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 SR15673177 / 28-Oct-2023
Policy No. & Type 20050031231849812075 Period of Insurance 31-Oct-2023 to 30-Oct-2024
Policy Issued On 28-Oct-2023 (00:00) Vehicle Identification No. MA3SFM61SNJ118835
Insured Name Mr. Zabir Ahmed Geographical Area INDIA
Invoice No 4131238091759 Accounting Code of Service 997134
S/O- LATE. RAFE UDDIN, VILL- LALONG KITTA LABAKPAR PART- I, P.S- LAKHIPUR, P.O- PAILAPOOL, DIST- CACHAR, ASSAM,,
Insured Address
SILCHAR-788098, Assam
Insured State & Code Assam-18 Place of Supply Assam GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 399558
Model & Variant MARUTI ALTO K10 VXI 1L 5MT BS6/MARUTI ALTO K10 VXI 1L 5MT Non Electrical Accessories 0
Registration No AS11X9134 Electrical Accessories 0
Year of Manufacture 2022 CNG/ LPG Kit 0
Engine- Chassis No K10CN 1070311 - MA3SFM61SNJ118835 Total IDV 399558
Cubic Capacity 998
Seating Capacity 5
Type Of Body Saloon
RTO Location AS11X9134 / CACHAR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) Pre-Existing Third Party Policy Details.
Vehicle 2913 Insurance Company Name SBI General Insurance Company Ltd.
Elec. Accessories 0 Policy No. 51056/N0000700940
Risk Inception Date 31-Oct-2022
Non- Elec. Accessories 0
Risk Expiry Date 30-Oct-2025
Kit (IMT-25) 0
Extra Premium towards Inbuilt CNG/LPG NA MISP - JAIN UDYOG, SILCHAR
Basic Premium 2913
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) 73 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%) 568
Discount for vehicles designed for handicapped NA
Sub - Total Deductibles 641
Add - On Coverages
Nil Depreciation Plus 0
Engine Protect 0
Invoice Protect 0
Net own Damage Premium (A) 2272
CGST@9% 204.48
SGST@9% 204.48
Total OD Premium 2681
Nominee Details : Nominee Name RINA BEGUM Age 35 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Credit Card 76660643191 ICICI BANK LIMITED 2681
Financier Type Financed Financier Name MAHINDRA & MAHINDRA FINANCIAL SERVICES LIMITED Financier Branch SILCHAR BRANCH
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 : https://www.cioins.co.in/Ombudsman
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
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of
the said sub-rule.
Authorized Signatory
Policy Issuing Office:-Silchar Division, Capital Travels Building, Club Road , Silchar, Dist: Cachar, Assam
GSTIN: 18AAACN9967E1Z2, CIN No.:U10200WB1906GOI001713
State Name : Assam
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The Certificate of Insurance Page 2 of 2
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