Auto Secure - Liability Only Policy

Name : Mr. SAYAM NEGI +91 8168284609 VRINSURANCE2011@GMAIL.COM

Valid from → Valid till
Address : WARD,
NO 08, POST OFFICE BHUNTER PARGANU KULLU, TP Cover Period 06 Apr '24(14:07Hrs) 05 Apr '25 (Midnight)
HP, CPA Cover for Owner 06 Apr '24 (14:07Hrs) 05 Apr '25 (Midnight)
KULLU, Driver Period
KULLU- 175125,
14 Premium amount : ₹ 1,374.00

Dear Mr. SAYAM NEGI

Welcome to Tata AIG General Insurance Company Limited family & we thank you for choosing our policy for your motor vehicle insurance. Your Policy No. 6101323886 has
been issued based on the information and declaration provided by you. You are requested to visit our website www.tataaig.com for full policy wordings

Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Policy Details Vehicle Details

Policy No & Certificate No : 6101323886 - 00 Registration no : PB 10 GW 7621

Insured Name : Mr. SAYAM NEGI Registration Authority : LUDHIANA PB 10

Address : WARD, Make/Model : TVS/NTORQ 125

NO 08, POST OFFICE BHUNTER PARGANU KULLU,
Fuel Type : PETROL
HP,
KULLU Variant : XT
KULLU- 175125,
Engine Number/Battery Number : AG7FJ2910131/
14
Chassis number : MD626AG71J2F51121
TP cover period : 06 Apr '24(14:07Hrs) to 05 Apr '25 (Midnight)
Engine/Battery Capacity (CC/ KW) : 124
CPA to Owner driver cover Period : 06 Apr '24 (14:07Hrs) to 05 Apr '25 (Midnight)
Seating Capacity (including driver) : 2
Policy Issuance Date : 05 Apr '24
Mfg Year : 2018
Customer / Lessor GSTIN : NA
Date of Registration : 05/07/2018
Customer ID : NA
Body Type : SCOOTER
Customer contact number : 8168284609
Trailer Regn No. / Chassis No. : NA
Proposal No : PR/24/6100724719
HP/HYP/Lease : NA
Covernote no / Issuance date : NA/05 Apr '24
Zone : B
Alternate Policy No : NA
Geographical Area : India

Schedule Of Premium

Section II Liability (B)

Third Party Premium
Basic TP premium ₹ 714.00

PA Benefits
One Year Compulsory PA Cover for Owner Driver ₹ 450.00

₹ 1,500,000

Total Liability Premium (B) ₹ 1,164.00

Net Premium (B) ₹ 1,164.00

IGST @18 % ₹ 210.00

Total Policy Premium ₹ 1,374.00

Agent Name : PROBUS INSURANCE

Agent License Code : 150 • Agent Contact No. : 1126521101(or landline)
BROKER PRIVATE LIMITED
 Auto Secure - Liability Only Policy

Drivers Clause : Persons or classes of persons entitled to drive : 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.
Limitations as to use : The Policy covers use of the vehicle for any purpose other than : a) Hire or Reward other than for the purpose of driving tuitions 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

Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate, as applicable, on the date of commencement of the
Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certifitate, as applicable, during the subsistence of the Policy.

Limits of Liability : Under Section I - 1 (i) of policy (Death of or bodily injury) : Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988
Under Section I -1 (ii) of policy (Third Party Property Damage) : ₹ 100.00• Under Section II : 1 Year(s) Compulsory PA Cover for Owner Driver CSI : ₹

Nominee details :
Name of the Nominee : MR SUNIL • Nominee Age : 57 • Relationship of the Nominee with the Insured : Father

Subject to : (A) IMT Endorsement No. : IMT 15

GSTIN : 24AABCT3518Q1Z2 - GUJARAT Service Accounting Code : 997134
TATA AIG Auto Secure endorsement No. (TA) :

For & On Behalf of Tata AIG General Insurance Company Ltd.

I/We hereby certify that the Policy to which this Certificate relates as well as this
Certificate of Insurance are issued in accordance with provisions of Chapter X and XI of Digitally Signed by: Malpa Devi Maharana
docit-digital-sign
Motor Vehicles Act, 1988. Date: 05/04/2024
In witness whereof this Policy has been signed at Mumbai on : Receipt (s) : Reason: Digital Signature
PD300007075346 05/04/2024
Location: Mumbai
For stamp duty of ₹ 0.25 paid. In cash or demand draft or by pay order, vide Receipt/
Challan no : dated the

Policy Number : 6101323886 • GSTN Number : 24AABCT3518Q1Z2

Policy Servicing Office : :R202, R203, R204 & R205, 2ND FLOOR, VENUS STRATUM, NEHRU NAGAR, AHMEDABAD 380015, GUJARAT , AHMEDABAD , GUJARAT , 380015 • Tel. No : 91 -
7949002500

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”.
Note : You are advised to go through the policy schedule cum certificate of insurance which is issued based on information and declaration provided by you. Transcript of
Information & Declaration is also provided herewith to enable you to go through the same again and if any error/ discrepancy is found in respect of vehicle details, No Claim
Bonus or any other information provided by you, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting
documents, otherwise it will be deemed to be correct. You may visit the company website at www.tataaig.com for detailed benefits, terms & conditions and exclusions of the
policy issued and held by you. You may also reach us at our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of policy wording. Our grievance redressal
procedure and details about ombudsman are available at the company website www.tataaig.com. You may also reach us at our 24*7 helpline 1800 266 7780 for grievance
redressal procedure and details about ombudsman. Please note that any mis-representation, fraud, non-disclosure of material facts or non-cooperation of the insured will
lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any. We will specifically seek confirmation on No Claim Bonus availed by
you from your previous insurer. In case we receive confirmation that you had lodged claim with them then we will intimate you to pay the No claim Bonus Amount within 20
days. In case we don’t receive the No Claim Bonus recovery then it will be adjusted against claim amount payable to you if any. This Schedule, Policy terms and conditions
available on the company website and Endorsements mentioned herein above shall be read together and any word or expression to which a specific meaning has been
attached to/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 the Company shall not be liable for any liability whatsoever arising from such changes unless written request is made to
the Company and the Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement.

Receipt

Receipt No. : PD300007075346 Receipt Date : 05/04/2024 Policy No. : 6101323886 00 00

Utilized from the receipt for

Sr. No. Policy Number Mode of Payment Total Premium (₹) Balance (₹)
policy (₹)

1 6101323886 00 00 onlinePayment 1,374 1,374 0

Payer Name : SAYAM NEGI

Note :

1. This is a computer generated receipt and does not require a signature.

2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.

GSTIN : 24AABCT3518Q1Z2 GUJARAT Service Accounting Code : 997134.

Revenue (consolidated) Stamp Duty duly paid vide challan No. date for applicable cases.
Issuance of this receipt does not amount acceptance of the risk by Tata AIG General Insurance Company Limited. The insurance cover for the risk shall be as per the terms
and` conditions of the insurance policy if and when issued.
 Auto Secure - Liability Only Policy

Transcript of Information/Declaration
Insured and Vehicle Details
1. Name (Registered Owner of the Motor Vehicle) : Mr. SAYAM NEGI
2. Vehicle Details : TVS NTORQ 125
3. Address for Communication : WARD, NO 08, POST OFFICE BHUNTER PARGANU KULLU, HP, KULLU, KULLU- 175125, 14
4. Vehicle Type : SCOOTER
5. Fuel Type : PETROL
6. Battery number :
7. Charger number :
8. No. of batteries :
9. Cost of battery :
10. No. of Chargers :
11. Is Battery provided by manufacturer:
12. Name of batter manufacturer :
13. Is battery a part of Ex-showroom price of the vehicle:
14. Insured’s Declared Value : ₹ 0
15. Date of Registration : 05/07/2018
16. Proposed Period of Insurance
TP cover period : 06 Apr '24(14:07Hrs) to 05 Apr '25 (Midnight)
CPA cover period : 06 Apr '24 (14:07Hrs) to 05 Apr '25 (Midnight)

Previous Insurance Details

1. Policy Number NA
2. Date of expiry : NA
3. Type of cover : NA
4. Name & address if the Insurer : NA
5. Claim in Previous Policy Period : No
6. Period of insurance
OD cover period : to

Nominee Details
1. Name of Nominee : MR SUNIL
2. Age of Nominee : 57
3. Relationship : Father
4. Name of Appointee (if Nominee is minor) : NA

Declaration for No Claim Bonus (If NCB Confirmation is not submitted but NCB claimed)
I/We declare that the rate of NCB claimed by me/us is correct and that NO CLAIM has arisen in the expiring Policy Period (Copy of Policy enclosed). I/We further
undertake that if this declaration is found incorrect all benefits under the Policy in respect of Own Damage Section I of the Policy will stand forfeited.
I hereby give my consent to receive one page insurance policy.

AML Guidelines :
I / we hereby confirm that all premiums paid / payable in future will be from bonafide sources and not paid out of proceeds of crime and that such premiums are
not disproportionate to my/our income. I / we understand that the Company has the right to call for documents to establish sources of funds and to cancel the
insurance policy in case I / we are found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money
laundering law in India.
I / we are not Politically Exposed Persons * nor are their close relatives / family members / associates. I / we shall keep the company informed if we subsequently
become a Politically Exposed Person / close relative / family member / associate of Politically Exposed Persons.
“Politically Exposed Persons” shall have the meaning assigned to it under Prevention of Money-Laundering (Maintenance of Records) Amendment Rules, 2023 as
amended from time to time.

Disclaimer : Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms & conditions, please refer sales brochure/ policy wordings on
www.tataaig.com carefully, before concluding a sale. Purchase of Tata AIG General Insurance Company Limited products are purely on voluntary basis.

Prohibition of Rebates : - Section 41 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015.
1. No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk
relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy, nor shall any person taking out or
renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakhs.

Grievance Redressal Procedure : As per Regulation 17 of IRDA of India (Protection of Policyholders Interests) Regulation, 2017.

Section 64 VB of the Insurance Act 1938 : Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.

Auto Secure - Liability Only Policy - UIN : IRDAN108RP0008V01200001

Tata AIG General Insurance Company Limited

Registered Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013, Maharashtra, India • 24x7 Toll Free No: 1800 266 7780 • Email :
customersupport@tataaig.com • website : www.tataaig.com • IRDA of India Registration No: 108 • CIN: U85110MH2000PLC128425 • Company PAN No. : AABCT3518Q

TAGIC/PS/MRTW/Feb 22/05 Ver1/All 2547