Tata AIG General Insurance Company Ltd.

Date: 22/04/2011
Policy No.: 0151254056 00

Mr. MANOJ SHARMA .

GALI NO-4-B,
SWATANTRA NAGAR,
NARELA,
DELHI 110040,
DELHI

Work Phone: 1

Client Id: 5002341525

Dear Mr. MANOJ SHARMA .,

It is my pleasure to welcome you to the Tata AIG family.

Your Policy number is 0151254056 00. The insurance coverage that you have opted for is Scooter/Motor Cycle
Insurance. The details of your coverages and the other guidelines regarding your policy can be had from the policy
document and the guide to our products that is enclosed with this. Please do file these documents for future reference.
I am sure that you will benefit from the best that we have to offer.

You and your family are offered security and convenience by us through a host of benefits under the policy that you
have opted for, security in the feeling that your assets are protected and convenience in accessing us as your insurer.
The most striking feature of this accessibility being the 24 - hour help line for all our policyholders. Please do call us
at this number in case you require any clarifications or services.

It is our promise to be there for you in your time of need.

We shall work on providing you with many more benefits that will stand by our commitment to provide you with
nothing but the best.

We thank you for choosing us for your requirements and promise you a pleasant experience called insurance.

Sincerely yours,

Tata AIG General Insurance Co. Ltd. Policy Holder Services, P. O. Box No. 9407, Chakala MIDC- Post Office. Mumbai 400093.
TOLLFREE HELP LINE: 1 800 119966
(Regd Office : Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013)

Branch: Chennai ORIGINAL Page 1 of 5

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 Tata AIG General Insurance Company Ltd.

RECEIPT

Receipt No.: W001539661 Receipt Date: 19/04/2011

Received with thanks from ICM Insurance Brokers Pvt. Ltd (ID:5002341525)

(Insured: Mr. MANOJ SHARMA . (ID:5002341525))

a sum of Rs. 50,000.00 ( Rupees Fifty Thousand and Paise 00 Only )

vide Cheque no. 529177 dated 18/04/2011 drawn on I.C.I.C.I. BANKING

CORPORATION LTD.,BESANT NAGAR branch towards

Sr. No. Policy No. Total Premium (Rs.) Utilised from Receipt (Rs.)
1 0151248134 591.00 591.00
2 0150858911 609.00 609.00
3 0151248727 840.00 840.00
4 0151249421 953.00 953.00
5 0151249669 666.00 666.00
6 0151249684 962.00 962.00
7 0151249721 1,384.00 1,384.00
8 0151249811 811.00 811.00
9 0151249980 552.00 552.00
10 0151250039 631.00 631.00
11 0151250107 870.00 870.00
12 0151250661 1,006.00 1,006.00
13 0151250721 446.00 446.00
14 0151250742 1,164.00 1,164.00
15 0151251259 1,113.00 1,113.00
16 0151251364 790.00 790.00
17 0151251433 655.00 655.00
18 0151251837 580.00 580.00
19 0151251877 732.00 732.00
20 0151251912 610.00 610.00
21 0151251937 763.00 763.00
22 0151252048 929.00 929.00
23 0151252127 765.00 765.00
24 0151252314 790.00 790.00
25 0151253672 636.00 636.00
26 0150849642 596.00 596.00
27 0151254056 660.00 660.00
Tata AIG General Insurance Co. Ltd. Policy Holder Services, P. O. Box No. 9407, Chakala MIDC- Post Office. Mumbai 400093
TOLLFREE HELP LINE: 1 800 119966
(Regd Office : Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013)
RP01 Branch: Chennai ORIGINAL Page 2 of 5
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 Excess: 28,896.00

REVENUE
STAMP

Note:
1. This is a computer generated receipt and does not require a signature.
2. This receipt is issued subject to realisation of the cheque.
3. Upon issuance of this receipt, all previously issued temporary receipts, if any, related to this policy, are
considered null and void.
4. Any excess amount will be adjusted against subsequent policy applications, or will be refunded on demand.
Service Tax Registration No : Insurance/Tata/Mumbai-I/1542/2001-02.

Tata AIG General Insurance Co. Ltd. Policy Holder Services, P. O. Box No. 9407, Chakala MIDC- Post Office. Mumbai 400093
TOLLFREE HELP LINE: 1 800 119966
(Regd Office : Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013)
RP01 Branch: Chennai ORIGINAL Page 3 of 5
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 Tata AIG General Insurance Company Ltd.
Certificate of Insurance and Policy Schedule
Form 51 of the Central Motor Vehicle Rules, 1989
Agent/Broker Producer Name - ICM Insurance Broker
Agent/Broker License Code - DB388/07 Agent/Broker Contact No.-
Certificate & Policy No. 0151254056 00 Policy Type Package Policy-Scooter/Motor Cycle Insurance
Effective time and date of commencement of Insurance From 00:01 Hours on 23/04/2011
Premium (incl.S.Tax) Rs. 660.00
Date of Expiry Midnight on 22/04/2012 Insured's Business/Profession PROFESSIONAL
Place of Registration NORTH WEST ZONE Geographical Area INDIA
Name and address of the Insured Under Hire Purchase/Hypothecation/Lease with
Name: MANOJ SHARMA .
Address : GALI NO-4-B,
SWATANTRA NAGAR,
NARELA,
DELHI 110040,
DELHI

Registration No. Make & Model Body Type Mfg. Year CC Seating Capacity Engine No. Chassis No.
DL8SAN5296 HERO HONDA CD 2008 100 2 28746 13662
DELUXE CAST
IDV of non-built-in Accessories(Rs.) Total Insured Declared
IDV of vehicle(Rs.) IDV of Side Car(Rs.) Bi-Fuel/CNG/LPG
Kit(Rs.) Electrical Non-Electrial Value (Rs.)
24,850.00 24,850.00
SCHEDULE OF PREMIUM
Own Damage Basic Rs. 382.00 Liability to Public Risk Rs. 300.00

Less : 35.00% for NCB Rs. 134.00 Add: Compulsory PA Cover for Owner-Driver Rs.1,00,000 Rs. 50.00

A. TOTAL OWN DAMAGE PREMIUM (rounded off) Rs. 248.00 B. TOTAL LIABILITY PREMIUM Rs. 350.00

COMPREHENSIVE PREMIUM(A+B) Rs. 598.00

NET PREMIUM Rs. 598.00

Add : 10.30% Service Tax Rs. 61.59

TOTAL PREMIUM Rs. 660.00

Drivers Clause : Persons or classes of persons entitled to drive : Limitations as to use:

Any person including the insured: Provided that a person driving holds an The Policy covers use of the vehicle for any purpose other than :
effective driving licence at the time of the accident and is not disqualified from a) Hire or Reward b) Carriage of goods (other than samples or personal
holding or obtaining such a licence. Provided also that the person holding an luggage) c) Organised racing d) Pace Making e) Speed testing f) Reliability
effective Learner's Licence may also drive the vehicle and that such a person Trials g) Any purpose in connection with Motor Trade.
satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

Limits of Liability: Subject to :

Under Section II-1 (i) of the policy (Death of or bodily injury) : Such amount as is necessary to A. Indian Motor Tariff Endorsement No. (IMT)
meet the requirements of the Motor Vehicles Act, 1988.
Under Section II-1 (ii) of the policy (Damage to Third Party Property ) : Rs. 100000.0/-
22
P.A. Cover for Owner - Driver under Section III: CSI : Rs. 100000.0/-
Deductible under Section - I Compulsory Deductible : Rs. 50.0/-
Voluntary Deductible : Rs. 0/-
Imposed Excess : Rs. 0.0/-
I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of For Tata AIG General Insurance Company Ltd.
Insurance are issued in accordance with the provisions of Chapter X and XI of Motor Vehicles Act,
1988.In witness whereof this Policy has been signed at MUMBAI on 19/04/2011..

Receipt(s): W001539661
Service Tax Registration No : Insurance/Tata/Mumbai-I/1542/2001-02.

The stamp duty of Rs. 0.50 /-(Rupees zero and Paise 50 Only) paid in cash or demand draft or by pay
order, vide Receipt/Challan no 29716 dated the 25/10/2010.

Tata AIG General Insurance Co. Ltd. Policy Holder Services, P. O. Box No. 9407, Chakala MIDC- Post Office. Mumbai 400093
TOLLFREE HELP LINE: 1 800 119966
(Regd Office : Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013)
DA17 Branch: Chennai ORIGINAL Page 4 of 5
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 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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF
RECOVERY".
This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been attached in any part of this
Policy or of the Schedule shall bear the same meaning wherever it may appear.
Any amendments/modifications/ alterations made on this system generated policy document is not valid and Company shall not be liable for any liability whatsoever
arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is made to the Company
and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company.

Tata AIG General Insurance Co. Ltd. Policy Holder Services, P. O. Box No. 9407, Chakala MIDC- Post Office. Mumbai 400093
TOLLFREE HELP LINE: 1 800 119966
(Regd Office : Peninsula Corporate Park, Nicholas Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013)
DA17 Branch: Chennai ORIGINAL Page 5 of 5
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