REF.No.

201610060084731 ClientId5006189646 Date06/10/2016

MRKVENKATRAO RegistrationAddress:
BBLOCK,122NEARBALUCHELASCHOOL
BBLOCK,122NEARBALUCHELASCHOOL
SONARI,JAMSHEDPUR
SONARI,JAMSHEDPUR
,JHARKHAND,EASTSINGHBHUM
EASTSINGHBHUM831011
EASTSINGHBHUM831011
EASTSINGHBHUM
EASTSINGHBHUM
JHARKHAND
JHARKHAND
INDIA
INDIA

Ref:RenewalofMotorPolicyNo.015270293903AutoSecurePrivateCarPackagePolicy
DearMRKVENKATRAO,

WethankyouforchoosingTataAIGforyourinsuranceneeds.WewishtoremindyouthatyourPolicyexpiresonmidnightof29/10/2016.ThePremiumonRenewalis 12,526/.

Therenewaldetailsofyourvehicleasmentionedbelowarebasedonthefollowingandaspercurrentregulations:
ThePremiumquotedisbasedontheclaimsexperienceunderthecurrentpolicy70dayspriortoexpiry.
Incaseanyclaimisreportedsubsequently,NoClaimBonusallowedwouldbewithdrawnandtherenewalpremiummaybesubjecttoloading.
TheIDV(ValueofInsurance)ofvehicleslessthan5yearsoldisbasedontheprovisionsoftheIndiaMotorTariffandtheIDVofvehiclesthatareobsoleteormorethan5
yearsoldhasbeentakenasperthemarketvalue.

Werequestyoutosigntherenewalnoticeandreturnthesamealongwithyourpaymentinstructionsbeforetheexpiryofthepolicytoavoidinspectionforpolicytostartafresh.
Kindlysatisfyyourselfwithallthedetailsofthevehicleasprovidedbelow.

Pleasecallonour24x7TollfreeHelpline18002667780/1800119966*(*TollfreefromMTNL/BSNLlinesonly)ifyouwishtopaybycreditcard.(*ConditionsApply)Youcan
alsocallusforavailingourfreechequepickupfacilityorforanyqueryonourtollfreenumberoranyofourlocalofficesatthecontactnumbersprovidedoverleaf.
Alternatively,[email protected].

Weassureyouofourbestservicesatalltimes.
Regards,
ForTataAIGGeneralInsuranceCompanyLimited

AtriChakraborty
SeniorVicePresidentOperationsandSystems

VEHICLEDETAILS
RegistrationNumber JH22A1803 RegistrationCity SaraikelaKharsawan
EngineNumber 2NRV029914 RegistrationDate 30/10/2011
ChassisNumber MBJB29BT800025588 SeatingCapacity 5
Make&Model TOYOTA&ETIOSVX FinancingInstitution STATEBANKOFINDIA,BISTUPUR,JAMSHEDPUR
CubicCapacity 1496 YearofManufacture 2011
VehicleIDV/AccessoriesIDV 3,81,395/0 Coverage AutoSecurePrivateCarPackagePolicy
Ifanyoftheabovementionedvehicledetailsareincorrect/missing,pleaseprovideuswiththecorrectdetailsinthespaceprovidedon2ndpage.

RENEWALDETAILS CHANGES
Coverage AutoSecurePrivateCarPackagePolicy
VehicleValue 3,81,395
ValueofElectricalAccessories 0
ValueofCNGKit 0
Premium
BasicTPincludingTPPDpremium 2,237
PremiumonVehicleandnonelectricalaccessories 8,505.11
CompulsoryPACoverforOwnerDriver 100
LegalLiabilitytopaiddriver 50
BonusorLoading/ImposedExcess 0%Bonus/0
AmountPayable( )
12,526
(IncludingServiceTax)
ServiceTaxRegistrationNo:AABCT3518QST004

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]
015270293900&nbsp&nbsp&nbsp&nbsp201610060084731&nbsp&nbsp&nbsp&nbsp0012678000&nbsp&nbsp&nbsp&nbsp0420
REF.No.201610060084731
CHANGESPROPOSEDONRENEWAL
FollowingarethedetailsofnonbuiltElectronic/NonElectronicaccessorieswhichIhaveinstalledanddesirecoverageintheRenewalPolicy.
Item MusicSystem AC Others
Make&SerialNo
YearofPurchase
Value.( )
OtherAdditions/DeletionsRequired

MyCorrect/MissingVehicleDetailsareasUnder.
RegistrationNumber RegistrationCity
EngineNumber RegistrationDate
ChassisNumber SeatingCapacity
Make&Model FinancingInstitution
CubicCapacity YearofManufacture
PleaseattachRCbookcopyforchangestobemadeinvehicledetailsandaLetterfromFinancierforchangeinfinancierdetails

MyChangedCommunicationAddressandTelephoneNos.areasmentionedbelow.

Address:_________________________________ ResidenceTelephoneNumbers:____________________________
________________________________________ OfficeTelephoneNumbers:________________________________
________________________________________ MobileNumber:__________________________________________
_____________________Pin:_______________ EmailId:_______________________________________________

PleaseprovidetheDetailsofNominationforOwnerDriverPersonalAccidentandNamedPersonPersonalAccident
InsuredPersonsDetails NomineeDetails AppointeeDetails(IfNomineeisMinor)
Cover CSI
Name Name Relationship Age Name Relationship
Opted
OwnerDriverPersonalAccident


NamedPersonPersonalAccident

Mypaymentdetailsareasfollows
Cheque/DDNo: Date:
NameofBank: Branch:

PleasewriteyourchequeinfavourofTataAIGGeneralInsuranceCompanyLimitedandcallusatour24x7TollfreeHelpline18002667780/1800119966*(*Tollfree
fromMTNL/BSNLlinesonly)ORbelowmentionednearestBranchphonenumberstoavailofourfreepickupoftherenewalpremiumorincaseyouhaveanyquery.

City STDCode 24hrTollnumbers Branchoffice{9:00amto6:00pmMondaytoFriday}

Mumbai 022 66939500
Delhi 011 66603500 43021000
Bangalore 080 66500001 66272829
Chennai 044 66841050 28255960/66220222
Hyderabad 040 66629882 66625300/01/02
Ahmedabad 079 66610201 66610920/21/22/23/24/25
Pune 020 66014156 66011111Ext138
Kolkata 033 22895063/64506374
Chandigarh 0172 4685000
Guwahati 0361 2462339/2462343
Jaipur 0141 5103146/2361995
Jamshedpur 0657 2487231/2487454
Baroda 0265 6622011/6643742/43

Iacknowledgereceivingrenewalnoticeinrespectofmymotorpolicyandagreetorenewthesaidpolicyforonecalenderyearasperdetailsprovidedherein.
Iherebydeclarethattheinformationprovidedaboveistrueandcorrrect.
Date:
Place: SignatureoftheInsured
Youhaveinsuredyourcar,nowprotectyourhomewithTataAIG'sHomesecureandyourfamilywiththeCarOwner'sPersonalAccidentPolicy.Asa
privilegedcustomerofTataAIG,weofferyouHomeSecureforaslittleas 2.65perdayandthepersonalAccidentpolicyforaslittleas 3.65perday!
*ConditionsApply.ForfurtherInformation,Pleasecallthe24x7TollfreeHelpline18002667780(*TollfreefromMTNL/BSNLlinesonly)

TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425,UINNo.:UINnotallocatedbyIRDAI
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:[email protected]
015270293900&nbsp&nbsp&nbsp&nbsp201610060084731&nbsp&nbsp&nbsp&nbsp0012678000&nbsp&nbsp&nbsp&nbsp0420