Auto Secure ­ Private Car Package Policy

Date : 07/11/2023

Name : MR VISHVENDRA KATARIA

Your Policy Details :
Address : HOUSE NO­176,
Policy Number : 3101680483
KHATANA FARM HOUSE DAFA MOHALLA KHERLA(177)
BHONDSI ­ 122102 Own Damage Policy Period: From 30/11/2023 to. Midnight Of 29/11/2024
GURGAON
Liabiliity Policy Period: From 30/11/2023 to. Midnight Of 29/11/2024
HARYANA
INDIA PA Cover to Owner Driver Policy Period: From 30/11/2023 to. Midnight
Of 29/11/2024
Premium Paid : 24,162.00

Dear MR VISHVENDRA KATARIA,

Welcome to Tata AIG General Insurance Company Limited’s family & we thank you for
choosing our Auto Secure ­ Private Car Package Policy for your vehicle insurance.

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

We would like to inform you that 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 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, thank you once again, for choosing Tata AIG General Insurance Company Limited for
insuring your vehicle. We assure you of our best of services at all times. Happy driving!
QRCode
Sincerely,
For Tata AIG General Insurance Company Limited

Authorized Signatory

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
 ^Premium mentioned covers Self and Family and is Inclusive of All Applicable Taxes, Conditions apply.

#Premium mentioned is Inclusive of All Applicable Taxes, Conditions apply.

*Tax benefit under section 80D of Income Tax Act 1961. Tax benefits are subject to changes in tax laws. If one purchases a health insurance policy for self/spouse/children, he/she can claim a tax deduction of
upto 25000. When one purchases a health insurance policy for parents (a senior citizen), he/she is eligible for an additional tax deduction benefit upto 30000.

Purchase of Tata AIG General Insurance Company Limited products are purely on voluntary basis. 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 Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
 Accident Guard Policy UIN: IRDA/NL­HLT/TAGI/P­P/V.I/195/13­14 MediPrime UIN:IRDA/NL­HLT/TAGI/P­H/V.I/34/13­14 Homesecure (Householders) Instachoice Policy for health component i.e. Personal
Accident cover UIN: 53/IRDAI/HLT/TAGI/NL­PACKAGE/2015­16

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
 Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent Name: RITU KUMARI
Agent License Code: AIG9404P; Agent Contact No.: 9555582121(mobile or landline)
Policy No.: 3101680483 Policy Code: 02/00/3184/02 Policy Type:
Auto Secure ­ Private Car Package Policy
Alternate Policy Number: Covernote No: Covernote Issuance Date:
Name & Address of Insured Period of Insurance
Name : MR V I S H V E N D R A K A T A R I A (Section ­ I Own Damage) From 00:01 Hours on 30/11/2023 To Midnight o f 29/11/2024
Address : HOUSE NO­176,
KHATANA FARM HOUSE DAFA MOHALLA KHERLA(177) (Section ­ II Liability) From 00:01 Hours on 30/11/2023 To Midnight o f 29/11/2024
BHONDSI ­ 122102
GURGAON (Section ­ III PA cover for owner driver) From 30/11/2023 To Midnight of 29/11/2024
HARYANA
INDIA
Place of supply ­HARYANA
State code ­06

Contact Number : 8979392707

Customer ID : 6098390887
GSTIN :
RTO Location: G U R G A O N Zone : B Geographical Area : India Hire Purchase / Hypothecation / Lease With: N/A

Licensed
carrying
Registration Make/Model/Body Trailer Registration
Engine No. Chassis No. Mfg. Year CC/KW Capacity
No. Type No. / Chassis No.
including
driver
HYUNDAI/CRETA / VTVT 1.6 SX
HR 72 D 4707 AT/ G4FGJU531574 MALC381CMJM493094 2018 1591 5
SUV
Insured Declared Value (IDV)
Bi­
IDV of Non­Electrical Electrical / Electronic
Year Fuel/CNG/LPG Trailer Side car Total IDV
Vehicle Accessories Accessories
Kit
1 686281 0 0 0 0 0 686281
SCHEDULE OF PREMIUM
Section ­ I OWN DAMAGE (A) Section ­ II LIABILITY (B)
Own Damage Premium on Vehicle & Accessories Third Party Premium
Basic OD Premium 5,735.59 Basic TP premium 7,897.00

PA Benefits
TOTAL OWN DAMAGE PREMIUM (A) 5,735.59 One Year Compulsory PA Cover for Owner Driver 1,500,000.00 375.00

Section ­ I ADD ON COVERS (C) Legal Liability

Add : Loss of personal belongings (TA 09) Sum Insured : 10,000.00 135.00 Add : Legal Liability to paid driver (IMT 28) Number of persons : 1 50.00
Add : Depreciation Reimbursement (TA 01) 5,833.39
Add : Emergency transport and hotel expenses (TA 10) TOTAL LIABILITY PREMIUM (B) 8,322.00
135.00
Any One Accident : 5000 Any One Year : 10000
Add : Key Replacement (TA 15) Sum Insured: 25,000.00 per occurrence limit 50% of SI 315.00 NET PREMIUM(A+B+C) 20,476.00
TOTAL ADD ON PREMIUM (C) 6,418.39 IGST @18 % 3,686.00

TOTAL POLICY PREMIUM 24,162.00

Road Side Assistance 136.88

(Inclusive of All Applicable Taxes)

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
Under Section II ­ 1 (i) of Such amount as is necessary to meet the Under Section II ­ 1 (ii) of 7,50,000 Under Section III : O n e 1,500,000.00 /­ Number of claims covered under
policy (Death of or bodily requirements of policy (Third Party Year Compulsory PA Cover for Depreciation Reimbursement
injury) the Motor Vehicles Act,1988. Property Damage) Owner Driver Cover :2

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
 Basis of claim settlement for
Tyre Secure cover :0
Deductible Under Section Compulsory Deductible : 2,000.00 UIN Numbers: IRDAN108RP0002V01200001/A0001V01200910
I Voluntary Deductible : 0.00 , IRDAN108RP0002V01200001/A0005V01200910
Imposed Excess : 0.00 , IRDAN108RP0002V01200001/A0054V01201819
Franchisee : 0.00 , IRDAN108RP0002V01200001/A0055V01201819
, IRDAN108RP0002V01200001/A0056V01201819
Subject to: A) IMT Endorsement No.: 22,28
B) TATA AIG Auto Secure endorsement No.(TA): 01, 08, 09, 10, 15
NOMINATION DETAILS
Name of the Nominee Relationship with Insured Name of Appointee (If nominee is minor) Relationship with Nominee
MRS NEHA Wife

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 NOIDA on 07/11/2023
Receipt No.(s): 101071060043382 , 07/11/2023

Stamp Duty of 0.25/ ­ is paid as provided under Article 47­B of Indian Stamp Act, 1899 and included in Consolidated Stamp Duty Paid to the Government of Maharashtra For TATA AIG General
Treasury vide Order of Addl. Controller Of Stamps, Mumbai at General Stamp Office, Fort, Mumbai ­ 400001., vide this Order No. LOA/CSD/01/2023/4269 Validity Period Insurance Company LTD.
Dt.26/10/2023 To Dt.04/10/2026/4269 Date:25/10/2023

GSTIN : 09AABCT3518Q1ZU ­ UTTAR PRADESH Authorized Signatory

Service Account Code: 997134
Policy Servicing Office : PLOT NO E­1, 1ST & 2ND FLOOR, SECTOR­8,, NOIDA, DISTRICT GAUTAM BUDH NAGAR,,GAUTAM BUDDHA NAGAR,UTTAR PRADESH,BISRAKA­201301, Tel No:91­91­7400412159, Fax No:91­
91­7400412161
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.tataaiginsuarance.in 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.

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat
Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
 RECEIPT

Receipt No. : 101071060043382 Receipt Date : 07/11/2023

Policy No : 3101680483

Received with thanks from MR VISHVENDRA KATARIA a sum of 24,299.00 ( Rupees Twenty Four Thousand Two Hundred Ninety Nine And Paise Zero Only) vide Card no.
XXXXXXXXXXXX9999

Utilized from the receipt

Sr. Policy
Total Premium ( ) for Balance ( )
No. Number
policy ( )
1 3101680483 24,162.00 24,299.00 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 duly paid vide challan No.LOA/CSD/47/2023/2581 date 22/05/2023 for applicable cases.

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
1. Name (Registered Owner of the Motor Vehicle)*: MR VISHVENDRA KATARIA

2. Address for Communication* : HOUSE NO­176,

KHATANA FARM HOUSE DAFA MOHALLA KHERLA(177)
BHONDSI ­ 122102
GURGAON
HARYANA
INDIA

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*: 3101680483 Date of Expiry*: 29/11/2023 Type of Cover: Package

Name of the Insurer*: TATAAIG

Accident in the previous policy period: No NCB in previous policy: 0 NCB claimed: 0

7. Own Damage period of insurance desired from*:30/11/2023 to midnight of 29/11/2024

8. Liability period of insurance desired from*:30/11/2023 to midnight of 29/11/2024

9. Compulsory PA cover for owner driver period of insurance desired from:30/11/2023 To Midnight of 29/11/2024

10. Financier’s Details: Please refer policy schedule cum certificate.

11. Extra Benefits opted

Un­Named Persons Personal Accident Cover for seating capacity, including driver: CSI N/A

Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) : N/A

One Year Compulsory PA Cover for Owner Driver : 1,500,000.00 /­

Name of the Nominee & Age: MRS NEHA 18 Relationship: Wife

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

12. Restriction of Cover/Discounts/Concessions/Extended Covers

Automobile association membership opted: No

Third Party Property Damage Cover restricted to 6,000/ only: No

Is Voluntary Deductible opted NO Amount of Deductible opted : N/A

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: MR VISHVENDRA KATARIA

Name of Bank & Branch:N/A , N/A Account Number:N/A IFSC Code of Bank: N/A

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 Section­1 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.

18. We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat
Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q UIN No : IRDAN108RP0002V01200001
TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]
 Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]

TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai­ 400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425, PAN : AABCT3518Q, UIN No : IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 1800­266­7780 E­mail: [email protected]