IRDAI Regn No - 137

Signature Not Verified

This Document is Digitally Signed
Signer : RANJAN KUMAR SAHOO
Date : 3/6/2020 3:47:09 PM
Reason:Signing Policy For SGI

CERTIFICATE CUM POLICY SCHEDULE

GCCV-PUBLIC CARRIERS OTHER THAN THREE WHEELERS PACKAGE POLICY - ZONE C
CIN No. U66010RJ2006PLC029979

MOTOR COMMERCIAL VEHICLE (PACKAGE POLICY) - UIN NO. IRDAN137RP0018V01200809 - SAC Code. 997134
Issue Office: 334027 - Address:- 1st Floor, 53A, Rafi Ahmed Kidwai Road, Kolkata-700016-KOLKATA WEST BENGAL 700016 Tel 7412078317 /
7412078318 / 7412078319
Policy No : 334027/31/20/010302 Prev Policy No - Geographical Area INDIA
Insured's Code/ Name: 124315168 MR.MD ISHTIAQUE
Address: 21/B RAFI AHMED KIDWAI ROAD,NEW BASTI KAMARHATI KAMARHATI
KOLKATA-KOLKATA WEST BENGAL 700058
Executive: NA0000006273 Broker Details / W.A. :LC0000000180 M/S.INVICTUS INSURANCE BROKING SERVICES PVT. LTD. / / Contact
No: 18002660101
Period of Insurance : From 00:00 on 31/03/2020 To Midnight of 30/03/2021 Prop No. - Issue date
Gross Premium: 17,366 GST:2182 Cess : 0 Total: 19,548

Registration Engine No Make - Model Type of Body / Cubic Seat Cap

Date Of Regn /
Capacity/
Mark & Place Chassis No Fuel Type Year of Manf G. V. W Delivery (IncL Driver)
WB 23 E 0837 S20638 TATA MOTORS-ACE HT BS 4 PICKUP 1550 03-05-17 1+1
Public Vehicle B09577 DIESEL 2017
Department
Trailer Registration No. :

IDV For the IDV For Non Electrical Electrical IDV of CNG/LPG KIT SI Total Value
Vehicle Trailers Accessories Accessories side car
2,66,780 0 0 2,66,780

SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY
OD TOTAL 1,205.00 BASIC TP COVER 15,746.00
TOTAL PREMIUM 17,366.00 ADD :GR36A-PA FOR OWNER DRIVER 315.00
ADD :CGST 6 % 945.00 ADD :LL TO PAID CLEANER COUNT : 1 50.00
ADD :SGST 6 % 945.00 ADD :LL TO PAID DRIVER COUNT : 1 50.00
ADD :CGST 9 % 146.00 TP TOTAL 16,161.00
ADD :SGST 9 % 146.00
FINAL PREMIUM 19,548.00
* NCB discount - 35 % Previous Policy : OG-19-3379-1803-00000598 - Previous Insurer : Bajaj Allianz General Insurance Company
Limited Nominee PA for Owner/Driver : Md Mustaque- Age : 52 - Relationship : FATHER - Appointee Name : NA - Appointee
Relationship : NA
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association, Voluntary Excess, Anti-Theft, Handicap Person, Driver Tuition, Fibre Glass,
CNG/LPG Unit, Geographical Extn, Imported Vehicle etc wherever applicable)
Deductibles under Section-I : COMPULSORY DEDUCTIBLE Rs.500
Subject to IMT Endorsement Printed herein/attached to : IMT-21,IMT-23,IMT-28,IMT-40
Hypothecation Agreement with:

Hire Purchase/Lease Agreement with:

-
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. 750000
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 1500000
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 goods at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules,
1989.
Limitations as to Use
Use Only For Carriage Of Goods Within The Meaning Of The Motor Vehicles Act. The Policy Does Not Cover: 1) Use For Organised Racing, Pace-Making, Reliability Trial Or Speed Testing.
(2) Use Whilst Drawing A Trailer Except The Towing (Other Than For Reward) Of Any One Disabled Mechanically Propelled Vehicle. (3) Use For Carrying Passengers In The Vehicles;
Except Employees (Other Than The Driver) Not Exceeding The Number Permitted In The Registration Document And Coming Under The Purview Of Workmen'S Compensation Act 1923.
The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor Vehicle's Act 1988
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms attached.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.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at KOLKATA

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 MVAct, 1988 isrecoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION.

Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.
In case of Claims/Grievance, Please contact us at: Toll Free No - 180030030000, 18001033009 Email id - chd@shriramgi.com

For and on behalf of

SHRIRAM GENERAL INSURANCE COMPANY LTD

Place : KOLKATA
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the expiry date of your
policy. If you do not want us to contact you, kindly send an e-mail for the same on dnd@shriramgi.com

Authorised Signatory
All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be ***DIGITALLY SIGNED
GSTIN No. - 19AAKCS2509K1Z0 considered as delayed intimation.
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 IRDAI Regn No - 137

Attached to and forming part of policy number 334027/31/20/010302

For NEFT/RTGS/IMPS or any other online payment kindly visit our website " www.shriramgi.com"
CIN No. U66010RJ2006PLC029979

For and on behalf of

SHRIRAM GENERAL INSURANCE COMPANY LTD

Place : KOLKATA
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the expiry date of your
policy. If you do not want us to contact you, kindly send an e-mail for the same on dnd@shriramgi.com

Authorised Signatory
All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be ***DIGITALLY SIGNED
GSTIN No. - 19AAKCS2509K1Z0 considered as delayed intimation.
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