Auto Secure - Standalone Own Damage Private Car Policy

Renewal Business-TRACKON-1
Date : 08/05/2024

Your Policy Details

Name : MR SANKALP SEN SAXENA

Address : FLAT NO 146, ANKUR APARTMENTS,,IP EXTN,,,DELHI Policy Number : 6201519438 01 00

DELHI,DELHI,110092.

Own Damage Policy Period : From 24/05/2024 to. Midnight of

23/05/2025

Phone No: 8800323974 Premium Paid : `14,928.00

Dear MR SANKALP SEN SAXENA ,

We thank you for reposing your faith in us by renewing your vehicle
insurance policy. Your policy has been renewed as per your advice
and incorporates changes (if any) requested by you.

We are enclosing policy schedule cum certificate of insurance ofyour

vehicle. You can access policy wordings, on our website
www.tataaig.com. 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.

As our valued customer, you will continue to enjoy a host of value

added benefits and give the extra protection that your vehicle needs.

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 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, UIN:IRDAN108RP0001V01201920 Page 1 of 6
 Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent Name : THE FEDERAL BANK LIMITED
Agent License Code : CA0227 Agent Contact No. : 0484 2201710
Policy Number: 6201519438 01 00 Policy Type: Auto Secure-Standalone Own Damage Private Car Policy
Policy Code: 00/01/3184/05
Alternate Policy Number: Q300350072491
Name & Address of Insured Period of Insurance
Name : MR SANKALP SEN SAXENA (Section - I Own Damage) From 00:00 Hours on 24/05/2024 To
Address : FLAT NO 146, ANKUR APARTMENTS,, IP EXTN, , , Midnight of 23/05/2025 .
DELHI,DELHI, DELHI, 110092

Contact Number : 8800323974

Customer Id : 6108435041
GSTIN : ZONE : A
Place of Supply : DELHI Hire Purchase / Hypothecation / Lease With : FEDERAL BANK
Supply Code : 07
RTO LOCATION : DELHI Lessor GSTIN Number :
Geographical Area : India
Contract / loan / Ref No. :

Licensed
Registration Make / Model / Body Engine Chassis Mfg. CC/K Trailer Registration No.
carrying Capacity
Number Type Number Number Year W / Chassis No.
including driver
HYUNDAI/I20 Asta
G4LFMM04686 MALBK512LNM1
22 BH 2 165B 1.2 MT Dual 2022 1197 5
0 37954
Tone/HATCH BACK
Insured Declared Value (IDV) `
Electrical /
Non Electrical Bifuel / CNG /
Year IDV Of Vehicle Electronic Trailer Side car Total IDV
Accessories LPG Kit
Accessories
1 734488 0 0 0 0 734488
SCHEDULE OF PREMIUM
Section - I OWN DAMAGE (A) Section - II ADDONS (B)

Own Damage Premium on Vehicle & NET PREMIUM ` 12,651.00

Accessories IGST @18% ` 2,277.00
TOTAL POLICY PREMIUM ` 14,928.00
Basic OD Premium ` 6,028.31
Road Side Assistance (Inclusive of applicable taxes) ` 136.88
Add: Repair Glass Fiber plastic ` 0.00

Discounts Under Own Damage Section

Less: No claim bonus (25%) ` 1,507.08

TOTAL OWN DAMAGE PREMIUM (A) ` 4,521.12

Section 1 Add On Covers ©

Add: Depreciation Reimbursement (TA 01) ` 1,983.12
Add: Return to Invoice (TA 05) ` 2,570.71
Add: Loss of personal belongings (TA 09) Sum
` 180.00
Insured:10000
Add: Emergency transport and hotel expenses (TA 10)
` 180.00
Any One Accident : 5000 Any One Year : 10000
Add: Key Replacement (TA 15) Sum Insured: 25000
` 425.00
per occurrence limit 50% of SI
Add: Engine Secure (TA 16) ` 954.83
Add: Tyre Secure (TA 17) ` 1,101.73
Add: Consumable expenses (TA 18) ` 734.49

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, UIN:IRDAN108RP0001V01201920 Page 2 of 6
TOTAL ADD ON PREMIUM (C) ` 8,129.88

Motor Third Party Policy Details

TP Cover TP Cover
Certificate & Policy No. Policy Type Insurance Company Name
Start Date End Date
3101921475 PackageComprehensive TATA AIG GENERAL INSURANCE CO.LTD. 24/05/2022 23/05/2025
Drivers Clause: Persons or classes of persons entitled to drive: 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.

Limitations as to Use: The Policy covers use of the vehicle for any purpose other than : a) Hire or Reward other than for the purpose of driving tuitions 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

LIMITS OF LIABILITY
Number of claims covered under Depreciation Reimbursement Cover: 2

Basis of claim settlement for Tyre Secure cover : REPLACEMENT BASIS

UIN Numbers: ,IRDAN108RP0001V01201920/A0007V01201920(TA 08)

Deductible Compulsory Deductible : ` 1,000.00
Under ,IRDAN108RP0001V01201920/A0003V01201920(TA 01)
Section I ,IRDAN108RP0001V01201920/A0005V02201920 (TA 05)
Voluntary Deductible : ` 0.00
,IRDAN108RP0001V01201920/A0008V01201920(TA 09)
,IRDAN108RP0001V01201920/A0009V01201920(TA 10)
Imposed Excess: ` 0.00
,IRDAN108RP0001V01201920/A0010V01201920(TA 15)
,IRDAN108RP0001V01201920/A0012V01201920(TA 16)
Franchisee: ` 0.00
,IRDAN108RP0001V01201920/A0013V01201920(TA 17)
,IRDAN108RP0001V01201920/A0014V01201920(TA 18)
Engine Secure Deductible- 5% of claim amount ,IRDAN108RP0001V01201920/A0015V01201920(TA 19)
in case of repair and 10% of claim amount in case of
replacement

Subject to: A) IMT Endorsement Number : 22 , 07

B) TATA AIG Auto Secure Endorsement Number (TA): 10 , 09 , 15 , 18 , 01 , 16 , 08 , 05 , 17

NOMINATION DETAILS
Name of the Nominee Relationship with insured Name of Appointee (If nominee is minor) Relationship with Nominee
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 MUMBAI on 08/05/2024
Receipt No.(s): 101071072898047 08/05/2024 For TATA AIG General Insurance Company LTD.
Stamp Duty of Rs.0.25/ - is paid as provided under Article 47-B ofIndian
Stamp Act, 1899 and included in Consolidated Stamp Duty Paid to the
Government of Maharashtra Treasury vide Order of Addl. ControllerOf
Stamps, Mumbai at General Stamp Office, Fort, Mumbai - 400001., videthis
Order No. LOA/ENF1/CSD/42/2024/1004 Validity Period Dt.05/02/2024To Authorized Signatory
Dt.24/01/2027/1004 Date:24/01/2024
GSTIN :09AABCT3518Q1ZU UTTAR PRADESH
Service Account Code: 997134

Policy Servicing Office : PLOT NO E-1, 1ST & 2ND FLOOR, SECTOR-8, NOIDA, DISTRICT GAUTAM BUDH NAGAR, NOIDA, UTTAR PRADESH GAUTAM
BUDDHA NAGAR UTTAR PRADESH

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, UIN:IRDAN108RP0001V01201920 Page 3 of 6
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness
certificate, as applicable, on the date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or
fitness Certificate, as applicable, during the subsistence of the Policy. Further, the Company reserves the right to take appropriate action in case
of any discrepancy in the PUC or fitness certificate.

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.

For Policy wordings, please scan the below QR code :

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, UIN:IRDAN108RP0001V01201920 Page 4 of 6
 RECEIPT

Receipt No. 101071072898047 Receipt Date: 08/05/2024

Policy No: 6201519438 01

Received with thanks from MR SANKALP SEN SAXENA a sum of 15065 ( Rupees Fifteen Thousand Sixty-Five And Paise Zero Only )
vide Credit / Debit Card No 9999XXXXXXXX dated 08/05/2024 Name as in credit/debit card - drawn on PAYABLE AT PAR branch towards

Sl.No. Policy Number Total Premium ` Utilized from the receipt for policy ` Balance `

1 6201519438 14,928.00 15,065.00 0.00

Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.

GSTIN: 09AABCT3518Q1ZU UTTAR PRADESH Service Accounting Code: 997134

Revenue (Consolidated) Stamp Duty paid vide challan No. LOA/ENF1/CSD/25/2023/5069 date 18/12/2023 for applicable cases

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, UIN:IRDAN108RP0001V01201920 Page 5 of 6
 Transcript of Proposal for Auto Secure - Standalone Own Damage Private Car Policy

1 Name (Registered Owner of the Motor Vehicle)* : MR SANKALP SEN SAXENA

2 Address For Communication* : FLAT NO 146, ANKUR APARTMENTS,,IP EXTN,,,DELHI,

DELHI,DELHI,110092.

3 Vehicle Details : Please refer policy schedule cum certificate

4 Fuel Type : PETROL

5 Insured’s Declared Value - Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number : 6201519438
Date of inception of OD portion : 24/05/2023
Date of Expiry of OD portion : 23/05/2024
Type of Cover : Standalone Own Damage
Name of the Insurer : TATAAIG
OD claim in previous year (Yes/No) : No
NCB in previous policy : 20
NCB claimed : 0
7 Period of insurance desired from* : 24/05/2024 to midnight of 23/05/2025
8 Financier’s Details: Please refer policy schedule cum certificate

9 Extra Benefits opted

Personal Accident Cover for Owner Damage:
Name of the Nominee : NA Age : RelationShip : NA

Name of Appointee (if Nominee is Minor) :NA Relationship to the Nominee : NA

Battery No :
Charger No :
10 Restriction of Cover/Discounts/Concessions/Extended Covers
Name of Automobile : No Membership no : No
Is Voluntary Deductible opted : No Amount of Deductible opted : 0
Vehicle is fitted with Anti Theft Device approved by ARAI : N/A

11 Add on covers : Please refer policy schedule cum certificate.

12 Bank Details (Required for Refund / Claims)

Name of the Account Holder : Name of Bank & Branch : ,

Account Number : IFSC Code of Bank :

13 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.

14 I hereby give my consent to receive one page insurance policy.

15 AML Guidelines:
1. I/we hereby confirm that all premiums paid / payable in future will be from bonafide sources and not paid out of proceeds of crime and
that such premiums are not disproportionate to my/our income. I / we understand that the Company has the right to call for documents to
establish sources of funds and to cancel the insurance policy in case I / we are found guilty by any competent court of law under any of
the statutes, directly or indirectly governing the prevention of money laundering law in India.
2. I / we are not Politically Exposed Persons * nor are their close relatives. I / we shall keep the company informed if we subsequently
become a Politically Exposed Person.
“Politically Exposed Persons” shall have the meaning assigned to it under sub clause (xii) of 3(b) of Chapter I of Master Direction – Know
Your Customer (KYC) Direction, 2016 issued by Reserve Bank of India (RBI), as amended from time to time
16 We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

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
Page 6 of 6
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0001V01201920