Auto Secure - Commercial Vehicle Package Policy - Miscellaneous & Special Types Vehicle

Date:03/01/2024

Your Policy Details:

Name: LIFEJET CARDIAC AMBULANCE SERVICE
Policy Number: 6301215560 00 00
Address: E-2 SECOND FLOOR CHARMS STAR,
BUILDING NEAR SANAI MANGAL KARYALAY,, Policy Period: From 00:00 Hours on 04/01/2024 to Midnight of
BAIL BAZAR KALYAN WEST, Thane, 03/01/2025
421301,
KALYAN, Premium Paid: ₹ 19,147.00
MAHARASHTRA

Dear LIFEJET CARDIAC AMBULANCE SERVICE ,

Welcome to Tata AIG General Insurance Company Limited family & we thank you for choosing our policy for your motor vehicle insurance.

We are enclosing Policy schedule cum certificate of insurance of your vehicle. You are requested to visit our website www.tataaig.com for policy
wording.

Your policy has been issued based on the information and declaration provided by you, No Claim Bonus (NCB) if shown on your policy schedule
has been allowed as you had not reported any claim in the previous policy.

Kindly go through the enclosed information/declaration provided by you and in case your policy shows No Claim Bonus, for which you are not
entitled as explained above or any other error/discrepancy then we request you to get in touch with us within 15 days of receipt of the policy for
correction otherwise all particulars will be deemed to be correct.

You may also reach us at our 24*7 helpline 1800 266 7780 for providing any information or in case you desire to have a printed copy of policy
wording.

We assure you of our best services at all times. Happy driving!

Sincerely,
For Tata AIG General Insurance Company Limited

Authorized Signatory

Tata AIG General Insurance Co. Ltd.,

7th and 8th Floor, Romell Tech Park,
Cama Industrial Estate, Western Express
Highway, Goregaon(E), Mumbai,
Maharashtra 400063

Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.

TATA AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN :IRDAN108RP0078V01201819
Page 1 of 4
 Auto Secure - Commercial Vehicle Package Policy - Miscellaneous & Special Types Vehicle

Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Agent Name: KRISHIV INSURANCE BROKING LLP

Agent License Code: 652 Agent Contact No.: 8291914810
Policy Number: 6301215560 00 00 Policy Type : Auto Secure - Commercial Class: Miscellaneous &
Policy Code: 00/00/3191/01 Commercial Vehicle Package Policy - Special Types Vehicle
Miscellaneous & Special Types Vehicle
Alternate Policy No: N/A Covernote No: N/A Covernote Issuance Date: N/A
Name & Address of Insured Period of Insurance
Name: LIFEJET CARDIAC AMBULANCE SERVICE (Section-I Own Damage) From 00:00 Hours on 04/01/2024 To Midnight of
Address: E-2 SECOND FLOOR CHARMS STAR, BUILDING NEAR SANAI MANGAL 03/01/2025
KARYALAY,, BAIL BAZAR KALYAN WEST, Thane, 421301, KALYAN,
(Section-II Liability) From 00:00 Hours on 04/01/2024 To Midnight of
MAHARASHTRA, INDIA
03/01/2025
Contact Number: 9321861504
Customer ID:
GSTIN: 27AHKPM9147M3ZI
Place of Supply: MAHARASHTRA
State Code: 27
RTO Location: KALYAN Zone: C Geographical Area: INDIA Hire Purchase / Hypothecation /
Lease With : KOTAK MAHINDRA
BANK LTD
Contract/Loan/Reference No:

Licensed
Registration Make / Model / Body Type/
Engine Number Chassis Number Mfg. Year CC/KW Carrying Capacity
Number Segment
Including Driver
FORCE/TRAVELLER/AMBULANCE
MH05EL3382 D71011046 MC1E1CKAXNP006361 2021 2596 2
2STR/CLOSED/AMBULANCE

Insured Declared Value (IDV) ₹

Electrical
Non Electrical Bi-Fuel / CNG
Vehicle IDV Body IDV Chassis IDV /Electronic Trailer IDV Total IDV
Accessories IDV /LPG Kit
Accessories
1287000 0 1287000 0 0 0 0 1287000

SCHEDULE OF PREMIUM
Section-I OWN DAMAGE (A) Section - II LIABILITY (B)
Own Damage Premium on Vehicle and Accessories Premium Amount Third Party Premium Premium Amount
Basic OD Premium ₹ 10261.25 Basic TP premium ₹ 7267.00
Loadings under Own Damage Section PA Benefits
Add: Cover for lamps, tyres/tubes ₹ 1539.19 PA cover to paid driver-IMT 17 ₹ 60.00
mudguards/Bonnet/side parts-IMT 23 No. of persons:1
Discounts under Own Damage Section SI for paiddriver:100000
Less: No claim bonus (25%) ₹ 2950.11 Legal Liability
TOTAL OWN DAMAGE PREMIUM (A) ₹ 8850.33 Add: Legal liability to paid driver - IMT 28 Number of ₹ 50.00
Section - I ADD ON COVERS persons:1
Add: Repair of glass, plastic, fibre and Rubber (TA 06) ₹ 0 TOTAL LIABILITY PREMIUM (B) ₹ 7377.00
NET PREMIUM (A+B+C) ₹ 16227.00
TOTAL ADD ON PREMIUM (C) ₹ 0
SGST@9% ₹ 1460.00
CGST@9% ₹ 1460.00
TOTAL POLICY PREMIUM ₹ 19147

Drivers Clause: Persons or Classes of Persons entitled to drive : Any of the following : a) The Insured b) Any other person who is driving on the Insured's
order or with his permission. Provided that the person driving holds or had held and has not been disqualified from 158 holding an effective driving license
with all the required endorsements thereon as per the Motor Vehicles Act, 1988 and the rules made there under for the time being in force to drive the
category of motor vehicle insured hereunder.

Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.

TATA AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN :IRDAN108RP0078V01201819
Page 2 of 4
 Auto Secure - Commercial Vehicle Package Policy - Miscellaneous & Special Types Vehicle

LIMITS OF LIABILITY
Under Section II Such amount as is necessary Under Section II - 1 (ii) ₹ 7,50,000 Under Section
- 1 (i) of policy to meet the requirements of of policy (Third Party III :
(Death of or the Motor Vehicles Act, 1988. Property Damage)
bodily injury)

UIN Numbers: IRDAN108RP0005V01200001/A0019V01201213

Deductible Compulsory Deductible: ₹ 6,435.00 No Claim The insured is entitled for a No Claim Bonus (NCB) on the
Under Imposed Excess: ₹ 0.00 Bonus : own damage section of the policy, if no claim is made or
Section I Franchisee: ₹ 0.00 pending during the preceding year(s), as follows: The
preceding year 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 will only be allowed provided
the policy is renewed within 90 days of the expiry date of the
previous policy.

This policy does not cover preexisting damages as per Inspection photographs and Report
Subject to: A) IMT Endorsement Number : IMT 23, IMT 17, IMT 28
B) TATA AIG Auto Secure Endorsement Number (TA) : TA 06

NOMINATION DETAILS
Name of Appointee (If nominee is
Name of the Nominee Relationship with Insured Relationship with Nominee
minor)
NA NA NA NA

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.
In witness whereof this Policy has been signed at THANE on 03/01/2024
Receipt No.(s) : For TATA AIG General Insurance Company LTD.
Consolidated Stamp Duty has been paid to the State Exchequer

GSTIN : 27AABCT3518Q1ZW-MAHARASHTRA
Service Account Code : 997134

Authorized Signatory
Policy Servicing Office: 2ND FLOOR, UNIT NOS. SB-143, 144,145 AND 146, HIGH STREET CUM HIGHLAND CORPORATE CENTRE, KAPURBAWDI JUNCTION, ,
THANE , MAHARASHTRA , 400607

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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed
'AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY'. This policy does not cover pre existing damages as per Inspection photographs and Report.
Note : This Schedule, Policy terms and conditions available on company website 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. You are advised to go through the policy schedule cum certificate of insurance which is issued based on your declaration and if any
error/ discrepancy is found in respect of vehicle details, No Claim Bonus or any other material information, it should be brought to our notice within 15 days of
receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. You may visit company website at
www.tataaig.com for detailed benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 266 7780 in case you
desire to have a printed copy of policy wording. Our grievance redressal procedure and details about ombudsman is also available in our policy wording.
Please note that any misrepresentation, non disclosure or withholding of material facts will lead to cancellation of policy ab initio with forfeiture of premium
and non consideration of claim, if any. We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we receive
confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own damage section of the policy.

Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.

TATA AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN :IRDAN108RP0078V01201819
Page 3 of 4
 Auto Secure - Commercial Vehicle Package Policy - Miscellaneous & Special Types Vehicle

Transcript Letter
1 Name (Registered Owner of the Motor Vehicle)* : LIFEJET CARDIAC AMBULANCE SERVICE
2 Address For Communication* : E-2 SECOND FLOOR CHARMS STAR, BUILDING NEAR SANAI MANGAL KARYALAY,, BAIL BAZAR KALYAN WEST,
Thane, 421301, KALYAN, MAHARASHTRA, INDIA
3 Vehicle Details : Please refer policy schedule cum certificate
4 Fuel Type : DIESEL
5 Insured’s Declared Value : Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number* : OG-23-1909-1811-00000056 Date of Expiry* : 03/01/2024 Type of Cover : Package (1 year OD + 1 Year
Name of the Insurer* : BAJAJ ALLIANZ NCB claimed : NA TP)
Accident in the previous policy period : NA NCB in previous policy : 20
7 Own Damage period of insurance desired from*: 04/01/2024 to Midnight of 03/01/2025
8 Liability period of insurance desired from*: 04/01/2024 to Midnight of 03/01/2025
9 Compulsory PA cover for owner driver period of insurance desired from : NA to Midnight of NA
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) : 1
Legal Liability to Non-Fare Paying Passengers other than Statutory Liability except the Fatal Accidents Act): NA
Compulsory PA Cover for Owner Driver : NA Term : Years
Name of the Nominee & Age: NA, NA Relationship : NA
Name of Appointee (if Nominee is Minor) : NA Relationship to the Nominee : NA
12 Restriction of Cover/Discounts/Concessions/Extended Covers
Third Party Property Damage Cover restricted to 6,000/ only : NO
Vehicle is fitted with Anti Theft Device approved by ARAI : NO
13 Add on covers : Please refer policy schedule cum certificate,
14 Bank Details (Required for Refund / Claims)
Name of the Account Holder : LIFEJET CARDIAC AMBULANCE SERVICE
Name of Bank & Branch :
Account Number : NA IFSC Code of Bank :
15 Declaration for No Claim Bonus : (If NCB Confirmation is not submitted but NCB claimed)
I/We declare that the rate of NCB claimed by me/us is correct and that NO CLAIM has arisen in the expiring Policy Period (Copy of Policy
enclosed). I/We further undertake that if this declaration is found incorrect all benefits under the Policy in respect of Section 1 of the Policy will
stand forfeited.
16 I hereby give my consent to receive one page insurance policy.
17 AML Guidelines:
1. I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of
proceeds of crime related to any of the offence listed in Prevention of Money Laundering Act, 2002.
2. I understand that the Company has the right to call for documents to establish sources of funds.
3. The insurance company has right to cancel the insurance contract in case I am/have been found guilty by any competent court of law under
any of the statutes, directly or indirectly governing the prevention of money laundering in India.

Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.

TATA AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Tollfree Number: 1800 266 7780 Fax: 0226693 8170 Email: [email protected] | Website: www.tataaig.com
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 PAN : AABCT3518Q UIN :IRDAN108RP0078V01201819
Page 4 of 4
 TAX RECEIPT

Transport Department, Government of Maharashtra

Registration Authority KALYAN, Maharashtra

Application No. / Receipt No. : MH240130V0242569 / MH240130C9997561 Vehicle Class: Ambulance

Received From: LIFEJET CARDIAC AMBULANCE SERVICE Payment Date: 2024-01-30 17:31:06.933661

Transaction Date: 30-Jan-2024 05:32 PM Vehicle No: MH05EL3382

Chasis No: MC1E1CKAXNP0XXXXX Bank Reference Number: 403020814110

GRN No: 9906679419025

transaction identification number MHY2401304517882

Rebate+/
Particula Amount(I Penalty(I Surcharg Total(In
Period Exemptio Interest Amount1 Amount2
r n Rs) n Rs) e(In Rs) Rs)
n

MV Tax 01-Feb-2024 to 31-Jan-2025 1200 0.0 0.0 0 0.0 0.0 0.0 1200

Total 0.0 0.0 1200

GRAND TOTAL (in Rs):1200/- (ONE THOUSAND TWO HUNDRED ONLY)

Verify the receipt by clicking Status>>Verify Receipt on Vahan Online Services portal at https://parivahan.gov.in/vahanservice
For further query ,Please go to the zone RTO : KALYAN, Maharashtra

Note::- This is computer generated slip, Signature is not required. Can be verified from QRcode

Note::-** Exemption, if any is added in Rebate column

 Form 59
[See rules 115 (2)]
Pollution Under Control Certificate
Authorised By :
Government of Maharashtra

Date : 30/01/2024
Time : 11:16:43 AM
Validity upto : 29/01/2025

Certificate SL. No. : MH00502290008621

Registration No. : MH05EL3382
Date of Registration : 03/Feb/2022
Month & Year of Manufacturing : October-2021
Valid Mobile Number : ******8908
Emission Norms : BHARAT STAGE VI
Fuel : DIESEL
PUC Code : MH0050229
GSTIN :
Fees : Rs.150.00
(GST to be paid extra as applicable)
MIL observation : No

Vehicle Photo with Registration plate

60 mm x 30 mm

Measured Value
Pollutant (as Units (as
Sr. No. Emission limits (upto 2 decimal
applicable) applicable)
places)

1 2 3 4 5

Carbon Monoxide (CO) percentage (%)

Idling Emissions
Hydrocarbon, (THC/HC) ppm

CO percentage (%)
High idling
RPM RPM 2500 ± 200
emissions
Lambda - 1 ± 0.03

Light absorption
Smoke Density
coefficient
1/metre 0.7 0.55

This PUC certificate is system generated through the national register of motor vehicles and does
not require any signature.

Note : 1. Vehicle owners to link their mobile numbers to registered vehicle by logging to https://puc.parivahan.gov.in

Authorised Signature with stamp of PUC operator

60mm x 20 mm