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CERTIFICATE OF REGISTRATIO

MPO9CK1989 MADHYA PRADESI STATE


www
MKAG
NTOLAC
COLOR wITE

POEL SEDONESE
weA
CE
VAL
TAX 1 t
Piwgese FER OF0
SUSK OBHAKOHAD
ANN
INDIAN UNION DRIVING LiCENCE
MADHYA PRADESH STATE Form 7
Number MP10R20s057189rv
Name
SHARMA
S/DW of ONANSIYAM SHARMA
Address GOUR KUNU BAHETI COLONY
SANAWAD
Org NGS6719/1996 KHARGONE,MP
sued on ORE lssued on 08-12-2016
DOB
07-07-197s BG:
is Licence to drive
Vehicle Clads MCWGR JLMV- HOLDERSIGN
Date of lssee 25-10-1996 AUMMOnucatio
Valid till (Trarisport) 2206-20
Valid till (Non-Transporty 06-07-2025 JAGDISH BLORE
TIVTe Car*PackOge
taath ztem
Policy Number:
3260263 12010001336 a r u kr Business Source: 326026
National insuranic
rht a7utera
4Tute
Issuing Office u t r Sales Channel Code: 9000129025
stsOffice Code: 326026 TH Name: Mr Babulal Patil
uter m Office Address: SANAWAD BC
tv t Contact Number: 9826945583
Sanawad Business
Center, Jawahar Marg, Near
Power House, Sanawad, Dist: Khargone,
451111. Customer Care Toll Free Number:
State Code: 23, Madhya Pradesh
1800 345 0330
yrtantaGSTIN: 23AAACN9967E 1ZB
Fu ziT/Contact Number: 7280 235355 email:[email protected]
taTgF T/Mobile Number: 0

E T Customer Name: MR SUSHIL


SHARMA GHANSHYAM SHARMA uTg T. Customer ID: 9541086049 ta PAN:
a Address: GALI NO. 4 BAHETI COLONY
SANAWAD., »RCity: SANAWAD,
m/District: NIMAR WEST, I/State: MADHYA
-
t Phonhe:

451111. PRADESH,a PIN:


/Cell: 9893845250
ta E-Mail

TerA TCt P E, Policy Effective from 00:00 hours, on 23/02/2021 31iaifa 75 to midnight of 22/02/2022
s e r Premium
10,849.00 a hz , a artu Cover Note Number and Date NA
atyreCGST 976.00
RrorEdarwd/SGST/UTGST 976.00
anggra/nGST R0.00
T 3yR/Kerala Flood 0.00 eTa tn mhunProposal Nurnber and Date 8800190220113409 Dt. 25/12/2020
Cess
a_asya/
Less:GST_TDS 0.00
t au ztU yRecoverable
0.00 etz rtear a t u Receipt Number and Date 3280268 12010002098 Dt. 20/02/2021
Stamp Duty
T o t a l Amount frt i tea a ranfa faf Previous Policy 326026311810001368 tand Dt.20/02/2020
12,801.00 Number and Expiry Date 326026311910001531 /and Dt.22/02/2021
/Rupees Twelve Thousand Eight Hundred One a Only.)
TE 1 r u Vehicle Details
T 1 T.`T.}TVehicie IDV 2,00,000.00 ot. zi Regn. Number MP-09-CK-1989
TE ÉT, T IDV r Trailer) NA T /HN G.Engine or M/c CLN166034
No.
a R H Å Electrical NA afeA HATChassis Number wwG11604BTO81434
Accessories
R 3YARINon Electrical sftery sfa. Regn. Authority Indore
Accessories NA

HIR T ~ Fiber Glass Tank NA RT India


Tfrs et Geographical Area
Ts/Trst gfzCNG/LPG Unit NA H1T Make VOLKSWAGEN
****
*orasnsann****-* ********** .******.******** *****
ATsA Model VENTO (2010-2012) 144022
t. z Addl. Towing NA aRye Variant IPL EDITION (2010-2012)
Charges
1598 aTE t/Class of Vehicle Private Car
5 SEDANWhite
T51TUT Body Type/
Licensed Seating Carying Color
Capacity
AH Year of Mfg. 2010 a k arara/ Date of 10/08/2011
Purchase

hfaun 1 arTyh Schedule of Premium


ra-fa Own Damage () afu zfar Legal Liability )
a-fa Tar (afaa yra ifua z uTr) Own Damage
Brt&uam »ATn/Legal Liability Cover 7,890.00
Cover(inclusive of add ons wherever opted for)
2,514.00 No of Workmen for Opt and Maint.(Upto 6+1 Driver) 1-per .00
afra gtzA/Personal Accident
FTotal
395.0
8,335.0
Fa Total 2,514.00

f a a Rarm Vehicle Own Damage Insurance Details


arataa % No Claim Bonus% 25.00
T y Compulsory Excess 2,000.00

TA v Ta am Third Party Insurance Details


2TRT I1-1(i) TEA ZU HAT/Limit of Htz aTEA TatAYH 1988 1THR 3HT422% zitN Such amount as is necessary to meet the requirement of the motor
liability under section l1-I6) vehicles Act 1988
7,50,000.00 (ftit y% ZA/ ZiTI À344 aTË VA ZTAT I ZrAT jua HHU HY(In respect of any one claim or series.
e7RT I1-I(i) à qEal under section l1-1(i)
claims arising out of one eventoccurrence.)

afaa gizm t aarm Personal Accident Cover Details


T T RR CSI
gA 7 Hrta T PA of Owner driver of the vehicle
Nominee SMT POONAM SHARMA, WIFE, 39 15,00.0
4 a f i persons
HRTtUnnamedpassengers 50
orc oments and Warranties Applicablp: IMT 29 1C 2

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