POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Policy Number: 915101004849920000

Name of Insured: Mrs. POOJA SWARUP.
Address: ., 111/6 SEC-1, PUSHP VIHAR, DELHI, DELHI, Delhi, Delhi - 110017
Business or Profession:

Agency Name: Direct

Agency Code:Nil
Contact Number: Nil

Telephone / Mobile No.: 9958643513

Email Id:
Period of Insurance: From 00:00 o clock on 27/03/2015 to midnight on 26/03/2016.

VEHICLE DETAILS
Registration Mark &
Place of Registration

DL 10 CC 1527
DL-10 North West Delhi-II: Rohini

Engine No.
CFW243431
Chassis No.
WVWA12607CT027851
Make
VOLKSWAGEN
Vehicle Model & Variant
POLO, 1.2 DIESEL COMFORTLINE
Fuel Type
Diesel
Body Type
Limitation 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. Organised 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 the policy Death of or bodily injury Such amount as is
necessary to meet the requirements of the Motor Vehicles Act, 1988
Under Section II-1 (ii) of the policy Damage to Third Party Property: Rs. 7.5 lakhs.
Personal Accident Cover under Section III for Owner Driver (CSI): 200,000.00
Compulsory Deductible under section I: 1000.00
Voluntary Deductible: 0
Imposed Deductible:
Receipt No.
: 9600051386314
Service Tax Registration No.
: AABCL5045NSD001
PAN Number
: AABCL5045N
Category
: General Insurance Business Services
Stamp Duty of Rs 0.50 has been paid vide receipt 1016 dated 10/04/2012

Financier Type
Financier Name
Cubic Capacity
1199
Manufacturing Year
2012
Seating Capacity (Including Driver)
5
Cover Type
Package
Geographical Area:
India
Automobile Association Membership No
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 learners license may also drive the vehicle and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
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 table:
Period of Insurance
% of NCB on OD premium
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.

INSUREDS DECLARED VALUE

For the Vehicle
385,200.00

For Trailers
0.00

Non Electrical Accessories

0.00

Electrical/ Electronic Accessories

0.00

Value of CNG/ LPG kit

0.00

Total Value
385,200.00

PREMIUM SCHEDULE
A. Own Damage
Basic Own Damage Premium
Depreciation Waiver (LT01)

Amount (`)
7,318.82
4,784.18

B. Liability
Basic Premium with Full TPPD
Personal Accident to Owner Driver
Legal Liability Paid Driver

Amount (`)
1,332.00
100.00
50.00

Total Liability Premium (B)

NET PREMIUM (A+B)
SERVICE TAX & EDUCATION CESS
POLICY PREMIUM
Subject to I.M.T. End. Nos. & Memorandum IMT 22, IMT 28 LT-01, Printed/ herein/ attached hereto under
The Policy terms & conditions can be downloaded from the official site of L&T General Insurance Co. Ltd. i.e www.ltinsurance.com.
Total Own Damage Premium (A)

Nominee Details:

1,482.00
13,585.00
1,679.00
15,264.00

12,103.00

(a) Name of the Nominee & Age: SUSHANT MOHAN SAXENA 29

(b) Relationship: HUSBAND

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 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 RIGHTS OF RECOVERY
In the event of non realisation of cheque, the policy shall be cancelled 'ab initio' & the Company shall not be responsible for any liabilities of whatsoever nature under this policy.
I/We hereby certify that the policy to which the certificate relates as well as the certificate of Insurance are issued in accordance with the provisions of Chapter X & XI of
M.V.Act 1988.
Issued At: Delhi Branch Date: 23/03/2015 Policy Issuing Office: Mumbai
For L&T General Insurance Company Limited,
Servicing Branch Address: Delhi Branch, 6th Floor DCM Building 16, Barakhamba Road, New Delhi-110001 Ph: 011-66664038

Authorized Signatory

Policy Number: 915101004849920000

IMT.22. Compulsory Deductible

(Applicable to Private Cars, three wheelers rated as private cars, all motorized two wheelers, taxis, private car type vehicle plying for public/private hire, private type taxi
let out on private hire)
Notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insured shall bear under Section 1 of the policy in respect of
each and every event (including event giving rise to a total loss/constructive total loss) the first Rs. 1,000.00 (or any less expenditure which may be incurred) of any
expenditure for which provision has been made under this policy and/or of any expenditure by the insurer in the exercise of his discretion under Condition no 3 of this
policy .
If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such amount shall be repaid by the insured to the insurer
forthwith.
For the purpose of this Endorsement the expression "event shall mean an event or series of events arising out of one cause in connection with the vehicle insured in
respect of which indemnity is provided under this policy.
Subject otherwise to the terms conditions limitations and exceptions of this Policy.

IMT.28. Legal Liability to Paid Driver and/or Conductor and/or Cleaner Employed in Connection with the Operation of Insured Vehicle (Vehicle NOT Used for Hire or
Reward)
In consideration of an additional premium of Rs. 50/- notwithstanding anything to the contrary contained in the policy it is hereby understood andagreedthatthe insurer
shall indemnify the insured against the insureds legal liability under theWorkmen'sCompensation Act,1923, the Fatal Accidents Act, 1855 or at Common Law and subsequent
amendments of these Acts prior to the date of this Endorsement in respect of personal injury to any paid driver and/or conductorand/or cleaner whilst engaged in the
service oftheinsured in such occupation in connectionwiththevehicle insured herein and will in addition be responsible for all costs and expenses incurred with its written
consent.
Provided always that
(1) this Endorsement does not indemnify the insuredin respect of any liability in cases where the insured holds or subsequentlyeffects with any insurer or group of insurers a
Policy of Insurance in respect of liability as herein defined for insureds general employees
(2) the insured shall take reasonable precautions to prevent accidents and shall comply with allstatutoryobligations
(3) in the event of the Policy being cancelled at the requestof the insured no refund of the premiumpaidin respect of this Endorsement will be allowed.
Subject otherwise to the terms conditions limitations and exceptions of the Policy except so far as necessary to meet the requirements of the Motor Vehicles Act, 1988.
LT -01 DEPRECIATION WAIVER
In consideration of the payment of an additional premium it is hereby understood and agreed that L & T General Insurance Company Ltd. undertakes to pay the amount
deducted towards the depreciation on replacement of parts if depreciation waiver is mentioned in the policy schedule and, if claim under Section I (Own Damage) of my
asset: Private Car Package Policy is valid and admissible.
Special conditions:
1) The benefits can be utilized for a maximum of two admissible claims during the policy period.
2) This benefit will not be used to change each and every part of the vehicle under my asset: Private Car Package Policy. The irreparability of part(s) will be decided by the
Surveyor/analyst as approved by LTGICL and not by You or the Repair Shop/Garage.
3) If the vehicle is not repaired at our tied up workshop, 10% of the payable amount under this cover will further be deducted. However, the discretion to waive the
deduction lies with LTGICL.
Exclusion(s):
We will not be liable for
1) Where a loss is covered with any other manufacturers warranty or recall campaign or under any other such packages at the same time
2) Any excess mentioned in my : asset Private Car Package Policy
Subject otherwise to the terms, exceptions, conditions and limitations of this policy.