Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

Service Branch Address: Unit No.417, ,P - 3 Krishna Apra, Sector 18,,DN-NOIDA,NOIDA - 201301.
Mar 13, 2023
Mr.MUKESH KUMAR SHARMA
NITHARI, SECTOR 31
NOIDA Intermediary Code: POS22861
ALIGARH,UTTAR PRADESH
Intermediary Name: Preeti Bhatnagar .
201301 Contact: -
Telephone :
Mobile: 70xxxxxx66
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Policy - Liability only
Certificate of Insurance and Policy No. Policy Period:Period of insurance
VMT0205951000100 From 13:15 hours on 15/03/2023 To Midnight of 14/03/2024
INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date
Mr.MUKESH KUMAR SHARMA 20/10/1980 India SELF EMPLOYED ALIGARH 22/06/2018
The Vehicle: any of the following (Two-wheeler shall be deemed to include a sidecar attached to it)
VEHICLE DETAILS
Registration Number UP81BY5287 Model Description CT 100 B
Engine Number DUYPJB72112 Type of Body Solo
Chassis Number MD2A18AY7JPB79051 Cubic Capacity 99
Make of the Vehicle BAJAJ Year of Manufacture 2018
Seating Capacity 2 Total Premium(in Rs.) 842.52
LIMITATIONS AS TO USE:The Policy covers use of the vehicle for any purpose DRIVER: Any person including the Insured:• Provided that a person driving holds an
other than: a) Hire or Reward b) Tution c) Carriage of goods (other than samples or effective driving license at the time of the accident and is not disqualified from holding or
personal luggage) d) Organised racing e) Pace making f) Speed testing g) Reliability obtaining such a license. • Provided also that the person holding an effective Learner’s
Trials h) Any purpose in connection with Motor Trade 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 the requirements of the Motor Vehicles Act, 1988. Under Section II-1 (ii) of the
Policy -Damage to Third Party Property - Rs 100,000. In respect of any one claim or series of claims arising out of one event.
Nominee Name : Nominee Age : 0 Relationship with :
Guardian Name : Guardian Age : 0 Guardian Relation :
Personal Accident cover for Owner - Driver under section III: CSI - Rs.0
B - LIABILITY
1. Basic premium including premium for TPPD 714.00
2. TPPD restricted to statutory limit of Rs.6000/- (Endt. IMT. 20) 0.00
3. Bi-fuel kit (CNG/LPG) 0.00
Add:
4. PA to Paid Driver CSI Rs. (IMT 17) 0.00
5. Geographical Area Extn.Endt.IMT-1 0.00
6. PA cover for Owner - Driver under Section III CSI Rs.0 0.00
7. PA to Unnamed Passengers (IMT 16) 0.00
Legal Liability ADD: SGST
64.26
8. Legal Liability To Paid Driver (IMT 28) 0.00 ADD: CGST 64.26
9. Legal Liability To Employees (IMT 29) 0.00
TOTAL LIABILITY PREMIUM (B) 714.00 TOTAL PREMIUM 842.52
In Witness whereof this Policy has been signed at Chennai on 13/03/2023 in lieu of Cover note No. dated Receipt No. CBCEAP0006004.Subject to IMT Endt. Nos & Memorandum . 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 the Motor Vehicles Act, 1988.
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" under Policy
Terms and Conditions.
For Royal Sundaram General Insurance Co. Limited

Signature Not Verified

Digitally signed by TAIKAD MAHADEVAN
SHYAMSUNDER
Date: 2023.03.13 13:24:14 IST
Reason: For RoyalSundaram
Location: Chennai
Authorised Signatory
Consolidated Stamp Duty Paid to Govt of TamilNadu This document is digitally signed, hence counter signature / stamp is not required.
GSTIN : 09AABCR7106G1ZH PAN Number : AABCR7106G
For Legal interpretation, English version will hold good.
f9bd7bcf75501e7f90c431894b215fc8
Point of Sales Person Name : Preeti Bhatnagar . Contact No : 9873063869
Aadhaar Card Number : 76XXXXXXXX24 PAN Number : AFUPB3296C

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:customer.services@royalsundaram.in www.royalsundaram.in
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

GST Invoice
Royal Sundaram General Insurance Co. Limited
DN:DN-NOIDA
Address: Unit No.417, ,P - 3 Krishna Apra, Sector 18,,DN-NOIDA,NOIDA - 201301.
GSTIN: 09AABCR7106G1ZH

Policy Number : VMT0205951000100

GST Invoice Number : VMT020595100000
Invoice Date : 15/03/2023

Address of insured:
Insured Name: Mr.MUKESH KUMAR SHARMA
NITHARI, SECTOR 31
NOIDA

NOIDA
State:UTTAR PRADESH
Pincode: 201301

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable Premium 714.00

SGST 9.00% 64.26

CGST 9.00% 64.26

Gross Premium 842.52

Indication if tax payable under reverse charge - No

“I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the
said sub-rule.”:
Note: “This document is digitally signed”
“This document is electronically generated.This document should be issued along with the Policy document.This document stands
invalid,if issued separately”

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:customer.services@royalsundaram.in www.royalsundaram.in