Satish

Reliance Private Vehicle Certificate cum Policy Schedule
Policy / Certificate No. :
11035523110001
Proposal /Covernote No :
W01081507605
Period of Insurance :
From 00:00 Hrs
Address :
Business/Occupation:
Professional
41-2-37,Krishnalanka,Vijayawada-13 , ANDHRA PRADESH
Hypothecated with :
Contact details :
9640887354
Zone :
Email :
[email protected]
Name of Insured :
MR. Eswar Rao
Particulars of vehicle Insured :
Registration No. &

Place
Make / Model Variant
AP-16-AM-8350 &
VIJAYAWADA
HEROHONADA/
PASSIONPsLUS
Engine No. / Chassis No. Type of Body
05E08M20818 /
05E09C21803
Cubic
Capacity
Mfg. Year
97.2
MAY-2005
Seating Cap
Limitations As To Use :
The Policy covers use for any purpose other than: a. Hire or Reward, b. Carriage of goods (other than samples or perso
e. Speed testing, f. Reliability trials, g. Any purpose in connection with Motor Trade.
Persons/Classes of Persons entitled to drive :

Any person including the Insured provided that a person driving holds an effective driving licens
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
Limits of Liability : a. Under Section II-1(i) of the Policy-Death of or bodily injury to any person so far as it is necessary
to meet the requirements of the Motor Vehicle Act, 1988. b. Under Section II(1)(ii) of the Policy-Damage to property other
than property belonging to the insured or held in trust or in the custody of control of the insured up to the limits specified
Rs. 750000/PA Cover for owner-driver under Section-III CSI - Rs. 2,00,000/Deductible under Section-1:
deductible Rs. /-
(i) Compulsory deductible Rs. 2000/- (ii) Additional compulsory deductible Rs. 0/-, (iii) Voluntary
Special Conditions:
__________________________________________________________________________________________________________
It is hereby declared and agreed that all pre-existing damages to the vehicle having occurred prior to the commencement of cover
are excluded from the scope of the policy. Consolidated Stamp duty Paid vide GRAS GRN No. MH003534299201415E dated 28
Ocotober 2014**** Not Applicable for the State of Jammu & Kashmir
I/We hereby certify that the Policy to which the certificate relates as well as this certificate of insurance are issued in accordance with
the provision of Chapter X and Chapter XI of M.V. Act, 1988. Note: In the event of dishonor of cheque, this policy document
automatically stands cancelled from inception irrespective of whether a separate communication is sent or not. No Claim Bonus will
only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy.
Insured's Declared Value
For the Vehicle

25000
For Trailers
0
Electrical / Electronic
Accessories
Non Electrical
Accessories
CNG / LPG
0
Schedule of Premium
A. Own Damage
Basic OD Including Add On Where Applicable
Total Net Basic Own Damage Premium(Including addon
covers as applicable.)
Less
Deduct 20% for NCB
Sub Total (deduction)
TOTAL OWN DAMAGE PREMIUM
B. Liability
Basic premium including premium fo

450 Liability Premium for Driving Tuition
Total
PA Benefits
90 Compulsory PA covers for owner-driv

TOTAL LIABILITY PREMIUM
540 PACKAGE PREMIUM (Total ODP +

Add: Service Tax @ 12%
Add: Educational Cess @ 2%

Add: Higher Educational Cess @ 1%
FINAL PREMIUM
Subject to I.M.T.Endt.Nos. & Memorandum printed/herein/attached hereto. IMT 22
Subject to Reliance GI Endorsement Numbers printed herein/attached hereto. 0

The policy has been issued based on the information provided by you and the policy is not valid if any of the information
provided is incorrect. Subject otherwise to the terms, conditions and exclusions of the Reliance Private Car Policy. In witness
whereof this Policy has been signed at Mumbai on 08-Jan-2015 in lieu of Cover Note No/Proposal No. W01081507600 Dated
08-Jan-2015
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 appealing 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 AND
RIGHT OF RECOVERY'. For legal interpretation, English version will hold good. NOTE: Kindly acknowledge receipt of this policy. In
case you find any variations against your proposal or any discrepancy in the policy, kindly contact us immediately
In the unfortunate event of a claim, Please call along with your Policy No.on 1800 103 1999 (toll free) or
022
41112600 (Standard STD Rates Apply) and register your claim immediately within 7 days from the date
of loss. For
Customer service, Please call along with your Policy No. on 1800 3009(toll free)|
www.reliancegeneral.co.in
Branch Issuance Office : Ground Floor & 1st Floor, MALHAAR THEATER Gokhale Road, Naupada,Thane(W) ,
MAHARASHTRA
Intermediary Code/Name :
Intermediary Contach No.:
Dear ESWAR RAO

We thank you for placing your trust with Reliance General Insurance Company Limited
We are pleased to enclose Private Car Package Policy as Proposed by you
(I) Details of Registered Owner/Insured

Name of the Insured
ESWAR RAO
State
Address
41-2-37, KRISHNALANKA
City
Email
[email protected]
Mobile number
Total Insured Declared Value (IDV)
25000
Total Premium amount
Policy Start date
09/01/2015
Policy End date
Hypothecation Type
Hypothecated
Name of Financial Institution
Address of Financial Institution
Renewal/Rollover/New
Make
HEROHONDA
Manufacturing Month/Year
Model
PASSION PLUS
Date of Purchase/Registration
Landline number
(II) Policy Details
(III) Vehicle Details
Variant
RTO Location
Registration number
Chassis Number
05E08M20818
05E09C21803
Vehicle IDV
25000
Value of Electrical Accessories
Value of CNG/LPG KIT
Value of Non Electrical Accesso
Electrical Accessories
NO
Legal Liability to Paid Driver
Non Electrical Accessories
NO
Personal Accident Cover for un

Passengers
CNG/LPG Kit Attached
NO
Extension in Geographical Area
Is Vehicle used for Driving Tuitions
NO
Legal Liability to Employees
Fiber Glass Fuel Tank
NO
If Yes Extension in Geographica
Personal Accident Cover for Named

Passengers
NO
Legal liability to Cleaner & cond
Legal liability to Non-Fare Passenger
No
Loading charged
Nil Depreciation Cover
NO
Total Covers
Motor Secure Plus
NO
Motor Secure Premium
Anti Theft Device Discount
NO
Automobile Association Disc
Voluntary Deductible Discount
NO
Automobile Association Membe

number/Name
Engine Number
Seating Capacity Including Driv
(IV) Additonal Cover/s Opted
(V) Add on Cover/s Opted
(VI) Discounts Claimed
Against this discount you have accepted an additional voluntary deductible of Rs 0 against each claim
Restrict TPPD Liability To 6000
NO
(VIl) PA to Owner Driver - Nominee Details

(VlIl) Payment Details
Payment Mode
Cash
Bank Name
Premium Amount
621
Payment Date
2216003113P106474959
Previous Insurer Name
(lX) Previous Year Policy Details

Policy Number
Policy End date
08/01/2015
Branch Name & Address
Claim (Yes or No)
NO
Current NCB %
NCB% for this Policy
YES
Declaration
I agree that the insurance benefit available to me shall become voidable in the event of any untrue or incorrect
statement, misrepresentation,non-description or non-disclosure in any particulars in the application form / personal
statement, declaration and connected documents or any material information has been withheld by me or anyone
acting on my behalf to obtain insurance benefit. I hereby declare that I am not aware of any neglect and omission
or error or existence of any circumstances likely to give rise to a claim thereof. I hereby declare, incase of false
declaration the Insurance Company shall have the right to cancel the policy. The insurance company shall have the
right to change the premium and conditions agreed to subject to such terms and conditions as has been
communicated to me. I hereby agree that my enrollment for insurance would be at the sole discretion of the
insurance company. I declare and warrant that the information I have given in this online form will be considered as
the proposal form in relation to myself (or other person or categories of persons to be insured) and any
documentation of information accompanying it or arising out of the answers I have given is complete and accurate
in all respects. I understand and agree that this online form and other information and documentation I have given
or will give,relating to myself or any other person to be insured, will be the basis of any insurance that you may
issue, and I also understand the consequences of any default. I further understand that the coverage offered is
subject to realization of premium payment.
Online Transaction Facility - Terms and Conditions:
Insured Name : ESWAR RAO

08/01/2015
Date :
The information that you give to Reliance General Insurance on this online form will be treated as the proposal form
and details in any supplemental information form or documentation supplied by you or on your behalf will influence
our decision to offer insurance and the terms upon which to offer it. Further, any policy we issue will be based on
what you have told us. It is therefore important that your answers are complete and accurate in all respect.
The questions in this online form are indicative rather than exhaustive. You must provide us with all information
relevant to the risk to be insured,even if it is not the subject of a question in this online form. If you are in any doubt
as to what information should be given, please email us at [email protected]. Any failure to provide us with
full and accurate material information may mean that your policy can be declared as void.
No insurance cover will be in force until we have approved it and the premium has been paid.
Statutory Warning - PROHIBITION OF REBATES (Under Section 41 of Insurance Act 1938)

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 the 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 prospectuses or tables of the Insurer.
Any person making default in complying with the provisions of this section shall be punishable with fine, which may
extend to five hundred rupees.
We hope the information shown above is found by you as correct
For detailed terms & condition (Policy Wordings) governing this policy, kindly refer our website.
In case of any query you may contact our customer care service numbers given on the face of the policy. We look
forward to having a long term & fruitful relationship
Yours truly
Authorized Signatory
For Reliance General Insurance Co ltd

Satish

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Reliance Private Vehicle Certificate cum Policy Schedule

Policy / Certificate No. :

From 00:00 Hrs

41-2-37,Krishnalanka,Vijayawada-13 , ANDHRA PRADESH

MR. Eswar Rao

Particulars of vehicle Insured :

Registration No. &

Make / Model Variant

Engine No. / Chassis No. Type of Body

Persons/Classes of Persons entitled to drive :

For the Vehicle

Basic premium including premium fo

90 Compulsory PA covers for owner-driv

540 PACKAGE PREMIUM (Total ODP +

Add: Educational Cess @ 2%

Subject to Reliance GI Endorsement Numbers printed herein/attached hereto. 0

Dear ESWAR RAO

(I) Details of Registered Owner/Insured

Total Insured Declared Value (IDV)

Total Premium amount

Policy Start date

Policy End date

Name of Financial Institution

Address of Financial Institution

(II) Policy Details

(III) Vehicle Details

Value of Electrical Accessories

Value of CNG/LPG KIT

Value of Non Electrical Accesso

Legal Liability to Paid Driver

Non Electrical Accessories

Personal Accident Cover for un

CNG/LPG Kit Attached

Extension in Geographical Area

Is Vehicle used for Driving Tuitions

Legal Liability to Employees

Fiber Glass Fuel Tank

If Yes Extension in Geographica

Personal Accident Cover for Named

Legal liability to Cleaner & cond

Legal liability to Non-Fare Passenger

Nil Depreciation Cover

Motor Secure Plus

Motor Secure Premium

Anti Theft Device Discount

Automobile Association Disc

Voluntary Deductible Discount

Automobile Association Membe

Seating Capacity Including Driv

(IV) Additonal Cover/s Opted

(V) Add on Cover/s Opted

(VI) Discounts Claimed

(VIl) PA to Owner Driver - Nominee Details

Previous Insurer Name

(lX) Previous Year Policy Details

Policy End date

Branch Name & Address

Claim (Yes or No)

NCB% for this Policy