The Certificate of Insurance Page 1 of 2

ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Stand-alone OD Policy ( Private Vehicle ) Proposal No. & Date SR06547741 / 29-Oct-2021
Policy No. & Type 55230031211847073720 Period of Insurance 30-Oct-2021 to 29-Oct-2022
Policy Issued On 29-Oct-2021 (00:00) Vehicle Identification No. MA3RFL41SLJ195532
Insured Name Mr Palam Maheswara Reddy Geographical Area INDIA
Invoice No 4131215526973 Accounting Code of Service 997134
S/O.PALAM NAGI REDDY,H NO:1- 24, HUSSINAPURAM,KOMMEMARRI, KURNOOL,
Insured Address
KURNOOL-518220, Andhra Pradesh
Insured State & Code Andhra Pradesh-37 Place of Supply Andhra Pradesh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 341553
Model & Variant S-PRESSO VXI+/MARUTI S-PRESSO VXI+ Non Electrical Accessories 0
Registration No AP39GR5239 Electrical Accessories 0
Year of Manufacture 2020 CNG/ LPG Kit 0
Engine- Chassis No K10BN 2338817 - MA3RFL41SLJ195532 Total IDV 341553
Cubic Capacity 998
Seating Capacity 5
Type Of Body Saloon
RTO Location AP39GR5239 / KURNOOL
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) Pre-Existing Third Party Policy Details.
Vehicle 4153 Insurance Company Name National Insurance Company Limited
Elec. Accessories 0 Policy No. 55230031201145665910
Risk Inception Date 30-Oct-2020
Non- Elec. Accessories 0
Risk Expiry Date 29-Oct-2023
Kit (IMT-25) 0
Extra Premium towards Inbuilt CNG/LPG NA MISP - MSA MOTORS, KURNOOL
Basic Premium 4153
Geographical Area Extn. (IMT-1) NA
Notes : ( For Stand-alone OD Policy )
Lamp, Tyres etc. (IMT 23) 0
Driving Tuition Loading On OD Premium (60%) NA 1. Policy Issuance is the subject to the realisation of cheque.
Fiber Glass Tank 0 2. Consolidate stamp duty paid to State Exchequer
3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Sub-Total Additions 0 4. Voluntary excess Rs (0)
Deductibles 5. Subject to Endorsements IMT ,7 10,
Voluntary Deductibles (IMT 22A) 0 6. The Coverage under this policy is only for Own Damage and no other liability in
connection with the vehicle.
Anti-Theft Device (IMT-10) 104 7. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from
AAI Membership (IMT-8) 0 NCB to Non-NCB, the recoverable amount may be more than the NCB amount.
No Claim Bonus (20%) 810
Discount for vehicles designed for handicapped NA
Sub - Total Deductibles 914
Add - On Coverages
Nil Depreciation Plus 2049
Engine Protect 0
Invoice Protect 0
Net own Damage Premium (A) 5288
CGST@9% 475.92
SGST@9% 475.92
Total OD Premium 6240
Nominee Details : Nominee Name ERAMREDDY VENKATA LAKSHMI Age 45 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 45165414 HSBC BANK LTD 6240
Financier Type Financed Financier Name STATE BANK OF INDIA Financier Branch KURNOOL
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.
Driver: 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.
Deductibles: Deductible under section-I : Rs 1000(Compulsory Deductible Rs 1000 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if no claim is made or pending during the preceding year (s), as per the following: The
preceding year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will
only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
IMPORTANT NOTICE: The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment made by the Company by 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". For Legal interpretation, English version will hold good.
For information on ombudsman you may visit website : http://www.gbic.co.in/ombudsman.html
I / We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X and Chapter XI of M.V. Act, 1988.
For National Insurance Company Limited

Authorized Signatory
Policy Issuing Office:-Kurnool Division, First Floor, 40/343A, Tula Complex, Gandhinagar, Kurnool, Andhra Pradesh
GSTIN: 37AAACN9967E4ZZ, CIN No.:U10200WB1906GOI001713
State Name : Andhra Pradesh

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The Certificate of Insurance Page 2 of 2

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