Reliance General Insurance Co.Ltd.

Servicing Office of Insurer: 2nd floor, no43B, sri abhirami tower, cowley bbrown road, RS Puram,
Coimbatore-641002, Coimbatore, Tamil Nadu (State Code:33) -641002, PH--18003009 Website:
https://www.reliancegeneral.co.in/
PAN: AABCR6747B . GSTIN: 33AABCR6747B1ZN Insurer's IRDA Registration Number: 103
Tollfree Helpline 18003009 Email: [email protected] CIN :
Standalone Motor Own Damage Cover (UIN-IRDAN103RP0001V01201920) CUM RECEIPT

OD Policy No. 993492223090000176 Policy Issued On 20-JAN-2022 (17:22)

Insured Name MR. ANANTHA KALYANA KRISHNAN .
Own Damage Period 05-FEB-2022(00:00) To 04-FEB-2023(Midnight) Motor Liability Period 05-FEB-2021(00:00) To 04-FEB-2024(Midnight)
Motor Liability Policy No 993492123740001521 (RGI)

Proposal No. & Date PPVBU11303881, 20-JAN-2022

Insured Add. 13 SRI VINAYAKA NAGAR KOVAIPUDHUR COIMBATORE, COIMBATORE , TAMIL NADU (State Code:33) -641042
Previous Insurer RGI Previous Policy No. 993492123740001521 05-FEB-2021 To 04-FEB-2022
Broker Details
IRDA Lic. No.: 375, CIN No.: U50300MH1997PLC149349 Broker Category: Composite Broker, Validity: 13-MAY-20 To 12-MAY-23
Name & Add.: TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD, 1ST FLOOR, AFL HOUSE, LOK BHARTI COMPLEX, MAROL MAROSHI ROAD,
ANDHERI (EAST), MUMBAI - 400 059

Make Model Sub Model Cubic Capacity Manufacturing Year Seating capacity

TATA MOTORS TIGOR TIGOR (P) XZA+ NEW 1199 2021 5

Body Type Registration No. RTO Invoice Date Engine No. Chassis No.

SEDAN TN 99 T 9372 COIMBATORE WEST 31-JAN-2021 REVTRN08AYXK11053 MAT629527MKA07866

Vehicle IDV CNG/LPG Kit Elec. Accessories Non-Elec. Accessories Total IDV

640,000 0 0 0 640,000

Schedule of Premium (Amount in Rs.)

Own Damage Premium (A)
Basic Premium Deductibles
Vehicle 7,149 Voluntary Deductibles (0) (IMT-22A) 0
Non-Elec. Accessories 0 Anti Theft Device (IMT-10) 0
Elec. Accessories (IMT-24) 0 AA Membership (IMT-8) 0
CNG/LPG Kit (IMT-25) 0 No Claim Bonus (20%) 1,430
Sub Total (Basic Premium) 7,149 Handicapped Discount (0%) 0
Geographical Area Extension (IMT-1) 0 Sub Total (Deductibles) 1,430
IMT 23 Premium 0
Add On Coverages (Refer Note 5) 3200
Sub Total-Addition 10349 Net Own Damage Premium (A) 8919

Note: 1.Warning that in case of dishonour of the premium cheque, this document stands
automatically cancelled 'ab-initio Total Premium (A) 8919
.2.Consolidated Stamp duty Paid vide Letter of Authorisation ³NO.LOA/CSD/202/2021/(Validity Period
Dt.15/12/2021 to ´date 01 Dec 2021 at General Stamp Office, Mumbai. ** Not CGST (9%) 803
Applicable for the State of Jammu & Kashmir
3.The policy is subject to compulsory deductible of Rs.1000 (IMT-22) SGST (9%) 803
5.Add-on: Nil Depreciation(Nil Depreciation-1 Year:3200)
6.The insurance company will display terms & conditions on its website
https://www.reliancegeneral.co.in/ which can
be accessed by you online.
*Subject to IMT Endt. Nos.& Memorandum:7,22
EX-SHOWROOM PRICE : 800000
Gross Premium Paid 10,525

Payment Details : Cheque No.: 111392429470, Cheque Date: 20-JAN-2022, Bank Name: CUG HDFC CCAVENUE, Bank City:
Hypothecation Details: STATE BANK OF INDIA - COIMBATORE - COIMBATORE
MISP Name: S R TRANZCARS PVT LTD, MISP PAN No: AAUCS5860M, MISP Code: TMIBASL/MISP/AAUCS5860M
SAC:997134, Description of Service :Motor Vehicle Insurance Services, Place of Supply :TAMIL NADU(State Code:33), Receipt No/Invoice No:9934922230900001
For & On Behalf of Reliance General Insurance Co.Ltd.

Authorized Signatory
In case of any claim or assistance required please contact our help line at 1800 209 0060 and you may also reach us at [email protected]
 Reliance General Insurance Co.Ltd.
Servicing Office of Insurer: 2nd floor, no43B, sri abhirami tower, cowley bbrown road, RS Puram,
Coimbatore-641002, Coimbatore, Tamil Nadu (State Code:33) -641002, PH--18003009 Website:
https://www.reliancegeneral.co.in/
PAN: AABCR6747B . GSTIN: 33AABCR6747B1ZN Insurer's IRDA Registration Number: 103
Tollfree Helpline 18003009 Email: [email protected] CIN :
Standalone Motor Own Damage Cover (UIN-IRDAN103RP0001V01201920) CUM RECEIPT

OD Policy No. 993492223090000176 Policy Issued On 20-JAN-2022 (17:22)

Insured Name MR. ANANTHA KALYANA KRISHNAN .
Own Damage Period 05-FEB-2022(00:00) To 04-FEB-2023(Midnight) Motor Liability Period 05-FEB-2021(00:00) To 04-FEB-2024(Midnight)
Motor Liability Policy No 993492123740001521 (RGI)

Limitations as to use: The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of
goods (other than samples or personal luggage) (3) Organized racing (4) Pace making (5) Speed testing (6) Reliability trials
(7) Any purpose in connection with motor trade.

Driver¶s Clause: Any person including the insured: Provided that the person driving holds an effective driving license at
the time of the accident and is not disqualified from holding or obtaining such license. Provided also that the person holding
an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the
Central Motor Vehicle Rules, 1989.

NCB Clause: 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)-20%, preceding two consecutive years-25%, preceding three consecutive
years-35%, preceding four consecutive years-45%, preceding five consecutive years-50% of NCB on OD Premium. NCB is
allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.

Own Damage Cover Clause: Own Damage Cover is subject to a valid Third Party Policy.
This policy covers damages to vehicle only and not the Third Party losses. Third Party cover is taken by the customer in
previous policy, details of which are as per the customer declaration only. Customer needs to ensure that there is a valid TP

Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the
schedule. Any payment made by the company by reasons 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 ³AVOIDANCE OF CERTAIN TERMS
& RIGHT OF RECOVERY´For legal interpretation English version will hold good.

Note: This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or
expression to which a specific meaning has been attached in any part of this policy or of the Schedule shall bear the same
meaning wherever it may appear. Any amendments/modifications/alterations made on this system generated policy
document is not valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes
required to be made in the policy once issued would be valid and effective, only after written request is made to the
Company and Company accepts the requested amendments/modifications/alterations and records the same through separate
endorsement to be issued by the company.
In Witness whereoff this policy has been signed at COIMBATORE on 20-JAN-2022 17:22
 Reliance General Insurance Co.Ltd.
Servicing Office of Insurer: 2nd floor, no43B, sri abhirami tower, cowley bbrown road, RS Puram,
Coimbatore-641002, Coimbatore, Tamil Nadu (State Code:33) -641002, PH--18003009 Website:
https://www.reliancegeneral.co.in/
PAN: AABCR6747B . GSTIN: 33AABCR6747B1ZN Insurer's IRDA Registration Number: 103
Tollfree Helpline 18003009 Email: [email protected] CIN :
Standalone Motor Own Damage Cover (UIN-IRDAN103RP0001V01201920) CUM RECEIPT

OD Policy No. 993492223090000176 Policy Issued On 20-JAN-2022 (17:22)

Insured Name MR. ANANTHA KALYANA KRISHNAN .
Own Damage Period 05-FEB-2022(00:00) To 04-FEB-2023(Midnight) Motor Liability Period 05-FEB-2021(00:00) To 04-FEB-2024(Midnight)
Motor Liability Policy No 993492123740001521 (RGI)

PRIVATE CAR PACKAGE POLICY: ADD ON COVERS

Nil Depreciation:
This add on cover is applicable only if it is mentioned in the policy schedule.
In consideration of payment of an additional premium and notwithstanding anything to the contrary contained in section I
of this Policy it is hereby understood and agreed that the Company will indemnify the Insured without deduction for
depreciation on parts other than tyres and tubes in respect of approved partial loss claims.
Provided that the indemnity granted by this Endorsement:
(1) shall be available only for maximum two accidents during the Policyperiod
(2) no indemnity shall be granted to Total Loss/ Constructive Total Loss/ Theft claims
(3) shall be applicable subject to insured vehicle being given for repairs to Company's Authorised Dealer/ Repairer only.
Subject otherwise to the terms, exceptions, conditions and limitations of the Policy.