AutoSecurePrivateCarPackagePolicy

Date:10/05/2017
Name:MRDEEPAKSAXENA
YourPolicyDetails:
Address:D8,
PolicyNumber:015706436600
INCOMETAXCOLONY,
DURGAPURA,JAIPUR302018 PolicyPeriod:From01/06/2017to.Midnight
JAIPUR302018 Of31/05/2018
JAIPUR PremiumPaid: 15,125.00
RAJASTHAN
INDIA

DearMRDEEPAKSAXENA,

WelcometoTataAIGGeneralInsuranceCompanyLimiteds
family&wethankyouforchoosingourAutoSecurePrivate
CarPackagePolicyforyourvehicleinsurance.

WeareenclosingPolicyschedulecumcertificateofinsuranceof
y o u r v e h i c l e . Y o u arerequestedtovisitourwebsite
www.tataaiginsurance.inforpolicywording.

Wewouldliketoinformyouthatpolicyhasbeenissuedbased
ontheinformationanddeclarationprovidedbyyou.NoClaim
Bonus(NCB)ifshownonyourpolicyschedulehasbeen
allowedasyouhadnotreportedanyclaimintheprevious
policy.

Kindlygothroughtheenclosedinformation/declaration
providedbyyouandincaseyourpolicyshowsNoClaim
Bonus,forwhichyouarenotentitledasexplainedaboveor
anyothererror/discrepancythenwerequestyoutogetin
touchwithuswithin15daysofreceiptofthepolicyfor
correctionotherwiseallparticularswillbedeemedtobe
correct.

Youmayreachusatour24*7helpline18002667780for
providinganyinformationorincaseyoudesiretohavea
printedcopyofpolicywording.

We,thankyouonceagain,forchoosingTataAIGGeneral
InsuranceCompanyLimitedforinsuringyourvehicle.We
assureyouofourbestofservicesatalltimes.Happydriving!

Sincerely,
ForTataAIGGeneralInsuranceCompanyLTD.

AtriChakraborty
AuthorizedSignatory

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]


^PremiummentionedcoversSelfandFamilyandisinclusiveofServiceTax,SwachhBharatCess&KrishiKalyanCess@15%,Conditions
apply.

#PremiummentionedisinclusiveofServiceTax,SwachhBharatCess&KrishiKalyanCess@14%,Conditionsapply.

*Taxbenefitundersection80DofIncomeTaxAct1961.Taxbenefitsaresubject tochangesintaxlaws.Ifonepurchasesahealth
insurancepolicyforself/spouse/children,he/shecanclaimataxdeductionofupto 25000.Whenonepurchasesahealthinsurance
policyforparents(aseniorcitizen),he/sheiseligibleforanadditionaltaxdeductionbenefitupto 30000.
PurchaseofTataAIGGeneralInsuranceCompanyLimitedproductsarepurelyonvoluntary basis.Insuranceisthesubjectmatter
ofthesolicitation.Formoredetailsonriskfactors,termsandconditionspleasereadsalesbrochurecarefullybeforeconcludinga
sale.
AccidentGuardPolicyUIN:IRDA/NLHLT/TAGI/PP/V.I/195/1314MediPrimeUIN:IRDA/NLHLT/TAGI/PH/V.I/34/1314
Homesecure(Householders)InstachoicePolicyforhealthcomponenti.e.PersonalAccidentcoverUIN:53/IRDAI/HLT/TAGI/NL
PACKAGE/201516

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]

CertificateOfInsuranceandPolicyScheduleForm51oftheCentralMotorVehicleRules,1989
Agent/Broker/ProducerName:DIRECT
Agent/BrokerLicenseCode:NAAgent/BrokerContactNo.:24*7TollfreeHelpline
18002667780/1800119966*(*TollfreefromMTNL/BSNLlinesonly)
Certificate&Policy 015706436600 PolicyType: AutoSecurePrivateCarPackagePolicy
No.:
PeriodofInsurance: From00:00Hrson01/06/2017DateofExpiry Tomidnightof31/05/2018
Premium(Incl.ofall
InsuredName&Address: 15,125.00
tax/cess)
MRDEEPAKSAXENA Insured
SERVICE
D8, Business/Profession:
INCOMETAXCOLONY, GeographicalArea: India
DURGAPURA,JAIPUR302018 RegistrationAuthority: Jamnagar
JAIPUR302018 HPA/Hyp/Leaseto: HDFCBANKLTDJAMNAGAR
JAIPUR
RAJASTHAN
INDIA
Seating
RegistrationNo. Make&Model EngineNo. ChassisNo. CC Mfg.Year BodyType
Capacity
CHEVROLETOPTRA
GJ10AC3174 MAGNUM2.0LT 003262 052627 1991 2007 SEDAN 5
TCDI
Bi IDVofnonbuiltinAccessories( ) TotalInsured
IDVofVehicle IDVoftrailers
Fuel/CNG/LPG Declared
() () Electrical NonElectrical
Kit( ) Values(IDV)( )
267,390.00 0.00 0.00 0.00 0.00 267,390.00
SCHEDULEOFPREMIUM
A.OWNDAMAGE B.LIABILITY
PremiumonVehicleandnonelectricalaccessories 5,161.96 Basic 7,890.00
A.TOTALOWNDAMAGEPREMIUM 5,161.96 Add:CompulsoryPACoverforOwnerDriver 2,00,000 100.00
C.TOTALADDONPREMIUM 0.00 B.TOTALLIABILITYPREMIUM 7,990.00
COMPREHENSIVEPREMIUM(A+B+C) 13,151.96
NETPREMIUM 13,152.00
ServiceTax@14% 1,841.48
[email protected]% 65.76
[email protected]% 65.76
TOTALPREMIUM 15,125.00
RoadSideAssistance 133.40
(Incl.ofallcess/tax)
DriversClause:Personsorclassesofpersonsentitledtodrive:Anypersonincludingtheinsured.Providedthatapersondrivingholdsan
effectivedrivinglicenseatthetimeoftheaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.Providedalsothatthe
personholdinganeffectiveLearner'sLicensemayalsodrivethevehicleandthatsuchapersonsatisfiestherequirementsofRule3ofthe
CentralMotorVehiclesRules,1989.
LimitationsastoUse:ThePolicycoversuseofthevehicleforanypurposeotherthan:a)HireorRewardb)Carriageofgoods(other
thansamplesorpersonalluggage)c)Organizedracingd)PaceMakinge)Speedtestingf)ReliabilityTrialsg)Anypurposeinconnectionwith
MotorTrade
LimitsofLiability:UnderSectionII1(i)ofpolicy(Deathoforbodilyinjury): I/weherebycertifythatthePolicytowhichthis
SuchamountasisnecessarytomeettherequirementsoftheMotorVehiclesAct, CertificaterelatesaswellasthisCertificateof
1988. Insuranceareissuedinaccordancewithprovisionsof
UnderSectionII1(ii)ofpolicy(ThirdPartyPropertyDamage): 7,50,000.00 ChapterXandXIofMotorVehiclesAct,1988.
UnderSectionIII:PAtoOwnerDriverCSI: 200,000.00 InwitnesswhereofthisPolicyhasbeensignedat
Nominee:MRSMAYANAKASAXENARelationship:Spouse JAIPURon10/05/2017
NumberofclaimscoveredunderDepreciationReimbursementCover:NA ReceiptNo.(s):10200100355379809/05/2017
BasisofclaimsettlementforTyreSecurecover:0 Thestampdutyof 0.50paidincashordemanddraft
orbypayorder,videReceipt/Challan
no:MH009670618201617Edated:22/03/2017
ThispolicydoesnotcoverpreexistingdamagesasperInspectionphotographsand ForTataAIGGeneralInsuranceCompanyLTD.
Report
DeductibleUnderSectionI: 2,000.00(CompulsoryDeductible: 2,000,
TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]
VoluntaryDeductible: 0,ImposedExcess: 0)Franchisee: 0.00
NoClaimBonus:TheinsuredisentitledforaNoClaimBonus(NCB)ontheown
damagesectionofthepolicy,ifnoclaimismadeorpendingduringthepreceding
year(s),asfollows:Theprecedingyear20%,,precedingtwoconsecutiveyears AtriChakraborty
25%,precedingthreeconsecutiveyears35%,precedingfourconsecutiveyears AuthorizedSignatory
45%,precedingfiveconsecutiveyears50%ofNCBonODPremium.NCBwillonly
beallowedprovidedthepolicyisrenewedwithin90daysoftheexpirydateofthe
previouspolicy.
Subjectto:A)IMTEndorsementNo.:07,22
B.TATAAIGAutoSecureendorsementNo.(TA):08,19
ServiceTaxRegistrationNo:AABCT3518QST004
PolicyServicingOffice:Central,2B,2ndFloor,"Turquoise",Panchvaticrossing,C.GRoad,Ahmedabad380006,TelNo:07930000025,
FaxNo:07966610919
IMPORTANTNOTICE
TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisSchedule.AnypaymentmadebytheCompanybyreasonofwidertermsappearingintheCertificateinordertocomply
withtheMotorVehiclesAct,1988isrecoverablefromtheInsured.Seetheclauseheaded'AVOIDANCEOFCERTAINTERMSANDRIGHTOFRECOVERY'.
Note:ThisSchedule,PolicytermsandconditionsavailableoncompanywebsiteandEndorsementsmentionedhereinaboveshallreadtogetherandwordorexpressiontowhicha
specificmeaninghasbeenattachedinanypartofthisPolicyoroftheScheduleshallbearthesamemeaningwhereveritmayappear.Anyamendments/modifications/alterationsmade
onthissystemgeneratedpolicydocumentisnotvalidandCompanyshallnotbeliableforanyliabilitywhatsoeverarisingfromsuchchanges.Anychangesrequiredtobemadeinthe
policyonceissued,wouldbevalidandeffective,onlyafterwrittenrequestismadetotheCompanyandCompanyacceptstherequestedamendments/modifications/alterationsand
recordsthesamethroughseparateendorsementtobeissuedbytheCompany.Youareadvisedtogothroughthepolicyschedulecumcertificateofinsurancewhichisissuedbased
onyourdeclarationandifanyerror/discrepancyisfoundinrespectofvehicledetails,NoClaimBonusoranyothermaterialinformation,itshouldbebroughttoournoticewithin15
daysofreceiptofthispolicyfornecessarycorrectionalongwiththesupportingdocuments,otherwiseitwillbedeemedcorrect.Youmayvisitcompanywebsiteat
www.tataaiginsuarance.infordetailedbenefits,terms&conditions&exclusionsofthepolicy.Youmayalsoreachusatour24*7helpline18002667780incaseyoudesiretohavea
printedcopyofpolicywording.Ourgrievanceredressalprocedureanddetailsaboutombudsmanisalsoavailableinourpolicywording.Pleasenotethatanymisrepresentation,non
disclosureorwithholdingofmaterialfactswillleadtocancellationofpolicyabinitiowithforfeitureofpremiumandnonconsiderationofclaim,ifany.Wewillspecificallyseek
confirmationonNoClaimBonusavailedbyyoufromyourpreviousinsurer.Incasewereceiveconfirmationthatyouhadlodgedclaimwiththemthenwewillforfeitallthebenefits
undersectionIi.e.owndamagesectionofthepolicy.

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]
 RECEIPT

ReceiptNo.:102001003553798 ReceiptDate:09/05/2017

PolicyNo:015706436600


ReceivedwiththanksfromMRDEEPAKSAXENAasumof 15,258.00(RupeesFifteenThousandTwoHundredFiftyEight

AndPaise00Only)videCardno.XXXXXXXXXXXX9999

Utilizedfromthereceipt
Sr. Policy
TotalPremium( ) for Balance( )
No. Number
policy( )
1 015706436600 15,258.00 15,258.00 0.00

Note:
1.Thisisacomputergeneratedreceiptanddoesnotrequireasignature.
2.UponissuanceofthisReceipt,allpreviouslyissuedtemporaryreceipts,ifany,relatedtothisPolicyshallbeconsiderednull

andvoid.
3.Amountsreceivedbychequeshallbesubjecttorealisation.
4.AnyamountreceivedinexcessofthePremiumisbeing/shallberefundedbytheCompany.

ServiceTaxRegistrationNo:AABCT3518QST004

Revenue(consolidated)StampDutydulypaidvidechallanNo.MH009884888201617Edate27/03/2017forapplicablecases.

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]

1.Name(RegisteredOwneroftheMotorVehicle)*:MRDEEPAKSAXENA

2.AddressforCommunication* :D8,
INCOMETAXCOLONY,
DURGAPURA,JAIPUR302018
JAIPUR302018
JAIPUR
RAJASTHAN
INDIA

3.VehicleDetails:Pleasereferpolicyschedulecumcertificate.

4.VehiclePurchasedisUsed5.VehicleType:Indigenous

6.FuelType:Diesel

7.InsuredsDeclaredValuePleasereferpolicyschedulecumcertificate.

8.PreviousInsuranceParticulars*:

PolicyNumber*:22030031160200005094DateofExpiry*:31/05/2017TypeofCover:PackageComprehensive

NameoftheInsurer*:THENEWINDIAASSURANCECO.LTD./JAMNAGAR,JAMNAGAR,JAMNAGAR,JAMNAGAR,GUJARAT,360405

Accidentinthepreviouspolicyperiod:NoNCBinpreviouspolicy:N/ANCBclaimed:1

9.PeriodofInsuranceDesiredfrom*:01/06/2017tomidnightof31/05/2018

10.FinanciersDetails:Pleasereferpolicyschedulecumcertificate.

11.ExtraBenefitsopted

UnNamedPersonsPersonalAccidentCoverforseatingcapacity,includingdriver:CSI N/A

WiderLegalLiabilitytoPaidDriver(AsperWorkmensCompensationAct,FatalAccidentAct&CommonLaw):N/A

PersonalAccidentCoverforOwnerDriver:CSI200000

NameoftheNominee&Age:MRSMAYANAKASAXENA43Relationship:Spouse

NameofAppointee(ifNomineeisMinor):N/ARelationshiptotheNominee:N/A

12.RestrictionofCover/Discounts/Concessions/ExtendedCovers

NameofAutomobile:Membershipno

ThirdPartyPropertyDamageCoverrestrictedto 6,000/only:No

IsVoluntaryDeductibleoptedNOAmountofDeductibleopted: N/A

VehicleisfittedwithAntiTheftDeviceapprovedbyARAI:No

13.AddoncoversPleasereferpolicyschedulecumcertificate.

14.BankDetails(RequiredforRefund/Claims)

NameoftheAccountHolder:MRDEEPAKSAXENA

NameofBank&Branch:N/A,N/AAccountNumber:N/AIFSCCodeofBank:N/A

15.DeclarationforNoClaimBonus(IfNCBConfirmationisnotsubmittedbutNCBclaimed)

I/WedeclarethattherateofNCBclaimedbyme/usiscorrectandthatNOCLAIMhasarisenintheexpiringPolicyPeriod(CopyofPolicy
enclosed).I/WefurtherundertakethatifthisdeclarationisfoundincorrectallbenefitsunderthePolicyinrespectofSection1ofthePolicy
willstandforfeited.

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]
16.Iherebygivemyconsenttoreceiveonepageinsurancepolicy.

17.AMLGuidelines:

1.I/weherebyconfirmthatallpremiumshavebeen/willbepaidfrombonafidesourcesandnopremiumshavebeen/willbepaidoutof
proceedsofcrimerelatedtoanyoftheoffencelistedinPreventionofMoneyLaunderingAct,2002.
2.IunderstandthattheCompanyhastherighttocallfordocumentstoestablishsourcesoffunds.
3.TheinsurancecompanyhasrighttocanceltheinsurancecontractincaseIam/havebeenfoundguiltybyanycompetentcourtoflawunder
anyofthestatutes,directlyorindirectlygoverningthepreventionofmoneylaunderinginIndia.

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]