ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Bundled Motor Policy- 3 Yr TP + 1 Yr OD ( Private Vehicle ) Proposal No. & Date N97164375 / 14-Jan-2021
Policy No. & Type MPX/SL133986 Period of Insurance Own Damage- 14-Jan-2021 to 13-Jan-2022
Third Party- 14-Jan-2021 to 13-Jan-2024
Policy Issued On 14-Jan-2021 (00:00) Vehicle Identification No. MA3ETDE1S00749187
Insured Name Mrs Mamta Dubey Geographical Area INDIA
Invoice No SL133986 Accounting Code of Service 997134
Insured Address # 2254/B, SECTOR -63,
CHANDIGARH-160047, Chandigarh
Insured State & Code Chandigarh-04 Place of Supply Chandigarh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 506350
Model & Variant CELERIO ZXI AMT BS-VI/MARUTI CELERIO ZXI 1L AGS Non Electrical Accessories 0
Registration No Electrical Accessories 0
Year of Manufacture 2021 CNG/ LPG Kit 0
Engine- Chassis No K10BN 2382744 - MA3ETDE1S00749187 Total IDV 506350
Cubic Capacity 998
Seating Capacity 5
Type Of Body Saloon
RTO Location CHANDIGARH
Schedule Of Premium (Amount in Rs.)
Part A(1 Year) & Part B (3Years) LIABILITY SECTION (B)
Vehicle 7697 Basic Third Party Liability 5286
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [3 Year] 914
PACover for 0 Person of Rs (0) each (IMT- 16 )
Kit (IMT-25) 0
Legal Liability (WC) to Driver (IMT-28) 150
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Basic Premium 7697 Legal Liability to Employees (IMT-29) 0
Geographical Area Extn. (IMT-1) NA Legal Liability to Passenger (IMT 46) 0
Lamp, Tyres etc. (IMT 23) 0 Driving Tuition Loading On TP Premium (60%) NA
Net Liability Premium (B) 6350
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 16387
Fiber Glass Tank 0 CGST @9% 1474.83
Sub-Total Additions 0 UTGST @9% 1474.83
Deductibles Gross Premium Paid 19337
Voluntary Deductibles (IMT 22A) 0 MISP - AUTOPACE NETWORK PRIVATE LIMITED, CHANDIGARH
Anti-Theft Device (IMT-10) 192
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus 0 0
Discount for vehicles designed for handicapped NA 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 192 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10, 28,
Depreciation Cover 2532 6. UIN : IRDAN139RP0039V01201819
Engine & Gear Box Protection Cover 0
Invoice Price Cover 0
Net own Damage Premium (A) 10037
Nominee Details : Nominee Name MRS KAVITADUBEY Age 46 Relation Sister
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 41621700 HSBC BANK LTD 19337
Financier Type Financed Financier Name ICICI BANK LIMITED Financier Branch .
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 preceding
year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will only be allowed provided
the policy is renewed within 90 days of the expiry date of the previous policy.
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 hold good.
For information on ombudsman you may visit website : http://www.gbic.co.in/ombudsman.html
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 Bharti AXA General Insurance co.ltd

Authorized Signatory
Policy Issuing Office:-1st Floor, SCO 350-351-352, Sector 34A, Chandigarh Chandigarh
GSTIN: 04AADCB2008D1ZK, CIN No.:U66030MH2007PLC351131
State Name : Chandigarh