Reliance General Insurance Company Limited.

Servicing Office : 1st Floor, A-12, Mohan Co-operative industrial Estate Mathura Road, New Delhi, , , NEW DELHI, DELHI (State
Code:07) -110044
5HOLDQFH3ULYDWH&DU3DFNDJH3ROLF\ UIN --IRDAN103RP0010V02100001
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCR6747B GSTIN: 07AABCR6747B1ZI CIN :U66603MH2000PLC128300 IRDAI Reg:103

Policy No: 996092323110022111 Proposal No. & Date: HIIB4947183, 04-OCT-2023

Policy Issued On: 04-OCT-2023 16:05 HRS Previous Policy No.: 991492223090018566
Insured Name: MRS. EKTA JAGGI Previous Insurer: Reliance General Insurance Company Limited.
Period of Own Damage : 06-OCT-2023 (00:00) To 05-OCT-2024 (1 YEAR)
191 LEFT SIDE OF MOTI WADA CHAUPAL MUNIRKA VILLAGE , Period of Liability Cover: 06-OCT-2023 (00:00) To 05-OCT-2024 (1 YEAR)
Insured Address:
NEW DELHI , DELHI (State Code:07) -110067
Period of Compulsory 06-OCT-2023 (00:00) To 05-OCT-2024 (1 YEAR)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX7279C NA ABHISHEK PATIAL 36 SPOUSE

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI VENUE 1.0 TURBO GDI MT SX 998 2020 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SUV DL 12 CS 9540 DELHI YES PETROL MALFC81ALLM139998
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
681,469 0 0 0 681,469 G3LCLM069908

Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)

Basic Own Damage Premium Basic Third Party Liability Premium 2,094
Vehicle 5,328 Bi-Fuel Kit 0
Non-Elec. Accessories (IMT-24) 0 Geographical Area Extension (IMT-1) 0
Elec. Accessories (IMT-24) 0 Sub Total (Third Party Liability) 2,094
Bi-Fuel Kit (IMT-25) 0 Personal Accident (PA) Cover
Geographical Area Extension (IMT-1) 0 Compulsory PA Cover for Owner Driver Rs 1500000 (IMT-15) 475
IMT 23 Premium 0 PA Cover for 0 Unnamed Passengers Rs 0 Each (IMT-16) 0
Sub Total (Basic Premium) 5,328 PA cover for Paid Driver of Rs 2 Lac (IMT-17) 0
Discount/Deductibles Sub Total PA Cover 475
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 134 Paid Driver (IMT-28) 50
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT-29) 0

No Claim Bonus (35%) 1,818 Sub Total (Legal Liability) 50

Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 2,619

Sub Total (Deductibles) 1,952 Total Premium (A+B) 12,428
Total Own Damage Premium 3,376 SGST(9%) 1,119
Add On Coverages ( ZD,CM,KP,PB ) 6433 CGST(9%) 1119
Net Own Damage Premium (A) 9,809 Gross Premium Paid 14,666
Add-on Cover Opted in the Policy: 1LO'HSUHFLDWLRQ ,5'$1539$9 &RQVXPDEOH([SHQVHV ,5'$1539$9 .H\3URWHFW
,5'$1539$9 3HUVRQDO%HORQJLQJV ,5'$1539$9
Notes: 1. Consolidated Stamp duty Paid vide Letter of Authorization ³NO.LOA/CSD/78/2023/(Validity Period Dt.01/07/2023 to Dt.01/01/2024)/3029 DT.26 JUN ´at General Stamp Office, Mumbai. ** Not
Applicable
2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) 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, 3.Geographical Area Ext. extended to (IMT-1): NA
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1000
4. Policy issuance is subject to realization of cheque if premium is paid by cheque
(IMT-22) & Voluntary Deductible of INR 0
7. Basic premium rates differ for NCB V/s Non -NCB , any wrong
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer website
NCB declaration will attract recovery of NCB portion & difference of
http://www.reliancegeneral.co.in
basic rate
*Hypothecation Details: FEDARAL BANK LTD - delhi - delhi Payment Mode: Cheque
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 15 Lakhs.
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.reliancegeneral.co.in/Insurance/About-Us/Grievance-Redressal.aspx 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 : DELHI(State Code : 07), Insurer Invoice Number : Y100423009625
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) Reliance General Insurance Company Limited.
Haryana 122001
Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-KONCEPT CARS INDIA PVT
CIN No.: U67200HR2021PTC098982 LTD
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0113
Email ID: connect@hiib.in DP NAME-PRATIBHA NEGI
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (KONCEPT CARS INDIA PRIVATE LIMITED) at +91-9911223303