Date : 10/01/2019

Policy No. : 2019-V6054244-FPV

Mr. Raj Kumar
H No-298, Chhuria Mohalla,
Okhla Ph-1, Tekhand Village,
New Delhi, To Activate Road Side Assistance(RSA) Cover,
Delhi, Pincode : 110020
SMS "ACTIVATE POLICY V6054244 " To 9222211100
Telephone(Mob) : 9313224459
(Standard SMS charges applicable)
Intermediary Name : SUNIL KHER - IAG

Dear Mr. Raj Kumar

Welcome to the Future Generali Experience.
We thank you for choosing Motor Secure insurance policy. Your Policy No. is 2019-V6054244-FPV . Motor Secure policy offers your
vehicle and yourself protection against any unforeseen vehicle accidents and loss to third party property or life arising there from as per
the coverage mentioned in the attached policy terms and conditions. We request you to kindly go through the same to acquaint yourself
with the available coverage .
Our initiatives will provide you with the highest standards of service, convenience and quality in motor insurance. Some of our
customerconveniences are as mentioned below:
1. Preferred Garages: We have a wide network of preferred garages that offer direct settlement facilities.
2. We also arrange a pickup facility for the damaged vehicle from the place of accident to our preferred garage for repairs. You
just have to call us. Expenses incurred for such facility is subject to the limit of towing charges as mentioned in the attached
policyterms and conditions.
3. Multiple Modes of Claim notification-In the unfortunate circumstances of an accident, you may notify us for a claim by
sending an SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable) or by calling us at 1800-220-233/
1860-500-3333/022-67837800 or by sending an email to [email protected] or walk into any of our nearest offices.

It will always be our endeavour to constantly better your experience by innovating and evolving our basket of conveniences. We strive to
deliver service which is personalized and is totally transparent. It is our aim to be with you in your time of need.
The policy has been issued on the basis of the proposal form . A copy has been enclosed for your reference . Please confirm that the
proposal form contains the correct information and is signed by you.

Please note : Transfer of benefits under this insurance policy is not automatic on the sale of the vehicle. The transferee must apply
within 14 days from the date of transfer of vehicle in writing to the insurance company with full details in a duly signed fresh proposal
form alongwith evidence of sale and transfer fees of ₹. 50/- + Goods and Service Tax.
**NCB has been allowed 20% on the basis of your declaration of 'No Claims' in your expiring policy. In case, we find that this
declaration is incorrect and/or false, all benefits under the Policy in respect of Section I of the policy will stand forfeited.
Once again, thank you for choosing to insure your vehicle with Future Generali and we look forward to being of service to you.
Assuring you of our best services at all times.

If undelivered, please return to:

Future Generali India Insurance Company Limited For Future Generali India Insurance Co. Ltd.
303-310, 3rd floor
Kailash Building
K.G. Marg
Connaught Place
( Authorized Signatory )
Delhi, 110001
Please review the communication address, email or contact nos. noted on this letter for correctness. In case of any change please contact our
nearest branch or call our care lines mentioned above. This will ensure you do not miss out on 'Service Updates' and 'Renewal Reminders'.
Now you can buy Health, Personal Accident, Travel, Home, Motor insurance & also renew your Future Generali Private Car Insurance
policy online. Visit us at www.futuregenerali.in
For any service request please sms SERVE to 9222211100. To provide feedback on our service, kindly sms HAPPY or UNHAPPY to
9222211100. We will call you back.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Tax Invoice

INSURED DETAILS
Policy Number : 2019-V6054244-FPV Address of Service Provider : Off Code-12,Future Generali India Insurance Co
Ltd, 303-310, 3rd floor, Kailash Building, K.G.
Marg, Connaught Place, Delhi, Pincode - 110001
Invoice Number : 201807PNT0064305

Reverse Charge : No Area Code : Delhi Branch Office

Name of Insured/Proposer : Mr. Raj Kumar FGI State Code : 07
Address : H No-298, Chhuria Mohalla, Okhla Ph-1, Tekhand FGI GSTIN Number : 07AABCF0191R1ZB
Village, New Delhi, Delhi, Pincode- 110020
Place of Supply(State Code): 07 Intermediary Name \ Code : SUNIL KHER \ 60022492
GSTIN / UIN Number : - Date of Issue / Invoice : 10/01/2019
Date
Period of Insurance : From 00:01 hours of 07/01/2019 HSN : 997134
To Midnight of 06/01/2020 Nature of Service : General Insurance Service

Received with thanks from Raj Kumar a sum of ₹ 24,090.00 towards Premium on the above mentioned policy.

PARTICULARS TAX(%) PREMIUM ( ₹ )

Gross Premium 20,415.00
Add : CGST 9% 1,837.35
Add : SGST 9% 1,837.35
Add : Cess -
Total (Rounded to nearest rupee) 24,090.00

NOTE :
1. In case of payment by cheque, in the event of dishonour of cheque for any reason whatsoever,insurance cover provided under this receipt automatically stands
cancelled from the inception irrespective of whether a seperate communication is sent or not.
2. Excess amount, if any, will be adjusted against subsequent policies, or will be refunded on demand.

For FUTURE GENERALI INDIA INSURANCE CO. LTD.

(Authorised Signatory)

Signature Not Verified

Digitally signed by SHARADA
RAMAKRISHNAN
Date: 2019.01.10 15:21:44
IST
Location: Mumbai
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 10/01/2019

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Future Secure Motor Insurance Policy- PACKAGE
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989
Policy Servicing : Off Code-12,Future Generali India Insurance Co Ltd, 303-310, 3rd floor, Kailash Building, K.G. Marg,
Office Connaught Place, Delhi, Pincode- 110001., Tel_No: 011-42660300
Policy No. : 2019-V6054244-FPV Period of Insurance : From 00:01 hrs of 07/01/2019 To
Insured : Mr. Raj Kumar Midnight of 06/01/2020.
Address : H No-298, Chhuria Mohalla, Okhla Covernote No : N0254110 Dated: 31/12/2018 Zone: A
Ph-1, Tekhand Village, New Delhi, Intermediary Name/Code : SUNIL KHER / 60022492
Delhi, 110020 Telephone(Mob,Hom) : 9911223304/9911223304
Email ID : [email protected]
GSTIN Number : - FGI GSTIN Number : 07AABCF0191R1ZB
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No., Make/Model of Vehicle Engine No. Chassis No.
RTA Location
DL12CM8558 MAHINDRA and MAHINDRA TDH4M84417 MA1TA2TDKH2M11165
DELHI SCORPIO S3
Year of Manufacture Cubic Capacity Type of Body Seating Premium
Capacity
2017 2523 Saloon 7 24,090.00
DRIVERS CLAUSE :- 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 - As per Motor Vehicle Rules, 1989 :- The Policy covers use of the vehicle for any purpose other
than: a) Hire or Reward, 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.
Geographical Area : INDIA
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 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 be good.
For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this
schedule.
IMPORTANT - 1) All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2) In case of payment by
cheque, in the event of dishonor of cheque for any reason whatsoever, insurance cover provided under this document
automatically stands cancelled from the inception irrespective of whether a seperate communication is sent or not.
**NCB has been allowed 20 % on the basis of your declaration of 'No Claims' in your expiring policy. In case, we find that this
declaration is incorrect and/or false, all benefits under the Policy in respect of Section I of the policy will stand forfeited.
LIMITS OF LIABILITY
Under Section II-I (i) : Death of or bodily injury - Such amount Under Section II-I (ii) : Damage to Third Party Property- ₹
as is necessary to meet the requirements of Motor Vehicles Act, 750000 /- in respect of any one claim or series of claims arising
1988 out of one event.
Under Section III : PA Owner – Driver as per premium Compulsory DeductibleUnder Sec I - ₹ 2,000.00
computation table
Hypothecation Agreement with:- HDFC BANK LTD ,
SPECIAL CONDITIONS – NIL
ADDITIONAL EXCESS – NIL
The nominee for Compulsory PA to owner driver cover is 01) KAVITA, aged :37 Years, Relationship : Wife, Nomination % :
100%

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Policy No : 2019-V6054244-FPV Period Of Insurance : From 00:01 hrs of 07/01/2019 To Midnight of 06/01/2020
INSURED'S DECLARED VALUE
For Vehicle-₹ For Non Elec For Side Car-₹ For Elec Accessories- For Bi-Fuel Kit Total Value-₹
Accessories - ₹ ₹ (CNG/LPG) - ₹
852,372 - - - - 852,372
SCHEDULE OF PREMIUM
PARTICULARS ₹ ₹
A-OWN DAMAGE
Basic Premium on Vehicle 9,321.34
**Less : No Claim Discount 20% 1,864.27
Add : Add-on Premium 4,688.04
Total Own Damage Premium (A) (rounded off) 12,145.00
B-LIABILITY
Basic Premium including Premium for TPPD 7,890.00
Add : Compulsory PA to Owner-Driver Rs. 15 lacs 330.00
Add : Legal Liability to Paid Driver/Cleaner/Employees (No. of persons 1) 50.00
Total Liability Premium (B) 8,270.00
Total Annual Premium (A+B) 20,415.00
Total Premium for the Policy Period 20,415.00
Goods and Service Tax 3,674.70
Total Premium (rounded off) 24,090.00
Class of Vehicle: Private Car Subject to Endorsement Nos. 07 ,22 ,28 ,15 ,
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 M .V. Act, 1988.
For FUTURE GENERALI INDIA INSURANCE CO. LTD.

Receipt No : Z8971971
Date of Issue : 10/01/2019
Place of Issuance : Mumbai*

*Address as mentioned below ( Authorized Signatory )

Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 10/01/2019
For registration of your Motor Claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable)
The stamp duty of Rs. 0.50/- paid by Letter Of Authorisation CSD/118/2018/3179/18, dated 16/08/2018. Mudrank - 2017/C.R.97/M-1,dated
09/01/2018.

Product UIN : IRDAN132P0001V04201213

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Annexure
Forming part of policy number:- 2019-V6054244-FPV
Motor Add-on Cover
Serial No. Add-on Description Premium Amount -₹.
(Before Tax)
1 Road Side Assistance 250.00
2 Zero Depreciation Cap 2,509.97
3 Theft Or Loss Of Keys 537.85
4 Loss Of Personal Belongings - Maximum payable amount Laptop:Rs. 50,000 ;Maximum 537.85
payable amount Mobile: Rs. 25,000
5 Consumables 852.37
Please refer the attached detailed policy wordings for the above mentioned coverages.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 ENDORSEMENTS
(Attached to and forming part of policy)

IMT. 7. VEHICLES SUBJECT TO HYPOTHECATION (ii) in respect of a vehicle rated under the Tariff for Private Car and in respect of a
AGREEMENT motorised two wheeler not carrying passengersfor hire or reward, if any deductible
in addition to the compulsorydeductibleprovided in this endorsementis voluntarily
It is hereby declared and agreed that the vehicle insured is pledged to /
borne by the insured, the sum representingthe aggregate of the compulsory and the
hypothecated with …. (hereinafter referred to as the “Pledgee”) and it is further
voluntary deductibles is to be inserted.
understood and agreed that the “Pledgee” is interested in any monies which but for
** to insert Condition no 3 in respect of a vehicle rated under Tariff for Private Car
this Endorsement would be payable to the insured under this policy in respect of
/ Two wheelers or Condition no 4 in respect of a vehicle rated under the Tariff for
such loss or damage to the vehicle insured as cannot be made good by repair and /
Commercial Vehicles.
or replacementof parts and such monies shall be paid to the Pledgee as long as they
are the Pledgee of the vehicle insured and their receipt shall be a full and final IMT. 28. LEGAL LIABILITY TO PAID DRIVER AND/ OR
discharge to the insurer in respect of such loss or damage. CONDUCTOR AND / OR CLEANER EMPLOYED
It is further declared and agreed that for the purpose of the Personal AccidentCover IN CONNECTION WITH THE OPERATION
for the owner-drivergranted under this policy, the insured named in the policy will OF INSURED VEHICLE
continue to be deemed as the owner-driver subject to compliance of provisions of (For all Classes of vehicles)
the policy relating to this cover. In consideration of an additional premium of Rs. 50/-notwithstanding anything to
Save as by this Endorsement expressly agreed that nothing herein shall modify or the contrary contained in the Policy it is hereby understood and agreed that the
affect the rights or liabilities of the Insured or the Insurer respectively under or in insurer shall indemnify the insured against the insured’s legal liability under the
connection with this Policy or any term, provision or condition thereof. Workmen's Compensation Act, 1923 , the Fatal Accidents Act, 1855 or at
Subject otherwise to the terms exceptions conditions and limitations of this policy. Common Law and subsequent amendments of these Acts prior to the date of this
IMT.15. PERSONAL ACCIDENT COVER TO THE INSURED Endorsement in respect of personal injury to any paid driver and/or conductor
OR ANY NAMED PERSON OTHER THAN PAID and/or cleaner whilst engaged in the service of the Insured in such occupation in
DRIVER OR CLEANER connectionwith the vehicle insured herein and will in addition be responsiblefor all
costs and expenses incurred with its written consent.
(Applicable to private cars Including three wheelers rated as private cars
Provided always that:
and motorized two wheelers with or without side car [not for hire or reward])
(1). this Endorsement does not indemnify the insured in respect of any liability in
In consideration of the payment of an additional premium It rs hereby agreed and
cases where the insured holds or subsequently effects with any insurer or group of
understood that the Company undertakes to pay compensation on the scale
insurers a Policy of Insurance in respect of liability as herein defined for insured's
provided below for bodily Injury as hereinafter defined sustained by the insured
general employees;
person in direct connection with the vehicle insured or whilst mounting and
(2). the insured shall take reasonable precautions to prevent accidents and shall
dismounting from or traveling in vehicle Insured and caused by violent accidental
comply with all statutory obligations;
external and visible means which independentlyof any other cause shall within six
* (3) the Insured shall keep record of the name of each paid driver conductor
calendar months of the occurrence of such Injury result In:-
cleaner or persons employed in loading and/or unloading and the amount of wages
Details of Injury Scale of Compensation
and salaries and other earnings paid to such employees and shall at all times allow
i) Death 100%
the Company to inspect such records on demand.
ii) Loss of two limbs or sight of two eyes or one 100% (4) in the event of the Policy being cancelled at the request of the Insured no refund
limb and sight of one eye
of the premium paid in respect of this Endorsement will be allowed.
iii) Loss of one limb or sight of one eye 50% Subject otherwise to the terms conditions limitations and exceptions of the Policy
iv) Permanent Total Disablement from 100% except so far as necessary to meet the requirements of the Motor Vehicles Act,
injuries other than named above 1988.
Provided always that :- *In case of Private cars/ motorised two wheelers(not used for hire or reward) delete
(1) compensationshall be payable under only one of the items (i) to (iv) above In this para.
respect of any such person arising out of any one occurrence and total liability of
the insurer shall not in the aggregate exceed the sum of Rs.........*during any one
period of insurance in respect of any such person.
(2) no compensation shall be payable in respect of death or Injury directly or
indirectly wholly or in part arising or resulting from or traceable to (a) Intentional
self Injury suicide or attempted suicide physical defect or infirmity or (b) an
accident happening whilst such person Is under the influence of Intoxicating liquor
or drugs.
(3) Such compensation shall be payable only with the approval of the insured
named in the policy and directly to the injured person or his/her legal
representative(s) whose receipt shall be a full dischargeIn respect of the Injury
of such person.
Subject otherwise to the terms exceptions conditions and limitations of this policy.
*The capital Sum Insured (CSI) per passenger is to be inserted.
IMT.22. COMPULSORY DEDUCTIBLE
(Applicable to Private Cars, three wheelers rated as private cars,all
motorized two wheelers, taxis, private car type vehicle plying for public /
private hire, private type taxi let out on private hire)
Notwithstanding anything to the contrary contained in the policy it is hereby
understood and agreed that the insured shall bear under Section 1 of the policy in
respect of each and every event (including event giving rise to a total
loss/constructivetotal loss) the first Rs……* (or any less expenditurewhich may be
incurred) of any expenditure for which provision has been made under this policy
and/or of any expenditure by the insurer in the exercise of his discretion under
Condition no ….** of this policy.
If the expenditure incurred by the insurer shall include any amount for which the
insured is responsiblehereunder such amount shall be repaid by the insured to the
insurer forthwith.
For the purpose of this Endorsementthe expression“event” shall mean an event or
series of events arising out of one cause in connection with the vehicle insured in
respect of which indemnity is provided under this policy.
Subject otherwise to the terms conditions limitations and exceptions of this Policy.
* (i) to insert amount as appropriate to the class of vehicle insured as per GR. 40
of the tariff.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287