The Oriental Insurance Co. Ltd.

Servicing Office of Insurer: Divisional Office Shree Krishna Plaza, 100 Ft. Road Shobhagpura, Udaipur,
Rajasthan (State Code:08) -313011, PH-0294-2980013 Website: www.orientalinsurance.org.in
PAN: AAACT0627R . GSTIN: 08AAACT0627R3ZX Insurer's IRDA Registration Number: 556
Tollfree Helpline 1800-11-8485 Email: [email protected] CIN :
U66010DL1947GO1007158
PRIVATE CAR PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 242596/31/2023/TMP/11493 Policy Issued On 29-MAY-2022 (18:40)

Insured Name MR. MOHD. FAISAL
Own Damage Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight) Motor Liability Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight)

Proposal No. & Date PPVBU11960034, 29-MAY-2022 CPA Cover Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight)
Insured Add. ,14/202 VIKAS NAGAR SEC-14 VIKAS NAGAR , LUCKNOW , UTTAR PRADESH (State Code:09) -226001
Previous Insurer NIA Previous Policy No. 12220031210350026545 18-JUN-2021 To 17-JUN-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 XZ 1.2 P 1199 2018 5

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

SEDAN UP 32 JX 7393 LUCKNOW 18-JUN-2018 REVTRN05DRYK35774 MAT629276JKE42651

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

300,274 0 0 0 300,274

Schedule of Premium (Amount in Rs.)

Own Damage Premium (A)
Basic Premium Deductibles
Vehicle 2,396 Voluntary Deductibles (0) (IMT-22A) 0
Non-Elec. Accessories 0 Anti Theft Device (IMT-10) 60
Elec. Accessories (IMT-24) 0 AA Membership (IMT-8) 0
CNG/LPG Kit (IMT-25) 0 No Claim Bonus (0%) 0
Sub Total (Basic Premium) 2,396 Handicapped Discount (0%) 0
Geographical Area Extension (IMT-1) 0 Sub Total (Deductibles) 60
IMT 23 Premium 0
Add On Coverages (Refer Note 5) 2300
Sub Total-Addition 4696 Net Own Damage Premium (A) 4636
Liability Premium (B)
Basic Third Party Liability 3221 PA Cover For 0 Persons of Rs. 200000 Each (IMT-16) 0
Third Party Liability For Bi-Fuel Kit 0 PA cover for Paid Driver of Rs 2,00,000 (IMT± 0
Third Party Liability For Geographical Area Extension 0 Legal Liability For Paid Driver (IMT-28) 50
PA Cover For Owner Driver Of Rs. 1500000 (IMT-15)
320 Legal Liability for Employees (for 0 persons) (IMT±  0
Net Liability Premium (B) 3591

Note : Warning that in case of dishonour of the premium cheque, this document stands
automatically cancelled 'ab-initio Total Premium (A+B) 8227
> Consolidated stamp duty paid to state exchequer.
> The policy is subject to compulsory deductible of Rs.1000 (IMT-22) IGST (18%) 1481
> Add-on: NIL DEPRECIATION(Nil Depreciation-1 Year:2300)
> The insurance company will display terms & conditions on its website www.orientalinsurance.org.in.

> Subject to IMT Endt. Nos.& Memorandum:7,22,10,28 Gross Premium Paid 9,708
EX-SHOWROOM PRICE : 600548
Nominee Details
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
NIKHAT AFROZ 46 MOTHER --N.A-- --N.A--
Payment Details : Cheque No.: 111518623189, Cheque Date: 29-MAY-2022, Bank Name: PAYLINK, Bank City:
Hypothecation Details: HDFC BANK LTD. - jaunpur - JAUNPUR
MISP Name: SRM MOTORS, MISP PAN No: AANCS2062A, MISP Code: TMIBASL/MISP/AANCS2062A
SAC:997134, Description of Service :Motor Vehicle Insurance Services, Place of Supply :UTTAR PRADESH(State Code:09), Receipt No/Invoice No:TMP23011493
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 Motor
Vehicle Act, 1988
For & On Behalf of The Oriental 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]
 The Oriental Insurance Co. Ltd.
Servicing Office of Insurer: Divisional Office Shree Krishna Plaza, 100 Ft. Road Shobhagpura, Udaipur,
Rajasthan (State Code:08) -313011, PH-0294-2980013 Website: www.orientalinsurance.org.in
PAN: AAACT0627R . GSTIN: 08AAACT0627R3ZX Insurer's IRDA Registration Number: 556
Tollfree Helpline 1800-11-8485 Email: [email protected] CIN :
U66010DL1947GO1007158
PRIVATE CAR PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 242596/31/2023/TMP/11493 Policy Issued On 29-MAY-2022 (18:40)

Insured Name MR. MOHD. FAISAL
Own Damage Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight) Motor Liability Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight)

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.

Limits of Liability Clause: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 Vehicle Act 1988.Under Section II-1 (ii) of the policy-Damage to third party property is
Rs.7.5lakhs PA Cover Under Section III for Owner-Driver is Rs. 1500000

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.

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 LUCKNOW on 29-MAY-2022 18:40
 The Oriental Insurance Co. Ltd.
Servicing Office of Insurer: Divisional Office Shree Krishna Plaza, 100 Ft. Road Shobhagpura, Udaipur,
Rajasthan (State Code:08) -313011, PH-0294-2980013 Website: www.orientalinsurance.org.in
PAN: AAACT0627R . GSTIN: 08AAACT0627R3ZX Insurer's IRDA Registration Number: 556
Tollfree Helpline 1800-11-8485 Email: [email protected] CIN :
U66010DL1947GO1007158
PRIVATE CAR PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 242596/31/2023/TMP/11493 Policy Issued On 29-MAY-2022 (18:40)

Insured Name MR. MOHD. FAISAL
Own Damage Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight) Motor Liability Period 18-JUN-2022(00:00) To 17-JUN-2023(Midnight)

PRIVATE CAR PACKAGE POLICY: ADD ON COVERS

"

Notwithstanding anything to the contrary contained in the policy, and provided additional premium has been paid, it is
hereby understood and agreed that in the event of a Partial Loss claim for damages to the vehicle insured under the
policy where liability is admitted, the insurer will indemnify the insured the full value of Expenses incurred for replacement
of damaged parts of insured vehicle without Application of depreciation there on Subject otherwise to the terms ,
conditions and exceptions of the policy

"