HDFC ERGO General Insurance Company Limited: Policy No. 2311 1002 5639 1400 001

HDFC ERGO General Insurance Company Limited
2311100256391400001
Certificate of Insurance cum Policy Schedule -

Policy No. 2311 1002 5639 1400 001
Endorsed Copy
Customer Id:101924880115
Motor Insurance - Private Car Comprehensive Policy
Insured Name MR SUNIL KUMAR RTO DELHI PAN No.

Corr.Address/ H.NO 318 A MAIN ROAD VILL MOHDPUR MAJRI -
Place of Supply DELHI, DELHI, 110081
Mobile 8818002351 Phone E Mail [email protected] Registration No. DL-04-CAQ-6596
Period of Insurance From Date & Time 10/12/2017 00:01hrs To Date & Time 09/12/2018 Midnight Policy Issuance Date 09/12/2017
Make Model - Variant Engine No Chassis No Mfg Yr Seats Body Type CC

HYUNDAI I10-ASTA 1.2 AT KAPPA2 WITH SUNROOF 950108 304855 2012 5 HATCHBACK 1197
Insured's Declared The Vehicle (`) For Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Value (IDV) 229,635 0 0 0 0 229,635
Nominee for Owner driver Appointee

Premium Details (`)
Own Damage Premium (a) Liability Premium (b)
Basic Own Damage: 3167 Basic Third Party Liability: 2863
LL to Paid Driver (IMT-28) 50
PA Cover for Owner Driver of ` 200000 100
Total Basic Premium 3167
Less: No Claim Bonus (50%) 1584

Total - Less
Net Liability Premium (b) 3013

Total Package Premium (a+b) 4596
Integrated Tax 18% 827
Net Own Damage Premium (a) 1583 Total Premium 5423
0 Geographical Area India Compulsory Deductible (IMT-22) ` 1000.00 Voluntary Deductible (IMT-22A) ` 0.00
Payment Details: Dated : Drawn on : Invoice No.: 100256391400001 HSN Code: 9971
Previous Policy No. FPV/I2071978/13/12/004365 Valid from 10/12/2016 to 09/12/2017 of BHARTI AXA GENERAL INSURANCE COMPANY LIMITED No Claim Bonus 45%
Policy Holder declare that no claim has been made in the previous year policy. If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.
List Of Endorsements
Endt No. Description Effective Date End Date Premium (In ` )
001 Change in NCB - Refund initiated through ELECTRONIC BANK PAYMENT dated 09/02/2018 10/12/2017 09/12/2018 -1869
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): ` 200000 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 by Demand Draft, vide Receipt/Challan no. dated as prescribed in Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004". Goods &
Services Tax Registration No: 27AABCL5045N1Z8 . IMPORTANT NOTICE: The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment
made b y the Company b y reason 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". Disclaimer: The Policy shall be void from inception if the premium in full is 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 a s mentioned in the report shall not be paid b y the Company. The policy i s 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 Services 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
Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.
Broker Name :D2C INSURANCE BROKING PVT LTD

Broker Code :200734909838
Duly Constituted Attorney
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016).CIN: U66030MH2007PLC177117.
Registered & Corporate Office: 1st Floor,HDFC House, 165 - 166 Backbay Reclamation,H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: D-301, 3rd Floor, Eastern Business District
(Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078. Toll Free Number: 1800 2700 700 Te.: +91 22 6638 3600 | Fax: 91 22 6638 3699 | [email protected] | www.hdfcergo.com.
UIN : IRDAN125P0005V01200203 IRDAI Reg No.146

HDFC ERGO General Insurance Company Limited: Policy No. 2311 1002 5639 1400 001

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HDFC ERGO General Insurance Company Limited

Certificate of Insurance cum Policy Schedule -

Insured Name MR SUNIL KUMAR RTO DELHI PAN No.

Make Model - Variant Engine No Chassis No Mfg Yr Seats Body Type CC

Nominee for Owner driver Appointee

Less: No Claim Bonus (50%) 1584

Net Liability Premium (b) 3013

Net Own Damage Premium (a) 1583 Total Premium 5423

Broker Name :D2C INSURANCE BROKING PVT LTD

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