CertificateOfInsuranceandPolicyScheduleForm51oftheCentralMotorVehicleRules,1989

Agent/Broker/ProducerName:DIRECT
Agent/BrokerLicenseCode:2Agent/BrokerContactNo.:24*7TollfreeHelpline18002667780/
1800119966*(*TollfreefromMTNL/BSNLlinesonly)
Certificate&PolicyNo.:
PeriodofInsurance:

010083833400
From00:00Hrson29/09/2015

PolicyType:
DateofExpiry

AutoSecurePrivateCarPackagePolicy
Tomidnightof28/09/2016

InsuredName&Address:
MRSANDEEPSURESHBORSE
1003STEEPESVASANT,
PLAWANSOFF,EEHIGHWAY
THANE400601
MAHARASHTRA

Premium(Incl.S.Tax)
Occupation:
GeographicalArea:
RegistrationAuthority:
HPA/Hyp/Leaseto:

15,359.00
OTHER
India
Nashik
HDFCBANKLTD

RegistrationNo.

Make&Model

EngineNo.

ChassisNo.

CC

Mfg.Year

BodyType

Seating
Capacity

MH15CT1340

SKODALAURA1.8TSI
AMBIENTE

CDA147232

TMBLKJ1Z1AA154920

1798

2010

SALOON

IDVofnonbuiltinAccessories( )

IDVofVehicle
()

IDVofSideCar
()

BiFuel/CNG/LPG
Kit( )

Electrical

NonElectrical

659,478.00

0.00

0.00

0.00

0.00

TotalInsured
Declared
Values(IDV)( )
659,478.00

SCHEDULEOFPREMIUM

A.OWNDAMAGE
PremiumonVehicleandnonelectricalaccessories

B.LIABILITY
11,023.17 Basic

Less:25%forNCB

2,755.79 Add:CompulsoryPACoverforOwnerDriver 2,00,000

A.TOTALOWNDAMAGEPREMIUM

8,267.38 Add:LegalLiabilitytopaiddriverasper(IMT28)

C.TOTALADDONPREMIUM

4,931.00
100.00
50.00

0.00 PAcovertounnamedpassengers(IMT16)No.ofPassengers:5CSIper
passenger 50,000.00
B.TOTALLIABILITYPREMIUM

125.00
5,206.00

COMPREHENSIVEPREMIUM(A+B+C)

13,473.38

NETPREMIUM

13,473.00

Add:14%ServiceTax
TOTALPREMIUM

1,886.00
15,359.00

DriversClause:Personsorclassesofpersonsentitledtodrive:Anypersonincludingtheinsured.Providedthatapersondrivingholdsaneffectivedrivinglicenseatthetime
oftheaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.ProvidedalsothatthepersonholdinganeffectiveLearner'sLicensemayalsodrivethevehicle
andthatsuchapersonsatisfiestherequirementsofRule3oftheCentralMotorVehiclesRules,1989.
LimitationsastoUse:ThePolicycoversuseofthevehicleforanypurposeotherthan:a)HireorRewardb)Carriageofgoods(otherthansamplesorpersonalluggage)c)
Organizedracingd)PaceMakinge)Speedtestingf)ReliabilityTrialsg)AnypurposeinconnectionwithMotorTrade
LimitsofLiability:UnderSectionII1(i)ofpolicy(Deathoforbodilyinjury):Suchamountasis I/weherebycertifythatthePolicytowhichthisCertificaterelatesas
necessarytomeettherequirementsoftheMotorVehiclesAct,1988.
wellasthisCertificateofInsuranceareissuedinaccordancewith
UnderSectionII1(ii)ofpolicy(ThirdPartyPropertyDamage): 7,50,000.00
provisionsofChapterXandXIofMotorVehiclesAct,1988.
UnderSectionIII:PAtoOwnerDriverCSI: 200,000.00
InwitnesswhereofthisPolicyhasbeensignedatMUMBAIon
Nominee:PRANALIAge:41Relationship:Wife
25/09/2015
DeductibleUnderSectionI: 2,000.00(CompulsoryDeductible: 2,000,VoluntaryDeductible: 0, ForTataAIGGeneralInsuranceCompanyLTD.
ImposedExcess: 0)Franchisee:
NoClaimBonus:TheinsuredisentitledforaNoClaimBonus(NCB)ontheowndamagesectionofthe
policy,ifnoclaimismadeorpendingduringtheprecedingyear(s),asfollows:Theprecedingyear
20%,,precedingtwoconsecutiveyears25%,precedingthreeconsecutiveyears35%,precedingfour
consecutiveyears45%,precedingfiveconsecutiveyears50%ofNCBonODPremium.NCBwillonlybe AtriChakraborty
allowedprovidedthepolicyisrenewedwithin90daysoftheexpirydateofthepreviouspolicy.
NationalHeadOperations&Systems
Subjectto:A)IMTEndorsementNo.:07,16,22,28
B.TATAAIGAutoSecureendorsementNo.(TA):08
ServiceTaxRegistrationNo:AABCT3518QST004
StampDuty 0.25paidvideChallanNo:dated
PolicyServicingOffice:Mumbai,A6,6thFloor,TradeWorld,KamalaMillsCompound,SenapatiBapatMarg,LowerParel,Mumbai400013,TelNo:02266382333,Fax
No:02266382390
IMPORTANTNOTICE
TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisSchedule.AnypaymentmadebytheCompanybyreasonofwiderterms
appearingintheCertificateinordertocomplywiththeMotorVehiclesAct,1988isrecoverablefromtheInsured.Seetheclauseheaded"AVOIDANCEOFCERTAINTERMS
ANDRIGHTOFRECOVERY".
Note:ThisSchedule,theattachedPolicyandEndorsementsmentionedhereinaboveshallreadtogetherandwordorexpressiontowhichaspecificmeaninghasbeen
attachedinanypartofthisPolicyoroftheScheduleshallbearthesamemeaningwhereveritmayappear.Anyamendments/modifications/alterationsmadeonthissystem
generatedpolicydocumentisnotvalidandCompanyshallnotbeliableforanyliabilitywhatsoeverarisingfromsuchchanges.Anychangesrequiredtobemadeinthepolicy
onceissued,wouldbevalidandeffective,onlyafterwrittenrequestismadetotheCompanyandCompanyacceptstherequestedamendments/modifications/alterationsand
recordsthesamethroughseparateendorsementtobeissuedbytheCompany.

Insuranceisthesubjectmatterofthesolicitation.Formoredetailsonriskfactors,termsandconditions,pleasereadsalesbrochurecarefullybeforeconcludingasale.
TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:customersupport@tataaig.com