3

MAGMA HOUSE, 24 Park Street , Kolkata -700016

(www.magma-hdi.co.in)

Date : 24/07/2013

To,
PANKAJ GUPTA

GUPTA NIWASGANGA ASHRAM

466001,
SEHORE,
MADHYA PRADESH.

Agent/ Intermediary Name and Code:LANDMARK INSURANCE BROKERS PVT LTD BRC0000011

Dear Mr. PANKAJ GUPTA

(Customer ID: 20000137234)

We extend our warm welcome to you as an esteemed customer of Magma HDI General Insurance Co Ltd.

At the outset, we wish to thank you for choosing Magma HDI as your preferred insurer and subscribing to MHDI Motor
Policy. Your policy No is P0014200013/4103/172838.

We hope that this is beginning of a long term relationship, because we aim to provide services of highest quality
constantly to our customers so that we continue to be the preferred insurance provider year on year.

In case of any queries, please call us on 1-800 - 3002 - 3202 or write to us at customercare@magma-hdi.co.in and we
shall get back to you at the earliest.

Assuring you of our best services at all times.

Best Regards

For Magma HDI General Insurance Co Ltd.

Authorised Signatory

3
 3

MAGMA HOUSE, 24 PARK STREET , KOLKATA -700016

COMMERCIAL VEHICLE CLASS (GCV) PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
Policy Servicing Office MAGMA FINCORP LTD T-5, III FLOOR, CITY CENTER ABOVE VISHAL MEGA MART ZONE I, M.P. NAGAR, BHOPAL (M.P.) 462011 BHOPAL- 462011
BHOPAL - 462011 MADHYA PRADESH
PH: FAX:
Policy No P0014200013/4103/172838 Period Of
From 00:00 Hrs of 24/07/2013
Geographical Area India Insurance
Insured PANKAJ GUPTA To Midnight of 23/07/2014
Address GUPTA NIWAS GANGA ASHRAM Agent No BRC0000011
466001 SEHORE MADHYA PRADESH
Business / Profession None Covernote No
Contact Number 9300641486 Covernote Date
PG/IR No. Zone Zone-C
Carrying on or engaged in the business or occupation of and no other for the purposes of this Insurance
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & Year of Public/Private Licensed Carrying
Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW
No. Manufacture Carrier capacity including Driver
MP - 37 - GA -
2012 404856 XD5805 ASHOK LEYLAND/2516 TIPPER/TIPPER 25000 Private Carriers 2
0926
IDV (INSURED'S DECLARED VALUE)
Non Electrical Electrical/electronic Other
IDV of Chassis IDV of Body Trailers Bi-Fuel kit(LPG/CNG) Total Value
Accessories Accessories accessories
1915000 200000 0 0 0 0/0 0 2,115,000.00
A-OWN DAMAGE B-LIABILITY
Own Damage Premium on vehicle and accessories Third Party Premium
Basic Cover Basic Cover
Basic - OD 21,794.40 Basic - TP 11,470.00
DISCOUNTS UNDER OWN DAMAGE SECTION PA Benefits
No claim bonus 20% 4,358.88 Compulsory pa to owner-driver - 2 lacs 100.00
TOTAL OWN-DAMAGE PREMIUM 17,436.00 Legal Liability
Under WC act-Driver/cleaner/employees-IMT 28 100.00
TOTAL LIABILITY PREMIUM 11,670.00
TOTAL POLICY PREMIUM 29,106.00
Service Tax(Including education cess & higher education cess) 3,597.50
TOTAL 32,704.00
Hire Purchase/ Lease /Hypothecated with HDFC BANK LTD
LIMITATIONS AS TO USE - THE POLICY COVERS USE ONLY UNDER A PERMIT WITHIN THE MEANING OF THE MOTOR VEHICLES ACT, 1988 OR SUCH A CARRIAGE FALLING UNDER
SUB-SECTION 3 OF SECTION 66 OF THE MOTOR VEHICLE'S ACT 1988.
The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing a trailer except the
towing (other than for reward) of any one disabled Mechanically propelled vehicle (only for Passenger Carrying Vehicles).
Persons or classes of
persons entitled to Any person including Insured:
drive:
Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a
Goods carriage license.Provided also that the person holding an effective learner's license may also drive the vehicle when not used for the transport of passengers at
the time of the accident and that such a person satisfies the requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.
Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a
Non-transport
license.Provided also that the person holding an effective learner's license may also drive the vehicle when not used for the transport of passengers at
Vehicles
the time of the accident and that such a person satisfies the requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY
Under Compulsory excess in Under In respect of any one Under Section Damage to Third Party Property Rs. Under PA Owner – Driver as per
Section I respect of each and Section II accident -- As per II-I (ii) 750000/- in respect of any one claim or Section III: premium computation table
every claim under Sec I -I (i) Motor Vehicle Act series of claims arising out of one event.
of motor policy : Rs.
1500/-
Subject to I.M.T Endorsement Nos. IMT 7,IMT 21,IMT 28,IMT 42
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Address of Nominee Relationship Percentage
MRS GUPTA 11/08/1984 28 WIFE 100
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 case of Claims, please contact us at 1-800 - 3002 - 3202 For Magma HDI General Insurance Co. Ltd.

Date of Issue : 24/07/2013

Place : Kolkata
Consolidated Stamps Duty on the issue of General Insurance Policies paid vide G.O. No 1598- F.T. dated 27/9/2012

Service Tax Registration no : AAGCM1685CSD001 Authorised Signatory

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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS
AND RIGHT OF RECOVERY". For legal interpretation English version will be good.

3
 3

RECEIPT

Receipt Number PIS/200013/14/100075581

Receipt Date 24/07/2013
Business Channel

Received with thanks from PANKAJ GUPTA

(Customer ID : 20000137234) a total sum of Rupees Thirty-Two Thousand Seven Hundred Two Only

Instrument Type Instrument No. Date Bank Name Branch Name Amount
CHEQUE 069394 23/07/2013 STATE BANK OF INDIA sehore 32,702.00

Total Amount Rs.32,702.00

Note:

* The insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy as detailed in Policy Document.

* Receipt is Subject to realisation of cheque(s)

For & on behalf of

Magma HDI General Insurance Company Ltd.

Authorised Signatory