The Oriental Insurance Company Limited

This document is digitally signed

Signer: BALWANT SINGH
Date: Saturday, January 19, 2019 5:12 PM
Location: Pune

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

PCCV-4 wheelers - carrying passengers-capacity NOT > 6
PACKAGE POLICY - ZONE A

Policy No : 131300/31/2019/64100 Prev Policy No : 4214023120187434

Cover Note No : - Cover Note Dt :

Insured's Code : 92618706 Issue Office Code : 131300

Insured's Name : GAYATHRI V (GSTIN: ) Issue Office Name : DO GHATKOPAR (GSTIN:
27AAACT0627R4ZW)
Address : 37, KAIWALYDHAMA BEHIND Address : SHOP ZONE, 5TH FLOOR
NAVDEEP SCHOOL M G ROAD
BASAVANAPURA MAIN ROAD KR
ROAD GHATKOPAR (WEST)
MUMBAI MAHARASHTRA 400086
BANGALORE KARNATAKA 560036

Tel /Fax /Email : / / 9880080888 / Tel /Fax /Email : 022 25021162,9969069579 / 022-
dv.manjunatha1988@gmail.com 25147092 /
131300@orientalinsurance.co.in;shankar
iyer@orientalinsurance.co.in

Local Servicing Office Code : 131300

Local Servicing Office Details : DO : GHATKOPAR, MUMBAI,SHOP ZONE, 5TH

Agent/Broker Details
Dev.Off.Code :
Agent/Broker : LC0000000416 COVERFOX INSURANCE BROKING PVT LTD
Address : AASTHA PLOT NO 71,SECTOR 10A,VASHI,NAVI
MUMBAI,MAHARASHTRA,400703
Tel /Fax /Email : 1800 209 9970//
Period of Insurance : FROM 00:00 ON 20/01/2019 TO MIDNIGHT OF 19/01/2020

Collection No & Dt : 3 9241078544 - 19/01/2019 GST INVOICE NO :271711251785 UIN :0

Gross Premium : 15,633 GST : 2,814 Stamp Duty : .5 Total : 18,447
Geographical Area : IND Area Extension :

Particulars of Insured Vehicle:

Registration Engine No. & Type Of Body Year Of Seating Cap Cubic
Mark & Place Chassis No. Make - Model Manf. (incl Driver) Capacity
G.V.W

KA 53 B 7560 101510 MARUTI SWIFT SEDAN 2015 4 + 1 1248

K.R.Puram RTO - 479025 DZIRE TOUR

Limitations as to Use
The Policy covers use only under a permit within the meaning of the Motor Vehicle Act 1988 or such a carriage falling under

Place : MUMBAI For and on behalf of

Date : 19/01/2019 The Oriental Insurance Company Limited

This is an electronically generated document (Policy

Schedule).The Policy document duly stamped will be sent by
post. Shri. Balwant Singh
In case of any query regarding the Policy please call Toll General Manager
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 The Oriental Insurance Company Limited

Attached to and forming part of policy number 131300/31/2019/64100

FLOOR,M G ROAD,GHATKOPAR (WEST),,,022

25021162,9969069579,9969069579,131300@ori
entalinsurance.co.in;shankariyer@orientalinsura

Sub-section 3 of Section 66 of the Motor Vehicles Act 1988.

Driver's Clause
Any person including 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 when not used for the transport of passengers at the time of accident and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

Limit of Liability
Under Section II-1(i) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-1 (ii) in respect of any one claim or series of claims arising out of one event is Rs. 0
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 1500000

Insured's Declared Value (IDV)

For the For Trailers Non Electrical Electrical Value of CNG Total Value
Vehicle Accessories Accessories LPG Kit

3,50,000 3,50,000

Nominee Name Age Relationship

SCHEDULE OF PREMIUM

A. OWN DAMAGE B. LIABILITY

BASIC OD COVER 12,068.00 ADD :BASIC TP COVER 10,667.00

LESS :Discount 8,448.00 BASIC TP TOTAL 10,667.00
BASIC OD TOTAL 3,620.00 ADD :PA FOR OWNER DRIVER-GR36A 320.00
ADD :ADD-ON COVER NIL 4,827.00 TP TOTAL 10,987.00
DEPRECIATION POLICY TOTAL PREMIUM 15,633.00
OD TOTAL 8,447.00 ADD :IGST 2,814.00
LESS :NO CLAIM BONUS-GR27 3,801.15 STAMP DUTY 0.50
MOTOR TOTAL OD 4,646.00 TOTAL AMOUNT 18,447.00

* NCB discount - 45 %

Deductibles under Section-I : Compulsory Deductible 500

Subject to IMT Endorsement Printed herein/attached to : IMT-22 , IMT-36 , OIC-1:Nil Depreciation Cover
IMPORTANT NOTICE

Place : MUMBAI For and on behalf of

Date : 19/01/2019 The Oriental Insurance Company Limited

This is an electronically generated document (Policy

Schedule).The Policy document duly stamped will be sent by
post. Shri. Balwant Singh
In case of any query regarding the Policy please call Toll General Manager
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 2 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 The Oriental Insurance Company Limited

Attached to and forming part of policy number 131300/31/2019/64100

nce.co.in

Details of IMT Endorsements are also available on the Company¿s Web Portal www.orientalinsurance.org.in

Hypothecation Agreement with: -

Hire Purchase/Lessor Agreement with: -

In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured
will comply with the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as
well as company's website.
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC
endorsements mentioned herein above which are available on Company's website: www.orientalinsurance.org.in or
on demand from the policy issuing office
WARRANTED THAT AT NO TIME THE GROSS LADEN OF WEIGHT OF THE VEHICLE EXCEEDS THE GROSS
VEHICLE WEIGHT MENTIONED IN THE SCHEDULE OF THE POLICY.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).

I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in
accordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act, 1988.
25% will be deducted from Claim Amount in the absence of Spot Survey.

No claim is admissible if driving license is found fake or is not valid,whether or not in the knowledge of the insured.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at
DO GHATKOPAR (GSTIN: 27AAACT0627R4ZW) on 19-JAN-19
The Insured is not Indemnified if the vehicle is used or driven otherwise than in accordance with thisSchedule.Any payment
made by the Company by reason of wider terms appearing in the Certificate in order to comply with the MVAct, 1988 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

For and on behalf of

Entered By :
The Oriental Insurance Company Limited
Examined By :

Policy Printed By : PRTL IP Shri. Balwant Singh

General Manager
Policy Printed On : 19-JAN-19 17:13:54 MAC :
Authorised Signatory

Place : MUMBAI For and on behalf of

Date : 19/01/2019 The Oriental Insurance Company Limited

This is an electronically generated document (Policy

Schedule).The Policy document duly stamped will be sent by
post. Shri. Balwant Singh
In case of any query regarding the Policy please call Toll General Manager
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 3 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in