The Certificate of Insurance Page 1 of 3

ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R107197072 / 10-Mar-2020
Policy No. & Type 11839325 Period of Insurance 11-Mar-2020 to 10-Mar-2021
Policy Issued On 10-Mar-2020 (00:00) Vehicle Identification No. MBHCZC03SJA108262
Insured Name M/S Shubh Motors Pvt Ltd Geographical Area INDIA
Invoice No R107197072 Accounting Code of Service 997134
B-663, OPP. MAHANADDA, MADAN MAHAL,
Insured Address
JABALPUR-482001, Madhya Pradesh
Insured State & Code Madhya Pradesh-23 Place of Supply Madhya Pradesh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 580521
Model & Variant MARUTI NEW SWIFT ZDI+/MARUTI SWIFT ZDI+ Non Electrical Accessories 0
Registration No MP20CH1745 Electrical Accessories 0
Year of Manufacture 2018 CNG/ LPG Kit 0
Engine- Chassis No 3221505 - MBHCZC03SJA108262 Total IDV 580521
Cubic Capacity 1248
Seating Capacity 5
Type Of Body Saloon
RTO Location MP20CH1745 / JABALPUR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 17044 Basic Third Party Liability 3221
Third Party Liability for Bi-fuel Kit 0
Elec. Accessories 0
Compulsory PA Cover Premium [0 Year] 0
Non- Elec. Accessories 0 PA Cover for 5 Person of Rs (100000) each (IMT- 16 ) 250
Kit (IMT-25) 0 Legal Liability (WC) to Driver (IMT-28) 50
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Legal Liability to Employees (IMT-29) 0
Basic Premium 17044
Legal Liability to Passenger (IMT 46) 0
Geographical Area Extn. (IMT-1) NA Driving Tuition Loading On TP Premium (60%) NA
Lamp, Tyres etc. (IMT 23) 0 Net Liability Premium (B) 3521
Total Premium (A+B) 27105
Driving Tuition Loading On OD Premium (60%) NA
IGST @18% 4878.90
Fiber Glass Tank 0 Gross Premium Paid 31984
Sub-Total Additions 0
MISP - Shubh Motors Pvt Ltd, JABALPUR
Deductibles
Voluntary Deductibles (IMT 22A) 0
Notes :
Anti-Theft Device (IMT-10) 426
AAI Membership (IMT-8) 0 1. Policy Issuance is the subject to the realisation of cheque.
No Claim Bonus 0 0 2. Consolidate stamp duty paid to State Exchequer
3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Discount for vehicles designed for handicapped NA 4. Voluntary excess Rs (0)
Sub - Total Deductibles 426 5. Subject to Endorsements IMT ,7 10, 28, 16,

Add - On Coverages
DEPRECIATION WAIVER 4064
Engine And Gear Box Protection Cover 1451
New Vehicle Replacement 1451
Net own Damage Premium (A) 23584
Nominee Details : Nominee Name Age 0 Relation
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 37025951 HSBC BANK LTD 31984
Financier Type Financed Financier Name ICICI BANK LIMITED Financier Branch JABALPUR

Limitations as to use:- 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.
Driver: 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.
Limits of Liability: Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is necessary to meet there requirements of the Motor Vehicles Act, 1988. Under Section II -1(ii) of the
Policy - Damage to Third Party Property - Rs.7.5 lakhs - (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Cover for Owner - Driver under section III (CSI) Rs -
Deductible under section-I : Rs 1000(Compulsory Deductible Rs 1000 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
No Claim Bonus: : The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if no claim is made or pending during the preceding year (s), as per the following: The

http://10.52.4.9/marutiInsurance/InsuranceSubsystem/InsuranceCertificatePrint.aspx?pid=1... 5/7/2020