(A joi nt venture between Al l ahabad Bank, Sompo Japan Ni pponkoa Insurance Inc.

, Indi an Overseas Bank, Karnataka Bank and Dabur Investments)

30/01/2020 USGI LOCATION: FARIDABAD BRANCH OFFICE

M/S DURGA BUILDWELL PVT LTD MARKETING OFFICIAL: MANISH SHARMA
SEC 110
INTERMEDIARY CODE: 201000676838
BHATTA COLONY
NOIDA NOIDA. INTERMEDIARY NAME: GHULAM AHMAD RAZA
NOIDA 201003
UTTAR PRADESH
LOAN A/C:
MOBILE NO: 9560832684

*2374/59756404/00/000*
Subject: RENEWAL NOTICE FOR POS GOODS CARRYING PACKAGE POLICY
Dear Sir/ Madam, Policy No- 2374/59756404/00/000

We wish to inform you that your captioned Policy is falling due for renewal on: 11/04/2020
The details of the risk covered in the above Policy is given over leaf.

The Premium Payable for the renewal, given overleaf may be remitted to us by Cheque / DD before the expiry of this
Policy to maintain continuity of your insurance.

The renewal coverage is based on your current claim status, which may alter in case of any claim lodged on us before expiry of
the current Policy.

The premium cited overleaf will be subject to review in event of a claim lodged after the date of issuance of this Renewal Notice.

Thanking you for placing your trust and confidence in Universal Sompo General Insurance Co. Ltd. and assuring you of our best
attention at all times.

In case of any query or clarification contact our executive / your insurance agent or our call centre.

This is computer generated letter and does not require signature

Renew the Policy with same terms and conditions.

Payment Details as under:

Cheque/ Demand Draft Number (Drawn on Universal Sompo General Insurance Co.Ltd.):
Dated

Drawn on Bank:

For Amount: Rs
You may place online payment link request to us on epay@universalsompo.com or call us at our call centre.
My Mobile / Telephone Number is :
My PAN Card Number is :
My G.S.T Number is :

Note: The premium instrument may be handed over with this Renewal Notice to Our Branch Office/your Insurance
Broker/Agent. You may alternatively courier the premium instrument and Renewal Notive duly signed to the following
address:

Universal Sompo General Insurance Co. Ltd. (Renewal Section)

Plot No: EL 94, T. T. C. Industrial Area,
Mahape, Navi Mumbai - 400710
OR
For any changes/ corrections in the policy and/ or to discuss the rates/ terms/ conditions/ coverage before renewing the Policy
to know about other products offered by Universal Sompo General Insurance Co. Ltd. Please contact us at our Call Centre.

Signature of the Insured Policy No:- 2374/59756404/00/000

Toll Free Number: 1 – 800 –224030 or 1 – 800 – 2004030

Landline Number: (022) - 27639800 or (022) - 39133700 (Local Charges Apply)
Fax Number: (022) 39171419 E-mail Address: renewalcontactus@universalsompo.com or contactclaims@universalsompo.com

IRDAI Registration No. 134 UIN NO. IRDA/USG/22/2008-09/LR/01

(A joi nt venture between Al l ahabad Bank, Sompo Japan Ni pponkoa Insurance Inc., Indi an Overseas Bank, Karnataka Bank and Dabur Investments)

POLICY NUMBER 2374/59756404/00/000 NAME M/S DURGA BUILDWELL PVT LTD POL END DATE 11/04/2020
PRODUCT POS GOODS CARRYING PACKAGE POLICY
VEHICLESUBCLASS: A2.D PRIVATE CARRIERS OTHER THAN 3 WHEELERS EXC 20000KG NOT EXC 40000KG
PARTICULARS OF VEHICLE INSURED

REGISTRATION CHASSIS ENGINE MAKE MODEL YOM BODY GVW ZONE NCB %
NUMBER NUMBER NUMBER TYPE (Kgs)

PB-13-BE-9975 MBYBA0163EAA3 31M84138582 ASIA MOTOR AMW 2518. 2014 OPEN 25000 C 20
3135 WORKS LTD (AMW )
TRAILER TYPE NUMBER OF TRAILERS 0.00
INSURED'S DECLARED VALUE (Rs.)

BASE VALUE TRAILER NON ELEC ACCESSORIES ELEC ACCESSORIES FIBER TANK CNG/LPG IDV

1,315,560.00 0.00 0.00 0.00 0.00 0.00 1,315,560.00

FINANCIAL INTEREST: :

PREMIUM COMPUTATION (Rs.)

BASIC OWN DAMAGE PREMIUM 19,810.00
TOTAL OWN DAMAGE (INCL. ACCESSORIES AND EXTENSIONS) AFTER LOADING/DISCOUNT 6,835.00
IMT 23 2,972.00
NO CLAIM BONUS -1,367.00
TOTAL OWN DAMAGE AFTER NCB 5,468.00
BASIC THIRD PARTY 17,476.00
LEGAL LIABILITY: PAID DRIVER 50.00
LEGAL LIABILITY: CELANER/CONDUCTOR/COOLIES 100.00
TOTAL LIABILITY PREMIUM 150.00
NET PREMIUM 23,094.00
GST** 3,108.00
RENEWAL PREMIUM 26,202.00
SPECIAL CONDITION: ROADSIDE ASSISTANCE INCLUDED IN THIS POLICY.Toll Free Nos-1800 209 6678/+91 044 6110 9918

*As per IRDAI circular No IRDAI/NL/CIR/MOTP/200/2018 dated 11/12/2018 if you choose to opt for the CPA cover as part of Liability policy or the Package policy it exists
today, you can continue to do so by paying the premium mentioned in this renewal notice. If you want to choose to take stand-alone CPA policy, the CPA cover offered in this
renewal notice shall be deleted on production of proof of such stand-alone CPA Policy or proof of having Individual Personal Accident Policy having Sum Insured of Rs 15,00,000/-
and above covering death and PTD Risk effective as on date.

**12% G.S.T on Basic Third Party Component and 18% G.S.T. on Other Component.
Note:- Kindly submit your a valid PUC Certificate along with premium on renewal of the insurance policy.

Please provide the below details mandatorily

NOMINEE NAME: RELATION WITH INSURED:

VEHICLE REG. NO: ENGINE NO: CHASSIS NO:

PUC NO: PUC CENTRE: PUC EXPIRY DATE:

NCB DECLARATION LETTER (To be field by the Insured)

I/We declare that the rate of NCB claimed by me/us is ____% during renewal of above mentioned policy number and that no claim has arisen in the expiring Policy during period from
_______________ to _______________.
I/We undertake that if this declaration is found to be incorrect submitted documents are fake all benefits under the policy will stand forfeited.
Yours faithfully, Name................................
Insured Signature..............
Note: This renewal notice contains two pages
Place.................................

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Scan this QR Code to Pay your renewal premium. S
2
3
7
4
Premium Payable Rs.26202/-

Toll Free Number: 1 – 800 –224030 or 1 – 800 – 2004030

Landline Number: (022) - 27639800 or (022) - 39133700 (Local Charges Apply)
Fax Number: (022) 39171419 E-mail Address: renewalcontactus@universalsompo.com or contactclaims@universalsompo.com

IRDAI Registration No. 134 UIN NO. IRDA/USG/22/2008-09/LR/01