C O MP R EHENS IVE P O LIC Y w it h C o n s u ma b le s

Summary

MarutiBaleno Valid from Valid till (midnight)

GJ01RS4672 14 JUL 21 13 JUL 22
Car owner Owner number Owner email
Roman Kirtikumar Patel XXXXXX6356 [email protected]
Prime Plan Policy price Car value
Offer
Comprehensive with Consumables ₹ 7634.00 ₹ 520096
Zero Depreciation
Voluntary Deductible*

Please refer overlay for more details

*The policyholder will bear Rs. 5000 over and above the standard charges in the event of a claim.

WELCOME! We’re happy to have you at Acko, and promise to be there for you always. You’re now a part of the
Acko Advantage program, which takes care of everything if your car ever runs into trouble. Just call us
immediately on 1800 266 2256 when things go wrong and we’ll take it from there.

Acko No n -A c k o
Advant age* Advant age
Free car pick-up from
home, office or accident
site

Repairs at our network of

expert garages.

3-day repair guarantee.

Cab voucher** worth Rs.

500/day if there's a repair
delay.

Car drop at your doorstep.

Cashless and hassle-free

processing.

*Only applicable in selected cities provided you call us immediately - Ahmedabad | Bangalore | Chennai | Delhi | Hyderabad | Kolkata | Mumbai | Pune
**Cab vouchers available in the cities mentioned above. Please refer the Terms & Conditions for more details

Ple as e No te : Previous Policy document is required in case of claim within 30 days of Acko Policy Start Date.

Acko Ge ne ral Ins urance Ltd.

If you are a workshop or garage staf f
Unit No. 301, E Wing, Lotus Corporate Park, Off Western Express Highway, Goregaon (E), Mumbai-
Please
400063 call Acko for quick settlements on 1800 209 9910 [ GST# for workshop Invoice 27AAOCA9055C1ZJ ]
Email: [email protected] | Phone: 18 00 266 2256 | www.acko.com
Product: Private Car Package Policy | CIN : U66000MH2016PLC28 738 5
IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ
UIN: IRDAN157P0007V01201718 , A0006V012018 19, A0009V012018 19 Page 1 of 5
What’s Covered
A snapshot of all the coverages in this policy.

Accide nts Fire T he f t

Damages caused due to an accident Damages resulting from self-ignition, In case of theft, insured value of the car
are covered. explosion and lightening are covered. will be paid.

C alamitie s T hird - Party Lo s s e s C o ns umable s

Damages caused due to earthquake, Third party losses resulting in injury, Covers the cost of consumables like
riots and other natural/man-made death or property damage in case of an nut, bolt, lubricant etc. consumed
calamities are covered. accident are covered. during car repair due to accident.

Ze ro de pre ciatio n
Comprehensive insurance plan pays
only the depreciated value of a car part
if a replacement is required, but Zero
dep or bumper to bumper plan covers
the full cost of replacement.

What’s Not Covered

A snapshot of all the coverages that are not covered in this policy.

No n Accide ntal Damage s C o ns e que ntial Lo s s & Nucle ar Ris k & War Ille gal Driving
Wear & tear, breakdowns, C o ntractual Liability Damages to your car due to Driving without a valid driving
failures, and deductibles are Indirect damage or liability nuclear risk, war & mutiny license, or under the influence of
not covered. Also arising due to your car alcohol and/or other illegal
consequential damages or accident. substances will not be covered.
liabilities that arise due to car
accidents will not be covered.

T yre s , T ube s & Engine C ar Re vie w Exce ptio n C o mme rcial us age o f the
Damage to tyres, tubes, and Pre-existing Damages as C ar
engine is not covered unless found on vehicle inspection. If the Car is registered as
they are damaged due to an Private vehicle & if it is used
accident. for commercial purpose than
the losses or liability due to
accident during such usage is
not covered in this policy.

The info rma tio n pro vide d he re in a bo ve is fo r the purpo s e o f illus tra tio n o nly. Fo r mo re de ta ils o n ris k fa cto rs , te rms ,
co nditio ns a nd e xclus io ns , ple a s e re a d the po licy wo rding s ( https ://www.a cko .co m/do wnlo a d ) ca re fully. Page 2 of 5
 C O MP R EHENS IVE P O LIC Y
Private Car Package Policy

P O L IC Y D E T AIL S VE HIC L E D E T AIL S

Insured Name: Roman Kirtikumar Patel Registration Number: GJ01RS4672
Address/Pincode: 38 0054 Make/Model: MarutiBaleno
Nominee Name: Sonali Roman Patel Purchase Year: 2016
Relationship: Spouse Engine CC: 1197
Period of Insurance: 14 Jul 21 (00:00 hrs) to 13 Jul 22 (23:59 hrs) Engine Number: K12MN4171511
Policy Issuance Date: 10 Jul 21 Chassis No: MA3EWB22SGG199503
Policy Number: ACCA0040718 3906/00

INS UR E D D E C L AR E D VAL UE ( ID V)
Ve hicle IDV (₹) Acce s s o rie s (₹) Bif ue l Kit (₹) T o tal IDV (₹)

520096 0 0 520096

P R E M IUM D E T AIL S ( ₹)
Own Damage Pre mium (A) Liability Pre mium (B)

Basic Own Damage ₹ 3433.0 Basic Third Party Liability ₹ 3221.0

NCB Discount ₹ -1592.0

Coupon Discount ₹ -249.0

Zero Depreciation Smart Saver ₹ 1545.0

Consumables ₹ 111.0

Net Own Damage Premium (A) ₹ 3248 .0 Net Liability Premium (B) ₹ 3221.0

Total Package Premium ₹ 6469.00

IGST (18 %) ₹ 1165.0

Total Premium ₹ 7634.00

Geographical Area: India Voluntary Deductible: ₹ 5000 Hypothecation: NA

No-Claim Bonus: 50 Compulsory Deductible: ₹ 1000

L i m i t at i o n s As T o U se : The Po licy co ve rs us e o f the ve hicle fo r a ny purpo s e o the r tha n: a ) Hire o r Re wa rd b) Ca rria g e o f g o o ds (o the r tha n s a mple s o r pe rs o na l
lug g a g e ) c) Org a nize d ra cing d) Pa ce ma king e ) Spe e d te s ting f) Re lia bility Tria ls g ) Any purpo s e in co nne ctio n with Mo to r Tra de . Pe rso n s o r Cl ass o f Pe rso n s
e n t i t l e d t o d ri ve : Any pe rs o n ((including the ins ure d), pro vide d tha t a pe rs o n driving ho lds a va lid driving lice ns e a t the time o f the a ccide nt a nd is no t dis qua lifie d
fro m ho lding o r o bta ining s uch a lice ns e . Pro vide d a ls o tha t the pe rs o n ho lding a va lid le a rne r's lice ns e ma y a ls o drive the ve hicle a nd tha t s uch a pe rs o n s a tis fie s
the re quire me nts o f Rule 3 o f the Ce ntra l Mo to r Ve hicle s Rule s , 198 9. L i m i t s o f L i ab i l i t y. 1. Unde r Se ctio n II-1 (i) o f the po licy - De a th o f o r bo dily injury - Such
a mo unt a s is ne ce s s a ry to me e t the re quire me nts o f the Mo to r Ve hicle s Act, 198 8 . 2 . Unde r Se ctio n II - 1(ii) o f the po licy -Da ma g e to Third Pa rty Pro pe rty - Rs . 7 5 0 0 0 0
T e rm s, Co n d i t i o n s & Exc l u si o n s: As pe r the India n Mo to r Ta riff. A pe rs o na l co py o f the s a me is a va ila ble fre e o f co s t o n re que s t & the s a me is a ls o a va ila ble a t o ur
we bs ite .
I / We he re by ce rtify tha t the po licy to which the ce rtifica te re la te s a s we ll a s the ce rtifica te o f ins ura nce a re is s ue d in a cco rda nce with the pro vis io n o f cha pte r X, XI o f
Mo to r Ve hicle s Act, 198 8 . " The s ta mp duty o f Rs . 0 .5 0 pa id by e le ctro nic me dium vide GRAS De fa ce no . 0 0 0 3 8 4 5 13 0 2 0 2 0 2 1 da te d 15 /12 /2 0 2 0 a s pre s cribe d in
Go ve rnme nt No tifica tio n Re ve nue & Fo re s t De pa rtme nt No . Mudra nk - 2 0 17 /C.R.97 /M-1, da te d 0 9/0 1/2 0 18 . GSTN: 2 7 AAOCA90 5 5 C1ZJ. IMPO RT ANT NO T ICE: The
Ins ure d is no t inde mnifie d if the ve hicle is us e d o r drive n o the rwis e tha n in a cco rda nce with this Sche dule . Any pa yme nt ma de by the Co mpa ny by re a s o n o f wide r
te rms a ppe a ring in the Ce rtifica te in o rde r to co mply with the Mo to r Ve hicle s Act, 198 8 is re co ve ra ble fro m the Ins ure d. Se e the cla us e he a de d " AVOIDANCE OF
CERTAIN TERMS AND RIGHT OF RECOVERY” in the po licy wo rding s . Di sc l ai m e r: The Po licy s ha ll be vo id fro m ince ptio n if the pre mium che que is no t re a lize d. In the
e ve nt o f mis re pre s e nta tio n, fra ud o r no n-dis clo s ure o f ma te ria l fa ct, the Co mpa ny re s e rve s the rig ht to ca nce l the Po licy. The po licy is is s ue d ba s is the info rma tio n
pro vide d by yo u, which is a va ila ble with the co mpa ny. In ca s e o f dis cre pa ncy/no n re co rding o f re le va nt info rma tio n in the po licy, the ins ure d is re que s te d to bring the
s a me to the no tice o f the co mpa ny within 15 da ys . This Po licy is to be re a d in co njunctio n with the Po licy wo rding s (https ://www.a cko .co m/do wnlo a d) a va ila ble o n the
we bs ite o f the Co mpa ny. On re ne wa l, the be ne fits pro vide d unde r the po licy a nd/o r te rms a nd co nditio ns o f the po licy including pre mium ra te ma y be s ubje ct to
cha ng e .

INT E R M E D IAR Y D E T AIL S

Name C o ntact Email Addre s s

AMAZON PAY (INDIA) PRIVATE 18 00 266 2256 amazon-insurance- 8 TH FLOOR, BRIGADE GATEWAY,26/1 DR.
LIMITED [email protected] RAJKUMAR ROAD,BANGALORE,KARNATAKA

Acko General Insurance Lt d .

Unit No . 3 0 1, E Wing , Lo tus Co rpo ra te Pa rk, Off We s te rn Expre s s Hig hwa y, Go re g a o n (E), Mumba i- 4 0 0 0 63
Ema il: he llo @ a cko .co m | Pho ne : 18 0 0 2 66 2 2 5 6 | www.a cko .co m
Pro duct: Priva te Ca r Pa cka g e Po licy | CIN : U660 0 0 MH2 0 16PLC2 8 7 3 8 5
IRDAI Re g No . 15 7 | HSN: 997 13 4 | GST: 2 7 AAOCA90 5 5 C1ZJ Fo r Acko Ge ne ra l Ins ura nce Ltd.
UIN: IRDAN15 7 P0 0 0 7 V0 12 0 17 18 , A0 0 0 6V0 12 0 18 19, A0 0 0 9V0 12 0 18 19 Duly Co ns titute d Atto rne y
Pa g e 3 o f 5
 P R EMIUM R EC EIP T

Received with thanks from Roman Kirtikumar Patel a sum of ₹ 763 4.00 towards premium on Car Insurance
Policy

INS UR E D D E T AIL S
Name of Insured: Roman Kirtikumar Patel
Period of Insurance: 14 Jul 21 (00:00 hrs) to 13 Jul 22 (23:59 hrs)
Policy Number: ACCA0040718 3906/00
Payment Date: 10 Jul 21

P R E M IUM D E T AIL S ( ₹)
Gross Premium ₹6469.00

IGST (18 %) ₹1165.0

Total Premium ₹7634.00

T E R M S & C O ND IT IO NS :
Issuance of this receipt does not amount to acceptance of the risk by Acko General Insurance Limited. The insurance cover for the risk shall be as
per the terms and conditions of the Insurance Policy if and when issued. * Cheque/DD/PO receipt is valid subject to realization of the instrument.

Acko Ge ne ral Ins urance Ltd.

Unit No. 301, E Wing, Lotus Corporate Park, Off Western Express Highway, Goregaon (E), Mumbai-
400063
Email: [email protected] | Phone: 18 00 266 2256 | www.acko.com
CIN : U66000MH2016PLC28 738 5 | IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ For Acko General Insurance Ltd.
UIN: IRDAN157P0007V01201718 , A0006V012018 19, A0009V012018 19 Duly Constituted Attorney
Page 4 of 5
 PRO PO S AL FO RM

Dear Roman Kirtikumar Patel,

We wish to inform you that the Insurance policy number ACCA00407183 906/00 has been issued on the
basis of the information and declaration given by you, the transcript whereof is mentioned below.

Please be informed that this Policy shall be construed to be void ab initio/invalid in the event we find that you have not disclosed
material or correct information required for the purpose of providing the below insurance cover and in case of any claim arising
under the policy in such a scenario, we shall be under no obligation whatsoever to settle such claim to you and the premium paid
by you under this policy shall stand fully forfeited.

P O L IC Y D E T AIL S P R E VIO US P O L IC Y D E T AIL S

Policy Number: ACCA0040718 3906/00 Previous Policy Expired: Not Expired
Period of Insurance: 14 Jul 21 (00:00 hrs) to 13 Jul 22 (23:59 hrs) Previous Policy Insurer: Acko General Insurance
Policy Issuance Date: 10 Jul 21 Previous Policy Number: DCCR003008 73906/00

C AR D E T AIL S C AR O W NE R D E T AIL S
Car Number: GJ01RS4672 Name: Roman Kirtikumar Patel
Make/Model: MarutiBaleno Email Address: [email protected]
Type: Private Mobile Number: XXXXXX6356
Fuel Type: petrol NCB: 50
Registration Year: 2016 Address/Pincode: 38 0054
Insured Declared Value (IDV): 520096
Accessories (IDV): 0
Engine Number: K12MN4171511
Chassis Number: MA3EWB22SGG199503

NO M INE E D E T AIL S
Name: Sonali Roman Patel
Relationship with Insured: Spouse

C O VE R D E T AIL S
Add-o ns / Othe rs Include d Exclude d

PA Cover -
Consumables -
Car Protect -
Zero Depreciation -
Voluntary Deductible (₹ 5000) -

T E R M S & C O ND IT IO NS :
“I/We desire to insure with Acko General Insurance Limited in respect of the vehicle described in this proposal form and confirm that the
statements contained in this application are my/our true and accurate representations. I/We undertake that if any of the statements are found to
be false or incorrect, the benefits under this policy would stand forfeited. I/We agree that this application and declaration shall be promissory and
shall be the basis of the contract between me/us and Acko General Insurance Limited. I/We agree to the Company taking appropriate measures to
capture the voice log for all such telephonic transactions carried out by me/us as required by the procedures/regulations internal or external to the
Company and shall not hold the Company responsible or liable for relying/using such recorded telephonic conversation. In the event of
nonrealization of the cheque or non-receipt of the amount of premium by the Company the policy shall be deemed cancelled ‘ab-initio’ and the
Company shall not be responsible for any liabilities of whatsoever nature under this Policy.” I/We agree to receive ‘Certificate of Insurance or Policy
Schedule’ only and shall access the policy terms, conditions and exclusions on the company’s website.

Acko Ge ne ral Ins urance Ltd.

Unit No. 301, E Wing, Lotus Corporate Park, Off Western Express Highway, Goregaon (E), Mumbai-
400063
Email: [email protected] | Phone: 18 00 266 2256 | www.acko.com
CIN : U66000MH2016PLC28 738 5 | IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ For Acko General Insurance Ltd.
UIN: IRDAN157P0007V01201718 , A0006V012018 19, A0009V012018 19 Duly Constituted Attorney
Page 5 of 5