IFFCO Tokio General Insurance Co. Ltd.

Unit Nos. 52-63, Mezzanine Floor Ansal Fortune Arcade Sec 18 Noida Uttar Pradesh 201301
Ph.:0124-2850200 IRDA Regn. No. : 106
SERVICING BRANCH GSTIN NO.:09AAACI7573H2Z9 , PAN NO.:AAACI7573H

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE

PRIVATE CAR BUNDLED POLICY (IRDAN106RP0010V01201819) ISSUED AT: 10:37 HOURS ON 25-SEP-2022

POLICY DETAILS NEW

POLICY NUMBER PROPOSAL NUMBER AND DATE PERIOD OF OWN DAMAGE (OD) COVER PERIOD OF LIABILITY (TP) COVER
TIT/92216494 P16919161 25-SEP-2022 (10:37 HOURS) 25-SEP-2022 To Midnight of 24-SEP-2023 (10:37 HOURS) 25-SEP-2022 To Midnight of 24-SEP-2025
PREVIOUS POLICY DETAILS
OD POLICY INSURER OD POLICY NUMBER PERIOD OF OD POLICY TP POLICY INSURER TP POLICY NUMBER PERIOD OF TP POLICY
To To
INSURED DETAILS INDIVIDUAL
NAME GSTIN PANCARD NUMBER UIN
MR. PRASHANT VERMA NA 0
ADDRESS DATE OF BIRTH
A106 1ST FLOOR TOWER AFFECTION RAMOUNT EMOTIONS NEAR YATHARTH HOSPITAL GREATER NOIDA WEST BISRAKH, GAUTAM BUDH NAGAR , UTTAR 18-DEC-1992
PRADESH-201306
NOMINEE NAME NOMINEE AGE NOMINEE RELATIONSHIP MOBILE NUMBER EMAIL ID
MRS. VERTIKA GUPTA VERMA 30 SPOUSE 98****5281 PRAS****@GMAIL.COM
VEHICLE DETAILS PRIVATE
VARIANT MAKE/MODEL CHASSIS NUMBER ENGINE/ MOTOR NUMBER YEAR OF MANUFACTURE
INNOVA CRYSTA 2.7 GPACKAGE: X, 7 SEATER I3 TOYOTA / INNOVA MBJJX8EMX00365157 2TRB016599 2022
HYPOTHECATION/LEASE INVOICE DATE CC / KW SEATING CAPACITY FUEL TYPE
ICICI BANK LIMITED NOIDA 24-SEP-2022 2694 7 PETROL
GEOGRAPHICAL AREA EXT. GEOGRAPHICAL AREA RTO CITY REGISTRATION NUMBER VEHICLE USAGE
INDIA GAUTAM BUDDHA NAGAR -
INSURED DECLARED VALUE (Rs.)
VEHICLE NON ELECTRICAL ACCESSORIES ELECTICAL ACCESSORIES CNG / LPG TOTAL
1806900 0 0 0 1806900
SCHEDULE OF PREMIUM
A. OWN DAMAGE (OD) SECTION AMOUNT (Rs.) B. LIABILITY SECTION AMOUNT (Rs.)
BASIC PREMIUM BASIC PREMIUM
VEHICLE 33223 THIRD PARTY LIABILITY ( INCLUDING TPPD ) 24596
NON ELECTRICAL ACCESSORIES (IMT-24) 0 GEOGRAPHICAL AREA EXT. ( IMT-1 ) 0
ELECTRICAL ACCESSORIES (IMT-24) 0 BI FUEL KIT 0
BI FUEL KIT (IMT-25) 0 SUB TOTAL (THIRD PARTY LIABILITY) 24596
SUB TOTAL (BASIC PREMIUM) 33223 PERSONAL ACCIDENT (PA) COVER
GEOGRAPHICAL AREA EXT (IMT-1) 0 COMPULSORY PA COVER FOR OWNER DRIVER (IMT-15) Rs. 1500000 909
IMT 23 0 PA COVER FOR PAID DRIVER (IMT-17) Rs. 200000 300
SUB TOTAL 33223 PA COVER (Rs. 100000 PER PERSON FOR 7 UNNAMED PERSONS) (IMT-16) 1050
DISCOUNTS SUB TOTAL (PA COVER) 2259
VOLUNTARY DEDUCTIBLE (IMT-22A) 0 LEGAL LIABILITY
ANTI THEFT DEVICE (IMT-10) 500 PAID DRIVER (IMT-28) 150
AA MEMBERSHIP (IMT-8) 0 EMPLOYEE (FOR 0 PERSON) (IMT-29) 0
HANDICAPPED DISCOUNT (IMT-12) 0 NON-FARE PAYING PASSENGER (IMT-37) 0
NCB (0%) 0 UNNAMED PASSENGER (0) ON AMBULANCE/HEARSES (IMT- 46) 0
SUB TOTAL (DISCOUNTS) 500 SUB TOTAL (LEGAL LIABILITY) 150
NET LIABILITY PREMIUM (B) 27005
ADD-ONS 20579 TOTAL PREMIUM (A+B) 80307
LOANER CAR PREMIUM (IMT-58) 0 CGST (9%) 7228
THEFT AND CONVERSION RISK (IMT-43) 0 SGST (9%) 7228
INDEMNITY TO HIRER (IMT-44) 0 IGST (18%) 0
UTGST (18%) 0
NET OWN DAMAGE PREMIUM (A) 53302 GROSS PREMIUM PAID 94763

ADD-ON COVERS OPTED IN THE POLICY

CONSUMABLES NIL DEPRECIATION ENGINE PROTECT
RETURN TO INVOICE TYRE AND ALLOY
KEY PROTECT

Note:- 1. Issue of Policy is subject to realisation of cheque if premium is paid by cheque. 2. Consolidated stamp duty paid to state exchequer. 3. The Policy is subject to a compulsory deductible of Rs. 2000 (IMT-22) and Voluntary
Deductible of Rs. 0.
PREMIUM PAYMENT DETAILS :
INVOICE NUMBER : 92216494 SAC CODE : 9971 DESCRIPTION OF SERVICE : GENERAL INSURANCE SERVICE
Warranty: Warranted that the insured named herein/owner of the vehicle holds a valid pollution under control (PUC) certificate and/or valid fitness certificate, as applicable, on the date of commencement of the policy and
undertakes to renew and maintain a valid and effective PUC and/or fitness certificate, as applicable, during the subsistence of the policy. Further, the company reserves the right to take appropriate action in case of any discrepancy in
the PUC or fitness certificate.
Limitations As To Use: Use only for social, domestic and pleasure purposes and for the insureds business. The policy does not cover the use for: (1) hire or reward (2) carriage of goods (other than samples or personal luggage) (3)
organised racing (4) pace making (5) speed testing (6) reliability trials (7) any purpose in connection with motor trade.
Driver's Clause: Any person including the insured: provided that the 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 learners 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 Clause: 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 vehicle act 1988.under section ii-1 (ii) of the policy damage to third party
property is rs.7.5 lakhs.
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 reasons 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 hold good.
Grivence Clause : For resolution of any query or grievance, insured may contact the respective branch office of the company or may call at (1800-103-5499) or may write an email at ([email protected]). In case
the insured is not satisfied with the response of the office, insured may contact the grievance officer of the company at ([email protected]).in the event of unsatisfactory response from the grievance office, he/she
may, subject to vested jurisdiction, approach the insurance ombudsman for the redressal of grievance. Details of insurance ombudsman offices are available at IRDAI website: www.irdai.gov.in, or on the website of general insurance
council: www.generalinsurancecouncil.org.in or on the company website (www.iffcotokio.co.in).
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 Cchapter XI of M.V. Act, 1988.
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in
terms of the provisions of the said sub-rule.
For & On Behalf of
BROKER NAME : Toyota Tsusho Insurance Broker India Pvt Ltd SCAN QR CODE TO VIEW THE POLICY
IFFCO Tokio General Insurance Co. Ltd.

Broker Code / IRDAI Composite Licence No. : 381 (Valid up to 01/09/2023).

CIN: U66010KA2008PTC045231
Email ID : [email protected]
Contact No. : 080-40449900

MISP Code : TTIBI/T/DL/ESP1136A

MISP Name : SPIRITED AUTO CARS (I) LTD
Designated Person Name :FELIX JOSEPH LOUIS
Authorised Signatory

PLEASE CONTACT INS.CO. & BROKER C/O ESPIRIT TOYOTA D-37 & 38 INDUSTRIAL AREA SITE-IV SURAJPUR KASNA GREATER NOIDA GAUTAM BUDH
NAGAR
FOR RENEWAL / CLAIMS ASSISTANCE
GAUTAM BUDH NAGAR UTTAR PRADESH 201306, GAUTAM BUDH NAGAR, UTTAR PRADESH, PIN CODE: 201306 CONTACT NO: -0120-4973000, 91-
9643200201