HDFC ERGO General Insurance Company Limited.

Servicing Office : HDFC ERGO General Insurance Company Limited , 3rd Floor, Nagpal Tower1, SCO ±
Ranjit Avenue , , AMRITSAR, PUNJAB (State Code:03) -143001
Standalone Motor Own Damage Cover - Private Cars UIN --IRDAN125RP0001V01201920
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCL5045N GSTIN: 03AABCL5045N1ZI CIN :U66030MH2007PLC177117 IRDAI Reg:146

Policy No: 2302205849575900000 Proposal No. & Date: HIIB5694327, 09-NOV-2023

Policy Issued On: 09-NOV-2023 18:11 HRS Previous Policy No.: 3311/00799927/000/00
Insured Name: MR. BHUPINDER PAL SINGH Previous Insurer: Cholamandalam MS General Insurance Co. Ltd.
Period of Own Damage : 18-NOV-2023 (00:00) To 17-NOV-2024 (1 YEAR)
S/O DALJIT SINGH L-3/799, GALI NO.6, NEW JASPAL NAGAR, Period of Liability Cover: NA
Insured Address:
SULTAN WIND ROAD, AMRITSAR , PUNJAB (State Code:03) -143001
Period of Compulsory NA
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX9147E NA

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI CRETA 1.5 MPI MT SX 1497 2022 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SUV PB 02 EL 5320 AMRITSAR YES PETROL MALPC812LNM401847
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
1,160,560 0 0 0 1,160,560 G4FLNV411589

Own Damage Premium (A) Amount(INR) Pre-Existing Third-Party Policy Details

Basic Own Damage Premium TP Insurance Company Name Cholamandalam MS General Insurance Co. Ltd.
Vehicle 7,407 TP Policy No 3311/00799927/000/00
Non-Elec. Accessories (IMT-24) 0 TP Risk Inception Date 18 Nov 2022
Elec. Accessories (IMT-24) 0 TP Risk Expiry Date 17 Nov 2025
Bi-Fuel Kit (IMT-25) 0
Geographical Area Extension (IMT-1) 0
IMT 23 Premium 0
Sub Total (Basic Premium) 7,407
Discount/Deductibles
Voluntary Deductibles (0) (IMT-22A) 0
Anti Theft Device (IMT-10) 0
AA Membership (IMT-8) 0

No Claim Bonus (20%) 1,482

Handicapped Discount (IMT-12) 0

Notes: 1. The stamp duty of Rs 0.50 paid by Demand Draft, vide Receipt/Challan no.
Sub Total (Deductibles) 1,482 NO.LOA/CSD/547/2022/(Validity Period Dt. 23/12/2022 to Dt. 31/12/2023)/5450/22 DATE-
22/Dec/2022
2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC)
Total Own Damage Premium 5,925 Certificate is held on the date of commencement of the Policy. The insured undertakes to renew and maintain
a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of the Policy.
Add On Coverages ( ZD, CM, KP, PB ) 6682 3.Geographical Area Ext. extended to (IMT-1): NA
Net Own Damage Premium (A) 12,607 4. Policy issuance is subject to realization of cheque if premium is paid by cheque
SGST(9%) 1,135 5.The policy is subject to compulsory deductible of INR 1000 (IMT-22) & Voluntary Deductible of INR 0
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer
CGST(9%) 1135 website http://www.hdfcergo.com
7. The Coverage under this policy is only for Own Damage and no other liability in connection with the
Gross Premium Paid 14,877 vehicle.
Add-on Cover Opted in the Policy: Zero Depreciation Claim(IRDAN125RP0001V01201920/A0014V01201920), Cost of Consumable Items (IRDAN125RP0001V01201920/A0007V01201920),
Emergency Assistance Wider(IRDAN125RP0001V01201920/A0013V01201920), Loss of Personal Belongings(IRDAN125RP0001V01201920/A0025V01202122)
*Hypothecation Details: BANK OF BARODA - AMRITSAR - ASR Payment Mode: Online
Limitations as to use:The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace
making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Driver's Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such
license. Provided also that the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Limits of Liability Clause: 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 Vehicle Act 1988.Under Section II-1 (ii) of
the policy-Damage to third party property is INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 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) - 20%, preceding
two consecutive years - 25%, preceding three consecutive years - 35%, preceding four consecutive years - 45%, preceding five consecutive years - 50% of NCB on OD Premium.
NCB is allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Declaration on Tax Invoice 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.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT
OF RECOVERY" For legal interruption, English version will hold good.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.hdfcergo.com/customer-voice/grievances or connect with the respective servicing
office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General Insurance
Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : PUNJAB(State Code : 03), Insurer Invoice Number : HAP/2058495759000
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 XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. Scan for Renewal For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, (Valid from 90 Days Prior to Expiry) HDFC ERGO General Insurance Company Limited.
Haryana 122001
Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-NOVELTY ASSOCIATES PVT
CIN No.: U67200HR2021PTC098982 LTD
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0293
Email ID: connect@hiib.in DP NAME-KULDEEP KAUR
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (NOVELTY AMRITSAR) at +91-9915762086