Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.

Service Branch Address:

8-3-300, First floor, Kothi Rampur, ,Hyderabad Road, ,CN-Karimnagar ,KARIMNAGAR - 515001.

Jun 15, 2020

Mr.AERRAM LAXMAN .
S/O BHOOMAIAH
NEXT RENEWAL
H NO 5-110/50 IS ON
GANGADHARA X ROAD KURIKYALA
KARIMNAGAR - 505445, TELANGANA 23/06/2021
Telephone :
Mobile : 94xxxxxx94

Certificate of Insurance and Policy No. Policy Period: Period of insurance

VPC1333338000100 From 00:00:00 hours on 24/06/2020 To Midnight of 23/06/2021

Dear Customer,
Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are delighted to have you as our customer.Please find enclosed
Private Car Policy No. VPC1333338000100 which has been issued based on the details mentioned below:
Name of the Insured: Mr.AERRAM LAXMAN .
Mobile No.: 94xxxxxx94 Email ID: mah********@gmail.com
Make of the Vehicle: HYUNDAI MOTORS LTD. Model Description: ELITE I20 ASTA 1.4 CRDI
Engine No.: D4FCGM103594 Chassis No.: MALBM51RLGM262673E
Premium Amount (Rs.) 16,331.20 Add-on Covers Opted : Yes
Previous Policy No. 2311201428117403000
Previous Policy Insurance Co. HDFC ERGO GENERAL INSURANCE CO LTD
Based On your declaration on No claim being made in expiring policy, we have extended next slab of no claim discount in
your policy (20 %)
CPA Status
Opted – Coverage Sum Insured :1,500,000
The policy is processed based on the information declared by you. While the information regarding the vehicle, insured
(yourselves), detail of covers and terms/conditions could be ascertained from the Certificate of Insurance and Policy
Schedule (Enclosed), some of the very critical ones like No Claim Bonus extended, KYC Details, status of Compulsory
Personal Accident (CPA) Cover and details regarding Vehicle Inspection if any etc. are furnished above.
Coverage of risk is subject to realization of the full premium, post which, insurance coverage under the policy would
commence. In-case the premium is not received by us due to cheque dishonor or any other reason or misrepresentation of
any information, the insurance cover shall be void ab-initio.
Please check all the information printed in these pages for its correctness and should there be a discrepancy, reach us
(Contact details provided below) for suitable rectification. In case there is no response within 15 days of policy inception, it will
be deemed that all information provided are correct and all future transactions would be based on such information only.
The above information is to be read in conjunction with the policy certificate of issuance and policy schedule and shall be
considered null and void without the same.
To read the “policy” & “add on” terms, conditions, exceptions and applicable endorsement, please log on to our
website www.royalsundaram.in. Should you have any queries, please contact our Customer Service helpline number
1860-425-0000. You may also write to [email protected]

Assuring you of our best services at all times.

Yours sincerely,
Signature Not Verified
Digitally signed by
THIRUNAVUKKARASU S
Date: 2020.06.15 18:24:15 IST
Reason: For RoyalSundaram
Location: Chennai

Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
4dcefe978bc2735a1387024fd95e4d5c

Note: To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in

For Motor Claim Intimations Call us first 1800 568 9999 (24/7 Tollfree)
Registered Office: 21, Patullos Road, Chennai - 600002 | IRDAI Reg. No.102 | CIN: U67200TN2000PLC045611
Customer Care 1860 425 0000 | Email: [email protected] | Visit: www.royalsundaram.in
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.

Service Branch Address:

8-3-300, First floor, Kothi Rampur, ,Hyderabad Road, ,CN-Karimnagar ,KARIMNAGAR - 515001.
Jun 15, 2020
Mr.AERRAM LAXMAN .
Intermediary Code: BR502965
S/O BHOOMAIAH Intermediary Name: D2C Insurance Broking
H NO 5-110/50
GANGADHARA X ROAD KURIKYALA Pvt. Ltd.
KARIMNAGAR - 505445,TELANGANA Contact: -
Telephone:
Mobile: 94xxxxxx94

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Package Policy
Certificate of Insurance and Policy No. Policy Period: Period of insurance
VPC1333338000100 From 00:00:00 hours on 24/06/2020 To Midnight of 23/06/2021

INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date

Mr.AERRAM LAXMAN . India KARIMNAGAR 11/07/2016

INSURED'S DECLARED VALUE (IDV) (in Rs.)

Non Electrical / Value of For Life
For the For Total Loss Of Invoice
Electrical Electronic CNG/LPG Time Road
Vehicle Trailers IDV Baggage Price
Accessories Accessories Kit Tax
506,340 0 0 0 0 506,340 0 0 0
VEHICLE DETAILS
Registration Number TS02ER3507 Type of Body HATCHBACK
Engine Number D4FCGM103594 Cubic Capacity 1,396
Chassis Number MALBM51RLGM262673E Year of Manufacture 2016
Make of the Vehicle HYUNDAI MOTORS LTD. Seating Capacity (including Driver) 5
Model Description ELITE I20 ASTA 1.4 CRDI Total Premium (in Rs.) 16,331
Persons or Classes of Persons entitled to Drive:
LIMITATIONS AS TO USE: Any person including the Insured
The Policy does not cover use for • Provided that a person driving holds an effective Driving Licence at
a) Hire or Reward b) Carriage of goods (other than samples or personal the time of the accident and is not disqualified from holding or
obtaining such a License.
luggage) • Provided also that the person holding an effective learner's license
c) Organized racing d) Pace Making e) Speed testing may also drive the vehicle when not used for the transport of goods
f ) Reliability Trials and any purpose in connection with motor trade at the time of the accident and that such a person satisfies the
requirements of Rule 3 of The Central Motor Vehicles Rules, 1989
LIMITS OF LIABILITY:
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 Vehicles Act, 1988.
Under Section II-1 (ii) of the Policy - Damage to Third Party Property - Rs 750,000 (as per IMT 20) - In respect of any one claim or series of claims
arising out of one event.
Personal Accident cover for Owner - Driver under section III: CSI - Rs.1,500,000\-

DEDUCTIBLE: Total deductible Rs. 1,000 in respect of each and every claim. (Compulsory Deductible [Rs.1,000], Voluntary
Deductible [Rs. 0], Imposed Deductible [Rs. 0] and Loss Of Baggage Deductible[Rs. 0] )

Document Code: Certificate of insurance & policy schedule continued in Page 2

OBRVSVZ99999
4dcefe978bc2735a1387024fd95e4d5c

GST Invoice Number: VPC133333800000 Invoice Date: 24/06/2020

HSN Taxable CGST SGST/UTGST IGST Total
SAC Value Rate Amount Rate Amount Rate Amount Amount
997134 13,840.00 9.00% 1,245.60 9.00% 1,245.60 16,331.20
Indication if tax payable under reverse charge - No
GSTN of the Insured:

For Motor Claim Intimations Call us first 1800 568 9999 (24/7 Tollfree)
Registered Office: 21, Patullos Road, Chennai - 600002 | IRDAI Reg. No.102 | CIN: U67200TN2000PLC045611
Customer Care 1860 425 0000 | Email: [email protected] | Visit: www.royalsundaram.in
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.

CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Package Policy

Policy No.VPC1333338000100
Premium in Premium in
A - OWN DAMAGE B - LIABILITY
Rs. Rs.
1. Basic premium on Vehicle and Non-Electrical Accessories 6,809.00 1. Basic premium including premium for TPPD 3,221.00
2. Electrical & Electronic accessories @ 4%(IMT 24) 0.00 2. Less: For restricted TPPD cover for Rs.6000 (IMT 20) 0.00
3. Bi-Fuel kit (CNG/LPG) @ 4% (IMT 25) 0.00 3. Bi-Fuel kit (CNG/LPG) 0.00
4. Trailers (IMT30) 0.00
ADD: ADD:
4. Trailer 0.00 Personal Accident Benefits
5. Geographical Area Extn.Endt.IMT-1 0.00 5. Under Section III (Owner Driver), CSI Rs.1,500,000 315.00
6. 30% for Imported vehicles without custom duty (IMT 19) 0.00 6. Geographical Area Extn.Endt.IMT-1 0.00
7. Named Passengers, CSI Rs.0.00 each as per list
7. Fibre Glass Tanks 0.00 0.00
attached (IMT 15)
8. 60% on OD Premium for Driving Tution 0.00 250.00
8. Unnamed Passengers, CSI Rs.100,000 each (IMT 16)
9. Additional Towing Charges. Rs.0 0.00
9. PA Cover to Paid Driver, CSI Rs.0 (IMT 17) 0.00
10. For any Other extra 0.00
Less: ADD:
10. Discount for Anti-theft devices (IMT 10) 0.00 Legal Liability:
11. Automobile Association Discount (IMT 8) 0.00 10. To Paid Driver (IMT 28) 50.00
12. Voluntary Deductible(IRDAN102A0006V01200910)of Rs.0 0.00
11. To Paid Employees (IMT 29) 0.00
(IMT 22 A)
13. 50% Discount for Vehicles specially designed/modified
for blind,handicapped and mentally challenged persons 0.00 12. For any other extra 0.00
(IMT 12)
14.Vintage Car Discount (IMT 9) 0.00 13. TOTAL LIABILITY PREMIUM (B) 3,836.00
15. Deduct:20% No Claim Bonus -1,361.80 14. Add: Underwriting Loading % 0.00
16. Add: Underwriting Loading 0.00 15. NET PREMIUM (A + B) 13,840.00
Add: Additional Cover for Package Policies
17. Depreciation Waiver (IRDAN102A0011V02201213) 4,557.00
18. Windshield Glass (IRDAN102A0004V01200910) 0.00
19. Cash in Lieu of Spare Car ,Limit per day.Rs (
0.00
IRDAN102A0007V01200910)
20. Full Invoice Price Insurance (IRDAN102A0008V01200910) 0.00 ADD: SGST 1,245.60
21. Life Time Road Tax (IRDAN102A0005V01200910) 0.00 ADD: CGST 1,245.60
22. Loss of Baggage (IRDAN102A0009V01200910) 0.00
23. NCB Protector Cover (IRDAN102A0002V01201314) 0.00
24. Engine Aggravation Cover(IRDAN102A0001V01201314) 0.00
25. Key Replacement Cover (IRDAN102A0001V01201516) 0.00
26. Tyre Cover Clause (IRDAN102A0003V01201718) 0.00
27. TOTAL OWN DAMAGE PREMIUM (A) 10,004.00 16. TOTAL PREMIUM PAYABLE 16,331.20
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous year. b) 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), as per the details given below:

Period of Insurance % of NCB on OD Premium Subject to IMT Endt. Nos. & Memorandum 28,16 & RSMOAC 1
(refer Terms & Conditions for relevant wording)
The preceding year 20 Under Hire Purchase/Lease Agreement /Hypothecated with STATE BANK OF
HYDERABAD
Preceding two consecutive years 25 Nominee Name Nominee Age Relationship with
MAHENDER 33 SON
Preceding three consecutive years 35
Guardian Name Guardian Age Guardian Relation
Preceding four consecutive years 45
Date and Signature of Proposal/Renewal notice 15/06/2020
Preceding five consecutive years 50
In Witness whereof this Policy has been signed at Chennai on 15/06/2020 , 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 the Motor Vehicles Act, 1988.
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" under Policy Terms and Conditions.
For Royal Sundaram General Insurance Co. Limited

Signature Not Verified

Digitally signed by
THIRUNAVUKKARASU S
Date: 2020.06.15 18:24:15 IST
Reason: For RoyalSundaram
Location: Chennai
Authorised Signatory

Consolidated Stamp Duty Paid to Govt of TamilNadu This document is digitally signed, hence counter signature / stamp is not required.

GSTIN : 36AABCR7106G1ZK UIN: IRDAN102P0004V02201617 PAN Number : AABCR7106G

For Legal interpretation, English version will hold good.
4dcefe978bc2735a1387024fd95e4d5c

For Motor Claim Intimations Call us first 1800 568 9999 (24/7 Tollfree)
Registered Office: 21, Patullos Road, Chennai - 600002 | IRDAI Reg. No.102 | CIN: U67200TN2000PLC045611
Customer Care 1860 425 0000 | Email: [email protected] | Visit: www.royalsundaram.in