Basic Liability Premium
SGST@6% ₹ 2119.00
CGST@6% ₹ 2119.00
Net Other Liability Premium (D) ₹ 100.00
GST on other liability cover
SGST@9% ₹ 9.00
CGST@9% ₹ 9.00
NET PREMIUM (B+D) ₹ 35413.00
TOTAL POLICY PREMIUM ₹ 39669

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 Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN : IRDAN108RP0008V01200001
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 Auto Secure - Liability Only Policy

Drivers Clause: Persons or Classes of Persons entitled to drive : Stage Carriage / Contract carriage / Private Service Vehicle Any person including 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 when not used for the transport of passengers at the time of the
accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Goods Carriage: Any person including insured: Provided that a person driving hold 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 when not
used for the transport of goods at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules,
1989.
Non Transport vehicles: Any person including 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

Warranty for Goods Warranted that at no time the Gross Laden Weight of the vehicle exceeds the Gross Vehicle weight mentioned in the Schedule
Carrying Vehicles: of the policy.

LIMITS OF LIABILITY
PA Owner Driver Capital Sum
Insured: 0 based on Insured’s
Under Section II declaration that he/she is not
Such amount as is necessary Under Section II - 1 (ii)
- 1 (i) of policy Under Section holding any effective driving
to meet the requirements of of policy (Third Party ₹ 7,50,000
(Death of or III : license and thus not eligible
the Motor Vehicles Act, 1988. Property Damage)
bodily injury) for Compulsory Personal
Accident cover for Owner
Driver.

This policy does not cover preexisting damages as per Inspection photographs and Report
Subject to: A) IMT Endorsement Number : IMT 28
B) TATA AIG Auto Secure Endorsement Number (TA) :

NOMINATION DETAILS
Name of Appointee (If nominee is
Name of the Nominee Relationship with Insured Relationship with Nominee
minor)
NA NA NA NA

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.
In witness whereof this Policy has been signed at KHARAGPUR on 21/12/2023
Receipt No.(s) : For TATA AIG General Insurance Company LTD.
Consolidated Stamp Duty has been paid to the State Exchequer.

GSTIN : 19AABCT3518Q1ZT-WEST BENGAL

Service Account Code : 997134

Authorized Signatory
Policy Servicing Office: MS TOWER,INDA OT ROAD, 1ST FLOOR, KHARAGPUR - 721305,WEST BENGAL , KHARAGPUR , WEST BENGAL , 721305

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 Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN : IRDAN108RP0008V01200001
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 Auto Secure - Liability Only Policy

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 policy does not cover pre existing damages as per Inspection photographs and Report.
Note : This Schedule, Policy terms and conditions available on company website 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. You are advised to go through the policy schedule cum certificate of insurance which is issued based on your declaration and if any
error/ discrepancy is found in respect of vehicle details, No Claim Bonus or any other material information, it should be brought to our notice within 15 days of
receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. You may visit company website at
www.tataaig.com for detailed benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 266 7780 in case you
desire to have a printed copy of policy wording. Our grievance redressal procedure and details about ombudsman is also available in our policy wording.
Please note that any misrepresentation, non disclosure or withholding of material facts will lead to cancellation of policy ab initio with forfeiture of premium
and non consideration of claim, if any. We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we receive
confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own damage section of the policy.

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 Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN : IRDAN108RP0008V01200001
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 Auto Secure - Liability Only Policy

Transcript Letter
1 Name (Registered Owner of the Motor Vehicle)* : Mr MD ALAMGIR
2 Address For Communication* : SANJOAL RANIKUTHI, KHARAGPUR, PASCHIM MEDINIPUR, 721301, KHARAGPUR, WEST BENGAL, INDIA
3 Vehicle Details : Please refer policy schedule cum certificate
4 Fuel Type : DIESEL
5 Insured’s Declared Value : Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number* : MP131772 Date of Expiry* : 01/01/1970 Type of Cover :
Name of the Insurer* : NA NCB claimed : NA
Accident in the previous policy period : NA NCB in previous policy : undefined
7 Own Damage period of insurance desired from*: NA to Midnight of NA
8 Liability period of insurance desired from*: 22/12/2023 to Midnight of 21/12/2024
9 Compulsory PA cover for owner driver period of insurance desired from : NA to Midnight of NA
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) : 2
Legal Liability to Non-Fare Paying Passengers other than Statutory Liability except the Fatal Accidents Act): NA
Compulsory PA Cover for Owner Driver : NA Term : Years
Name of the Nominee & Age: NA, NA Relationship : NA
Name of Appointee (if Nominee is Minor) : NA Relationship to the Nominee : NA
12 Restriction of Cover/Discounts/Concessions/Extended Covers
Third Party Property Damage Cover restricted to 6,000/ only : NO
Vehicle is fitted with Anti Theft Device approved by ARAI : NO
13 Add on covers : Please refer policy schedule cum certificate,
14 Bank Details (Required for Refund / Claims)
Name of the Account Holder : MD ALAMGIR
Name of Bank & Branch :
Account Number : NA IFSC Code of Bank :
15 Declaration for No Claim Bonus : (If NCB Confirmation is not submitted but NCB claimed)
I/We declare that the rate of NCB claimed by me/us is correct and that NO CLAIM has arisen in the expiring Policy Period (Copy of Policy
enclosed). I/We further undertake that if this declaration is found incorrect all benefits under the Policy in respect of Section 1 of the Policy will
stand forfeited.
16 I hereby give my consent to receive one page insurance policy.
17 AML Guidelines:
1. I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of
proceeds of crime related to any of the offence listed in Prevention of Money Laundering Act, 2002.
2. I understand that the Company has the right to call for documents to establish sources of funds.
3. The insurance company has right to cancel the insurance contract in case I am/have been found guilty by any competent court of law under
any of the statutes, directly or indirectly governing the prevention of money laundering in India.

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 Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN : IRDAN108RP0008V01200001
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