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 R109007189 / 02-May-2020
Policy No. & Type 32160131201145198794 Period of Insurance 04-May-2020 to 03-May-2021
Policy Issued On 02-May-2020 (00:00) Vehicle Identification No. MA3NYFB1SHC215101
Insured Name Mr. Anil Yadav Geographical Area INDIA
Invoice No 4131203905734 Accounting Code of Service 997134
836 LALPUR POLIPATHAR GWARIGHAT , Jabalpur,
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 501343
Model & Variant VITARA BREZZA VDI/MARUTI VITARA BREZZA VDI Non Electrical Accessories 0
Registration No MP20CG3660 Electrical Accessories 0
Year of Manufacture 2017 CNG/ LPG Kit 0
Engine- Chassis No 5414095 - MA3NYFB1SHC215101 Total IDV 501343
Cubic Capacity 1248
Seating Capacity 5
Type Of Body Saloon
RTO Location MP20CG3660 / JABALPUR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 7600 Basic Third Party Liability 3221
Third Party Liability for Bi-fuel Kit 0
Elec. Accessories 0
Compulsory PA Cover Premium [1 Year] 275
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 7600
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) 3796
Total Premium (A+B) 18447
Driving Tuition Loading On OD Premium (60%) NA
CGST @9% 1660.23
Fiber Glass Tank 0 SGST @9% 1660.23
Sub-Total Additions 0 Gross Premium Paid 21767
Deductibles
MISP - Shubh Motors Pvt Ltd, JABALPUR
Voluntary Deductibles (IMT 22A) 0
Anti-Theft Device (IMT-10) 190
Notes :
AAI Membership (IMT-8) 0
No Claim Bonus (20%) 1482 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Discount for vehicles designed for handicapped NA
3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Sub - Total Deductibles 1672 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10, 28, 16,
Add - On Coverages
Nil Depreciation Plus 4512
Engine Protect 1253
Invoice Protect 2958
Net own Damage Premium (A) 14651
Nominee Details : Nominee Name MANISHA YADAV Age 36 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Electronic Payment 109839418093 ELECTRONIC PAYMENT 21767
Financier Type Financed Financier Name AU FINANCIERS INDIA PVT LTD 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 1500000
- 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

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