CIN No- U66010RJ2006PLCO29979 IRDA REGISTRATION NO -137

CERTIFICATE CUM POLICY SCHEDULE

GCCV-PUBLIC CARRIERS OTHER THAN THREE WHEELERS PACKAGE POLICY - ZONE C
Issue Office: 10003-E - 8, RIICO INDUSTRIAL AREA SITA PURA -JAIPUR RAJASTHAN 302022 Tel
Policy No : 10003/31/20547542
10003/31/12/267749 Prev Policy No - 10003/31/19/624987 Geographical Area INDIA
Insured's Code/ Name: IN-22567421/
3187149 SURENDRAKUMARMISHRA
SATISH VISHWAKARMA
Address: R/OH 805/CIVIL
NO. 1396/2LINES 228001SITA
WARD KANDSITAKUND
NO.73 SHANKAR NAGARSULTANPUR- UTTAR
KARMETA MADHOTAL KARMETA , JABALPUR ,
PRADESH
JABALPUR TelMADHYAPRADESH
- Fax SULTANPUR 482001
Executive: NA0000000390 Broker Details :LC0000000002 M/S.R S I B P Ltd. Contact No:
Period of Insurance : From
From00:00
00.00on 12/09/2011
HrsHrs To Midnight
of 02/06/2020
of 2/06/2020 of 11/09/2012
To Midnight Cvr Note
of 01/06/2020 1 CvrNo.Note
- Issue
No - N.A Issue date
date e -N.A
Gross Premium: 17,835
15682.00 Service Tax: 1,837 Total: 19,672
IGST -1960.00 Collection No & Dt BG
Total- 17642

Registration Engine No Make - Model Type of Body Cubic Year Of Seating Capacity
Mark & Place Chassis No Capacity G. V. W Manf (Including Driver)
UP 44 F 9091
MP-20-LA-2483 40G62347711
275IDI05MQZSE4186& TATA
TATA MOTORS
MOTORS LTD-2515 TC PICKUP/DIESEL
STD 0.00/2009
1 1550 2004
25000 31/12/2009
1 + 1 1+1
(STD)
Sultanpur
& JABALPUR 426021HVZ006052
MAT4450519ZP56092 3HT
IDV For the IDV For Non Electrical Electrical CNG KIT SI Total Value
Vehicle Trailers Accessories Accessories
5,52,698
110119.00 0 0.00 0.00 0 5,52,698
110119.00
SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY
BASIC OD COVER 926.86 13,625.00 BASIC TP COVER 10,550.00
LESS :DETARIFF DISCOUNT ON BASIC OD 15682.00 2,725.00 ADD :GR36A-PA FOR OWNER DRIVER 14390.00 100.00
LESS :NO CLAIM BONUS-GR27 3,815.00 ADD :LL TO PAID CLEANER COUNT : 2 315.00 50.00
233.00
OD TOTAL 7,085.00 ADD :LL TO EMPLOYEES COUNT : 1 25.00
1727.00 50.00
ADD :LL TO PAID DRIVER COUNT : 1 14755.00 25.00
TP TOTAL 10,750.00
TOTAL PREMIUM 17,835.00
FINAL PREMIUM - 17642.00 ADD :SERVICE TAX 1,837.00
TOTAL AMOUNT 19,672.00
* NCB discount - 35
0%%
Deductibles under Section-I : Compulsory Deductible Rs.1500
Subject to IMT Endorsement Printed herein/attached to : IMT-39 , IMT-40 , IMT-28 , IMT-21
Hypothecation Agreement with: SHRIRAM TRANSPORT FINANCE CO LTD, SULTANPUR, LUCKNOW,
JABALPUR BRANCH SULTNO003280003, Pin Code - -
JBLPRO707130002
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. 200000
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 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 Head Office - III on 18-AUG-11
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.
Preinspection Report: Not Applicable
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.

Entered By : For and on behalf of

SHRIRAM GENERAL INSURANCE COMPANY LTD
Examined By : SVS0R144

Place : JAIPUR Proposal Date : 18/08/2011

02/06/2020 18/08/2011
Date : 05/08/2020
All the Amounts mentioned in this policy are in Indian Rupees
Authorised Signatory
Service Tax Reg. No. AAKCS2509KST001 Page 1 of 1