Date : 28/01/2018

Ganapathi Manoj
Flat G5 Prime Habitat Building
Eswar Villas Gate right side
Eswar Villas Road
Nizampet, Hyderabad 500090

Dear Ganapathi Manoj,

RENEWAL NOTICE FOR YOUR MOTOR POLICY NO. S8568480

Thank you for insuring your motor vehicle with Bharti AXA General Insurance Co. Ltd.

We wish to inform you that your SMART Motor Two Wheeler Policy no. S8568480 is up for renewal on 10/02/2018. The premium due on renewal
is INR 1060 inclusive of taxes.

Your Vehicle Details

Vehicle Make and Model Year of Manufacture Registration No
HONDA MOTORS-ACTIVA-HON273 2012 AP09CN4038
5 Easy ways to renew your policy
Mobile Email Id Website Advisor Call Us
Pay by clicking on the Pay by clicking on the
Renew on www.bharti- Reach out to your Call us on 1800
link received on your link received on your
axagi.co.in Agent/Dealer 103 2292 (Toll-free)
registered mobile number. registered email id.
Details of your Advisor
Advisor Name Advisor ID Advisor Contact Number
2C000002

The details of your premium are given below. The mentioned premium will apply only in case there is no change in the information provided before the
expiry of the policy.

In case of expiry you will need to arrange for pre-inspection of your vehicle. We do recommend that you complete the renewal process at the earliest
and definitely before the lapse of your policy.

Thank you for being our valued customer and we look forward to hearing from you.

Yours Truly,
For Bharti AXA General Insurance Co. Ltd. (IRDA Regn. No.139)
This is a computer generated letter. No signature is required.

Important Note

The premium amount is computed based on the criteria mentioned below:

1. The premium quote is based on the claim experience under the current policy as on date of generation of this renewal Notice.
2. If any claim is reported subsequently, No-Claim-Bonus benefit will not be applicable and premium is subject to change.
3. In case, the renewal instruction is received by us later than 10/02/2018, acceptance of the vehicle would be subject to satisfactory inspection and
underwriting guidelines effective on the date of receipt of instruction.
4. Kindly check your vehicle details and policy details before signing the document/s and return the document/s to our representative along with the
premium payment.
5. Kindly issue the cheque/DD in favour of “Bharti AXA General Insurance Co. Ltd.” If you have any further enquiry or need any details on our
other products please call our customer care number . 1800 103 2292 (toll free)

Insurance is the subject matter of solicitation

 DETAILS OF YOUR POLICY
HONDA MOTORS-ACTIVA-
Make and Model Registration No AP09CN4038
HON273
Year of Manf 2012 Regn Location/Zone AP08/ B
CC/Tonnage 109/ B Chassis No ME4JC448KC7604881
Seating Capacity/LCC 2 Engine No JC44E5605142
Coverage COMPREHENSIVE Financing Institution Hypothecation - -
Vehicle /Non Elec.Acc.IDV INR 22108 IDV Trailer/Side Car INR 0.000000
Electrical Accessories IDV INR 0 Bi Fuel Kit IDV INR 0
Kindly submit RC Book copy for changes to be made in the above mentioned Vehicle details. And letter from Financier in case of any change in the Financing Institution
Proposed Correction/ Changes on Renewal
Depreciated IDV INR 22108 Basic TP Premium INR 720
Basic Premium INR 389 Comp PA to Owner Driver INR 50
Electrical Accessories Premium INR 0 PA to Passengers INR 0
Bi Fuel Kit Premium(CNG/LPG) INR 0 Legal Liability to Paid Driver INR 0
Geographical Extn Premium INR 0.000000 Liability for bi fuel Kit INR 0
Fibre Glass Premium INR 0 Geographical Extn Premium INR 0.000000
Trailer OD Premium INR 0.000000 Trailer/Side car TP Premium INR 0.000000
Own Premises Premium INR 0 Restricted TPPD INR 0
IMT-23 Premium INR 0 LL to NonFare INR 0
AAI Discount Premium INR 0 Legal Liability to Others INR 0
Overturning Premium INR 0 Total Liability Premium INR 770
Voluntary excess Premium INR 0 Total:- OD and TP Premium INR 898
Anti Theft Discount INR 0
Handicapped Discount INR 0
NCB Percentage 45%
NCB Amount INR 175
Total OD Premium INR 128

Premium (in Rs.)

Add On 0.00

GST 162.00
Total Premium Payable 1060.00
Proposed insurance period (In case of break in insurance) from: time _________ am/pm Date ____________ to midnight on_________________.
ADDITIONS (IF ANY)
I/We wish to include the below mentioned Accessories/Coverage to my renewal policy. All the accessories stated by me are already installed by me/us
in the vehicle
Description Details Sum Insured Premium

PARTICULAR CHANGES
Change in Communication Address
Residence Telephone no: Office Telephone no:
Mobile no: Email ID:
PAYMENT DETAILS
Cheque/DD No. Date
INSURED BANK ACCOUNT DETAILS
A/C no: Bank Name IFSC Code
Branch Name, Contact no and Address:

I/We acknowledge receipt of the renewal notice in respect of my Motor Policy and agree to renew the said policy for one calendar Year as per the
details provided herein. I/We hereby declare that the information provided above is true and correct
CC: 0 Date:
CA: 0 Place: Signature of the Insured