Date : 11/09/2019

Policy No.: 2019-V6566559-FTW

Mr. HARISH M
#2988/A,4TH CROSS,8TH MAIN,
ROAD,KUMARSWAMY LAYOUT,
2ND STAGE,
BANGALORE,
KARNATAKA, Pincode: 560078
Intermediary Name : GANESH V.-IAG

Dear Mr. HARISH M

Welcome to the Future Generali Experience.

We thank you for choosing Motor Secure insurance policy. Your Policy No. is 2019-V6566559-FTW. Motor Secure policy offers your
vehicle and yourself protection against any unforeseen vehicle accidents and loss to third party property or life arising there from as per
the coverage mentioned in the attached policy terms and conditions. We request you to kindly go through the same to acquaint yourself
with the available coverage.
Our initiatives will provide you with the highest standards of service, convenience and quality in motor insurance.
In the unfortunate circumstances of an accident, you may notify us for a claim by sending an SMS MOTORCLAIM to 9222211100
(Standard SMS charges applicable) or by calling us at 1800-220-233/ 1860-500-3333/ 022-67837800 or email us at
fgcare@futuregenerali.in or walk into any of our nearest offices.
It will always be our endeavour to constantly better your experience by innovating and evolving our basket of conveniences. We strive to
deliver service which is personalized and is totally transparent. It is our aim to be with you in your time of need.

The policy has been issued on the basis of the information provided by you. The extract of the information has been enclosed for your
reference. we would request you to peruse the policy and satisfy yourself that it requirement fully.

Please note : Transfer of benefits under this insurance policy is not automatic on the sale of the vehicle. The transferee must apply
within 14 days from the date of transfer of vehicle in writing to the insurance company with full details in a duly signed fresh proposal
form along with evidence of sale and transfer fees of ₹. 50/- + Goods and Service tax .

Once again, thank you for choosing to insure your vehicle with Future Generali and we look forward to being of service to you.
Assuring you of our best services at all times.

If undelivered, please return to:

Future Generali India Insurance Company Limited For Future Generali India Insurance Co. Ltd.
3rd and 4th Floor, # 31
Shravanee Krishna Mansion
100 Feet Road, 2nd Block
Jayanagar, Bangalore (Authorised Signatory)
Karnataka, 560011

Please review the communication address, email or contact nos. noted on this letter for correctness. In case of any change please contact our
nearest branch or call our care lines mentioned above. This will ensure you do not miss out on 'Service Updates' and 'Renewal Reminders'.
Now you can buy Health, Personal Accident, Travel, Home, Motor insurance & also renew your Future Generali Private Car Insurance policy
online. Visit us at www.futuregenerali.in
For any service request please sms SERVE to 9222211100. To provide feedback on our service, kindly sms HAPPY or UNHAPPY to
9222211100. We will call you back.
Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Tax Invoice

INSURED DETAILS
Policy Number : 2019-V6566559-FTW Address of Service Provider : Off Code-13,Future Generali India Insurance Co
Ltd, 3rd and 4th Floor, # 31, Shravanee Krishna
Mansion, 100 Feet Road, 2nd Block, Jayanagar,
Invoice Number : 201929PNT0031550
Bangalore, Karnataka, Pincode - 560011

Reverse Charge : No Area Code : Bangalore Branch Office

Name of Insured/Proposer : Mr. HARISH M FGI State Code : 29
Address : #2988/A,4TH CROSS,8TH MAIN, FGI GSTIN Number : 29AABCF0191R1Z5
ROAD,KUMARSWAMY LAYOUT, 2ND
STAGE, BANGALORE, KARNATAKA, Pincode-
560078
Place of Supply(State Code): 29 Intermediary Name \ Code : GANESH V. \ 60027949
GSTIN / UIN Number : - Date of Issue / Invoice : 11/09/2019
Date
Period of Insurance : From 17:46 hours of 11/09/2019 HSN : 997134
To Midnight of 10/09/2020 Nature of Service : General Insurance Service

Received with thanks from HARISH M a sum of ₹ 2,248.00 towards Premium on the above mentioned policy.

PARTICULARS TAX(%) PREMIUM ( ₹ )

Gross Premium 1,905.00
Add : CGST 9% 171.45
Add : SGST 9% 171.45
Add : Cess -
Total (Rounded to nearest rupee) 2,248.00

NOTE :
1. In case of payment by cheque, in the event of dishonour of cheque for any reason whatsoever,insurance cover provided under this receipt automatically stands
cancelled from the inception irrespective of whether a seperate communication is sent or not.
2. Excess amount, if any, will be adjusted against subsequent policies, or will be refunded on demand.

For FUTURE GENERALI INDIA INSURANCE CO. LTD.

(Authorised Signatory)

Signature Not Verified

Digitally signed by DS Future
Generali India Insurance Co.
Ltd.
Date: 2019.09.11 17:46:17 IST
Location: Mumbai
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 11/09/2019

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Future Secure Motor Insurance Policy- PACKAGE
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989
Policy Servicing : Off Code-13,Future Generali India Insurance Co Ltd, 3rd and 4th Floor, # 31, Shravanee Krishna Mansion,
Office 100 Feet Road, 2nd Block, Jayanagar, Bangalore, Karnataka, Pincode- 560011., Tel_No: 080-42630600
Policy No. : 2019-V6566559-FTW Period of Insurance : From 17:46 hrs of 11/09/2019 To
Insured : Mr. HARISH M Midnight of 10/09/2020.
Address : #2988/A,4TH CROSS,8TH MAIN, Covernote No : - Dated: Zone: A
ROAD,KUMARSWAMY Intermediary Name/Code : GANESH V. / 60027949
LAYOUT, 2ND STAGE, Telephone(Mob,Hom) : 9980424653/9980424653
BANGALORE, KARNATAKA, Email ID : ganesh9458@gmail.com
560078
GSTIN Number : - FGI GSTIN Number : 29AABCF0191R1Z5
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No., Make/Model of Vehicle Engine No. Chassis No.
RTA Location
KA05JV6861 TVS APACHE RTR 180 OE6GG2127112 MD634KE63G2G60411
BANGALORE
Year of Manufacture Cubic Capacity Type of Body Seating Premium
Capacity
2016 180 BIKE 2 2,248.00
TP Policy Insurer Name :
TP Policy No : -
TP Policy Period : - To -
DRIVERS CLAUSE :- 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 Learner’s License may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central
Motor Vehicles Rules, 1989.
LIMITATIONS AS TO USE - As per Motor Vehicle Rules, 1989 :- 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) Organized racing, d) Pace making, e)
Speed testing, f) Reliability Trials, g) Any purpose in connection with Motor Trade.
Geographical Area : INDIA
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.
For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this
schedule.
Not with standing anything mentioned herein to the contrary it is agreed and declared that the cover under this policy does not
extend to those parts mentioned as damaged /scratched /dented noted in the photographs/inspection report number
13-IMD-090919-940715 dated 09/09/2019
IMPORTANT - 1) All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2) In case of payment by
cheque, in the event of dishonor of cheque for any reason whatsoever, insurance cover provided under this document
automatically stands cancelled from the inception irrespective of whether a seperate communication is sent or not.
LIMITS OF LIABILITY
Under Section II-I (i) : Death of or bodily injury - Such amount Under Section II-I (ii) : Damage to Third Party Property- ₹
as is necessary to meet the requirements of Motor Vehicles Act, 100000 /- in respect of any one claim or series of claims arising
1988 out of one event.
Under Section III : PA Owner – Driver as per premium Compulsory DeductibleUnder Sec I - ₹ 100.00
computation table
Hypothecation Agreement with:- NIL
SPECIAL CONDITIONS – NIL
ADDITIONAL EXCESS – NIL
The nominee for Compulsory PA to owner driver cover is 01) LEGAL HEIR, aged :21 Years, Relationship : Legal Executor,
Nomination % : 100%

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Policy No : 2019-V6566559-FTW Period Of Insurance : From 17:46 hrs of 11/09/2019 To Midnight of 10/09/2020
INSURED'S DECLARED VALUE
For Vehicle-₹ For Non Elec For Side Car-₹ For Elec Accessories- For Bi-Fuel Kit Total Value-₹
Accessories - ₹ ₹ (CNG/LPG) - ₹
42,598 - - - - 42,598
SCHEDULE OF PREMIUM
PARTICULARS ₹ ₹
A-OWN DAMAGE
Basic Premium on Vehicle 381.89
Total Own Damage Premium (A) (rounded off) 382.00
B-LIABILITY
Basic Premium including Premium for TPPD 1,193.00
Add : Compulsory PA to Owner-Driver Rs. 15 lacs 330.00
Total Liability Premium (B) 1,523.00
Total Annual Premium (A+B) 1,905.00
Total Premium for the Policy Period 1,905.00
Goods and Service Tax 342.90
Total Premium (rounded off) 2,248.00
Class of Vehicle: Two Wheelers Subject to Endorsement Nos. 22 ,15 ,
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.
For FUTURE GENERALI INDIA INSURANCE CO. LTD.

Receipt No :
Date of Issue : 11/09/2019
Place of Issuance : Mumbai*

*Address as mentioned below ( Authorized Signatory )

Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 11/09/2019
For registration of your Motor Claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable)
The stamp duty of Rs. 0.50/- paid by Letter Of Authorisation No. CSD/109/2019/3891/19, dated 09/08/2019. Mudrank -
2017/C.R.97/M-1,dated 09/01/2018.

Product UIN : IRDAN132P0016V01200708

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Dear HARISH M,

We wish to inform you that the Insurance policy number V6566559 has been issued on the basis of the information and
declaration given by you, the transcript whereof is mentioned below. In case of any disagreement or objection or any changes
with respect to information mentioned below, we request you to please revert back within a period of 15 days from date of your
receipt of this transcript or the policy start date whichever is earlier, failing which it will be deemed that you are satisfied with
the correctness of the details mentioned below. Please be informed that this Policy shall be construed to be void ab initio/invalid
in the event we find that you have not disclosed material or correct information required for the purpose of providing the below
insurance cover and in case of any claim arising under the policy in such a scenario, we shall be under no obligation whatsoever
to settle such claim to you and the premium paid by you under this policy shall stand fully forfeited.
Future Secure Motor Insurance Policy - TRANSCRIPT/DECLARATION
Sr No Insured Details
1 Insured Name HARISH M
2 Registration address of the Insured #2988/A,4TH CROSS,8TH MAIN, ROAD,KUMARSWAMY
LAYOUT, 2ND STAGE, BANGALORE, KARNATAKA,
560078
3 Communication address of the Insured #2988/A,4TH CROSS,8TH MAIN, ROAD,KUMARSWAMY
LAYOUT, 2ND STAGE, BANGALORE, KARNATAKA,
Pincode :- 560078
4 Residence Telephone no
5 Mobile no
6 Email id
Policy Details
7 Policy Number V6566559
8 Risk start time and date 11/09/2019/17:46
9 Risk end date 10/09/2020
10 Renewal NCB % 0%
Vehicle Details
11 Make and Model of vehicle insured TVS APACHE RTR 180
12 Registration No KA05JV6861
13 Engine No OE6GG2127112
14 Chassis No MD634KE63G2G60411
15 Cubic Capacity 180
16 Year of Manufacturing 2016
17 RTO where vehicle is/will be registered BANGALORE
18 Seating Capacity 2
19 Date of Registration / Purchase 03/08/2016
20 Usage of the vehicle TW
21 Fuel Type Petrol
Previous Insurance Details
24 Previous Insurer Name
25 Expiring Policy No
26 Expiring Policy Expiry Date
27 No Claim Bonus % under expiring policy 0.00 %
28 Is there any claim in expiring policy -
IDV Details
29 Vehicle IDV on Renewal ₹.42,598
30 Electrical Accessories IDV ₹.0
31 Non Electrical Accessories IDV ₹.0
32 CNG IDV ₹.0
33 Add on Plan Not Applicable
Third Party Coverages Opted
34 Basic Premium including Premium for TPPD Opted
35 Add:-Trailers Not Opted
36 Less : Limit of Liability under sec II-1(ii)-₹. 6000 Not Opted
37 Add : Bi-Fuel Kit (CNG/LPG) Not Opted
38 Add : Geographical Area Extn Not Opted

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 39 Add : Compulsory PA to Owner-Driver ₹. 15 lacs Opted
40 Add : PA to persons other than Owner/Driver (No. of Not Opted
persons 0)PA Limit ₹.0 per person.
41 Add : PA to Drivers/Cleaner/Conductors (No. of Not Opted
persons 0) PA Limit ₹ 0 per person.
42 PA to Named Persons other than Owner Driver As per Opted
Annexure attached
43 Add : Legal Liability to Paid Not Opted
Driver/Cleaner/Employees (No. of persons 0)
44 Add : Legal Liability to (No. of persons 0) Not Opted
45 Add : Increased Limit of Liability under sec II-1(ii)-₹. Not Opted
7.5lacs
Own Damage Coverages Opted
46 Basic Premium on Vehicle Opted
47 Add : Non-Electrical Accessories Not Opted
48 Add : Electrical/Electronic Accessories Not Opted
49 Add : Bi-Fuel Kit (CNG/LPG) Not Opted
50 Add : Trailers Not Opted
51 Add : Geographical Area Extn Not Opted
52 Add : Embassy Loading Not Opted
53 Add : Fibre Glass Tanks Not Opted
54 Add : Driving Tutions Not Opted
55 Add : Rallies Not Opted
56 Less : Anti Theft Not Opted
57 Less : Vehicles Specially Designed/Modified For Not Opted
Handicapped Persons
58 Less : Use confined to own premises Not Opted
59 Less : Automobile Association Membership Not Opted
60 Less : Vintage Car Not Opted
61 Less : Voluntary Deductible-₹. 0 Not Opted
62 Add : Add-on Premium Not Opted
Nominee Details
63 Nominee Name LEGAL HEIR
64 Nominee Relationship with Insured Legal Executor
65 Nominee Age in Y or M 21Y
66 Nominee % 100
67 Appointee Name -
68 Relationship of Appointee with Nominee -
In case of Disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please
contact our Help Line numbers & register your objections/changes/disagreement to the contents of this transcript or you may also
send us email or written correspondence at the below address within a period of 15 days from date of receipt of this transcript or
the policy start date whichever is earlier.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 ENDORSEMENTS
(Attached to and forming part of policy)

IMT.15. PERSONAL ACCIDENT COVER TO THE INSURED

OR ANY NAMED PERSON OTHER THAN PAID
DRIVER OR CLEANER
(Applicable to private cars Including three wheelers rated as private cars
and motorized two wheelers with or without side car [not for hire or reward])
In consideration of the payment of an additional premium It rs hereby agreed and
understood that the Company undertakes to pay compensation on the scale
provided below for bodily Injury as hereinafter defined sustained by the insured
person in direct connection with the vehicle insured or whilst mounting and
dismounting from or traveling in vehicle Insured and caused by violent accidental
external and visible means which independentlyof any other cause shall within six
calendar months of the occurrence of such Injury result In:-
Details of Injury Scale of Compensation
i) Death 100%
ii) Loss of two limbs or sight of two eyes or one 100%
limb and sight of one eye
iii) Loss of one limb or sight of one eye 50%
iv) Permanent Total Disablement from 100%
injuries other than named above
Provided always that :-
(1) compensationshall be payable under only one of the items (i) to (iv) above In
respect of any such person arising out of any one occurrence and total liability of
the insurer shall not in the aggregate exceed the sum of Rs.........*during any one
period of insurance in respect of any such person.
(2) no compensation shall be payable in respect of death or Injury directly or
indirectly wholly or in part arising or resulting from or traceable to (a) Intentional
self Injury suicide or attempted suicide physical defect or infirmity or (b) an
accident happening whilst such person Is under the influence of Intoxicating liquor
or drugs.
(3) Such compensation shall be payable only with the approval of the insured
named in the policy and directly to the injured person or his/her legal
representative(s) whose receipt shall be a full dischargeIn respect of the Injury
of such person.
Subject otherwise to the terms exceptions conditions and limitations of this policy.
*The capital Sum Insured (CSI) per passenger is to be inserted.
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/constructivetotal loss) the first Rs……* (or any less expenditurewhich 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 ….** of this policy.
If the expenditure incurred by the insurer shall include any amount for which the
insured is responsiblehereunder such amount shall be repaid by the insured to the
insurer forthwith.
For the purpose of this Endorsementthe 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.
* (i) to insert amount as appropriate to the class of vehicle insured as per GR. 40
of the tariff.
(ii) in respect of a vehicle rated under the Tariff for Private Car and in respect of a
motorised two wheeler not carrying passengersfor hire or reward, if any deductible
in addition to the compulsorydeductibleprovided in this endorsementis voluntarily
borne by the insured, the sum representingthe aggregate of the compulsory and the
voluntary deductibles is to be inserted.
** to insert Condition no 3 in respect of a vehicle rated under Tariff for Private Car
/ Two wheelers or Condition no 4 in respect of a vehicle rated under the Tariff for
Commercial Vehicles.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287