Date : 26/02/2021

Policy No.: V8225645

Mr. SUDARMA V ACHARYA
S/O VASUDEVA ACHARYA,
NEAR HARADIKATTE, To renew SMS, REN to 9222211100
UPPINANGADY ROAD PUTTUR TQ,
DAKSHINA KANNADA,
KARNATAKA, Pincode: 574201
Telephone(Mob) : 8867807840
Email Id : [email protected]
Intermediary Name : KAVYASHREE SHETTY-IAG
PTW

Dear Mr. SUDARMA V ACHARYA

Welcome to the Future Generali Experience.

We thank you for choosing Motor Secure insurance policy. Your Policy No. is V8225645. 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.
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 email us at
[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 information provided by you. The extract of the information has been enclosed for
your reference. We would request you to peruse the policy and satisfy yourself that it meets with your requirement fully.

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 along with evidence of sale and transfer fees of ₹. 50/- + Goods and Service tax .

We would like to assure you that the electronic copy of your policy is as authentic and valid as the physical copy and it can be used as a
proof of insurance wherever required.
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.
2nd Floor Empire Mall
M.G.Road
-
Mangalore (Authorised Signatory)
Karnataka, 575003

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, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 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 : V8225645 Address of Service Provider : Off Code-44,Future Generali India Insurance Co
Ltd, 2nd Floor Empire Mall, M.G.Road, -,
Mangalore, Karnataka, Pincode - 575003
Invoice Number : 202029PNT0197984

Reverse Charge : No Area Code : Mangalore Branch Office

Name of Insured/Proposer : Mr. SUDARMA V ACHARYA FGI State Code : 29
Address : S/O VASUDEVA ACHARYA, NEAR FGI GSTIN Number : 29AABCF0191R1Z5
HARADIKATTE, UPPINANGADU ROAD FGI PAN Number : AABCF0191R
PUTTUR TQ, DAKSHINA KANNADA,
KARNATAKA, Pincode- 574201
Place of Supply(State Code): 29 Intermediary Name \ Code : KAVYASHREE SHETTY \ 60081466
GSTIN / UIN Number : - Date of Issue / Invoice : 26/02/2021
Date
Period of Insurance : From 00:01 hours of 28/02/2021 HSN : 997134
To Midnight of 27/02/2022 Nature of Service : General Insurance Service

Received with thanks from a sum of ₹ 1,408.00 towards Premium on the above mentioned policy.

PARTICULARS TAX(%) PREMIUM ( ₹ )

Gross Premium 1,193.00
Add : CGST 9% 107.37
Add : SGST 9% 107.37
Add : Cess -
Total (Rounded to nearest rupee) 1,408.00

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 DS Future
Generali India Insurance Co.
Ltd.
Date: 2021.02.26 13:35:15 IST
Location: Mumbai
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 26/02/2021

Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 POS - Motor Secure Two Wheeler Insurance Policy
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989
Policy Servicing : Off Code-44,Future Generali India Insurance Co Ltd, 2nd Floor Empire Mall, M.G.Road, -, Mangalore,
Office Karnataka, Pincode- 575003., Tel_No: 0824-4249222
Policy No. : V8225645 Period of Insurance : From 00:01 hrs of 28/02/2021 To
Insured : Mr. SUDARMA V ACHARYA Midnight of 27/02/2022.
Address : S/O VASUDEVA ACHARYA, Covernote No : - Dated: Zone: B
NEAR HARADIKATTE, Intermediary Name/Code : KAVYASHREE SHETTY / 60081466
UPPINANGADU ROAD PUTTUR Telephone(Mob,Hom) : 9448369091/9448369091
TQ, DAKSHINA KANNADA, Email ID : [email protected]
KARNATAKA, 574201 Intermediary Pan card : MCHPS8808R
No
GSTIN Number : - FGI GSTIN Number : 29AABCF0191R1Z5
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No., Make/Model of Vehicle Engine No. Chassis No.
RTA Location
KA21S6913 TVS APACHE RTR 160 KickStart 0E4CE2582885 MD634KE45E2C90879
PUTTUR
Year of Manufacture Cubic Capacity Type of Body Seating Premium
Capacity
2014 160 BIKE 2 1,408.00
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.
Warranted that the *Vehicle insured herewith has a valid Pollution Under Control (PUC) Certificate as on the inception date
of the policy.(*Not applicable for Electric Vehicles and New Non- Electric Vehicles).
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, 100000 /- 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 - NA
computation table
Hypothecation Agreement with:- NIL
SPECIAL CONDITIONS – NIL
ADDITIONAL EXCESS – NIL

Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 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 : V8225645 Period Of Insurance : From 00:01 hrs of 28/02/2021 To Midnight of 27/02/2022
INSURED'S DECLARED VALUE
For Vehicle -₹ For Non Elec For Side Car-₹ For Elec Accessories- For Bi-Fuel Kit Total Value-₹
Accessories - ₹ ₹ (CNG/LPG) - ₹
- - - - -
SCHEDULE OF PREMIUM
PARTICULARS ₹ ₹
A-OWN DAMAGE
Total Own Damage Premium (A) (rounded off) 0
B-LIABILITY
Basic Premium including Premium for TPPD 1,193.00
Total Liability Premium (B) 1,193.00
Total Annual Premium (A+B) 1,193.00
Total Premium for the Policy Period 1,193.00
Goods and Service Tax 214.74
Total Premium (rounded off) 1,408.00
Class of Vehicle: Two Wheelers Subject to Endorsement Nos.
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 :
Date of Issue : 26/02/2021
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 26/02/2021
For registration of your Motor Claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable)
The stamp duty of Rs. 0.25/- paid by Letter Of Authorisation No. CSD/227/2021/301/21, Dated 25/01/2021. Mudrank -
2017/C.R.97/M-1,dated 09/01/2018.

Product UIN : 1/RD/FGIICL/MOTORS/FS/07-

Infectious Disease / COVID-19 Exclusion

Notwithstanding any provision to the contrary, this Reinsurance / Insurance excludes any loss, damage, liability, expense, fines,
penalties or any other amount directly or indirectly caused by, in connection with, or in any way involving or arising out of any
of the following –including any fear or threat thereof, whether actual or perceived – :
¨ Any infectious disease, virus, bacterium or other microorganism (whether asymptomatic or not); or
¨ Coronavirus (COVID-19) including any mutation or variation thereof; or
¨ Pandemic or epidemic, as declared as such by the World Health Organization or any governmental authority.

Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Dear SUDARMA V ACHARYA,

We wish to inform you that the Insurance policy number V8225645 has been issued on the basis of the information and
declaration given by you, the transcript whereof is mentioned below. In case of any disagreement or objection or any changes
with respect to information mentioned below, we request you to please revert back within a period of 15 days from date of your
receipt of this transcript or the policy start date whichever is earlier, failing which it will be deemed that you are satisfied with
the correctness of the details mentioned below. Please be informed that this Policy shall be construed to be void ab initio/invalid
in the event we find that you have not disclosed material or correct information required for the purpose of providing the below
insurance cover and in case of any claim arising under the policy in such a scenario, we shall be under no obligation whatsoever
to settle such claim to you and the premium paid by you under this policy shall stand fully forfeited.
POS - Motor Secure Two Wheeler Insurance Policy - TRANSCRIPT/DECLARATION
Sr No Insured Details
1 Insured Name SUDARMA V ACHARYA
2 Registration address of the Insured S/O VASUDEVA ACHARYA, NEAR HARADIKATTE,
UPPINANGADU ROAD PUTTUR TQ, DAKSHINA
KANNADA, KARNATAKA, 574201
3 Communication address of the Insured S/O VASUDEVA ACHARYA, NEAR HARADIKATTE,
UPPINANGADY ROAD PUTTUR TQ, DAKSHINA
KANNADA, KARNATAKA, Pincode :- 574201
4 Residence Telephone no 8867807840
5 Mobile no 8867807840
6 Email id [email protected]
Policy Details
7 Policy Number V8225645
8 Risk start time and date 28/02/2021/00:01
9 Risk end date 27/02/2022
10 Renewal NCB % 0%
Vehicle Details
11 Make and Model of vehicle insured TVS APACHE RTR 160 KickStart
12 Registration No KA21S6913
13 Engine No 0E4CE2582885
14 Chassis No MD634KE45E2C90879
15 Cubic Capacity 160
16 Year of Manufacturing 2014
17 RTO where vehicle is/will be registered PUTTUR
18 Seating Capacity 2
19 Date of Registration / Purchase 27/09/2014
20 Usage of the vehicle TW
21 Fuel Type Petrol
22 Hypothecation/Lease/Hire Purchase
23 Bank Name
24 Vehicle * being insured has valid Pollution Under Yes
Control (PUC) Certificate as on inception date of
policy.(*Not applicable for New Vehicle)
Previous Insurance Details
25 Previous Insurer Name
26 Expiring Policy No

27 Expiring Policy Expiry Date

28 No Claim Bonus % under expiring policy 0.00 %
29 Is there any claim in expiring policy -
IDV Details
30 Vehicle IDV on Renewal ₹.-
31 Electrical Accessories IDV ₹.0
32 Non Electrical Accessories IDV ₹.0
33 CNG IDV ₹.0
34 Add on Plan

Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Third Party Coverages Opted
35 Basic Premium including Premium for TPPD Opted
36 Add:-Trailers Not Opted
37 Less : Limit of Liability under sec II-1(ii)-₹. 6000 Not Opted
38 Add : Bi-Fuel Kit (CNG/LPG) Not Opted
39 Add : Geographical Area Extn Not Opted
40 Add : Compulsory PA to Owner-Driver ₹. lacs Not Opted
41 Add : PA to persons other than Owner/Driver (No. of Not Opted
persons 0)PA Limit ₹.0 per person.
42 Add : PA to Drivers/Cleaner/Conductors (No. of Not Opted
persons 0) PA Limit ₹ 0 per person.
43 PA to Named Persons other than Owner Driver As per Not Opted
Annexure attached
44 Add : Legal Liability to Paid Not Opted
Driver/Cleaner/Employees (No. of persons 0)
45 Add : Legal Liability to (No. of persons 0) Not Opted
46 Add : Increased Limit of Liability under sec II-1(ii)-₹. Not Opted
7.5lacs
Own Damage Coverages Opted
47 Basic Premium on Vehicle Not Opted
48 Add : Non-Electrical Accessories Not Opted
49 Add : Electrical/Electronic Accessories Not Opted
50 Add : Bi-Fuel Kit (CNG/LPG) Not Opted
51 Add : Trailers Not Opted
52 Add : Geographical Area Extn Not Opted
53 Add : Embassy Loading Not Opted
54 Add : Fibre Glass Tanks Not Opted
55 Add : Driving Tutions Not Opted
56 Add : Rallies Not Opted
57 Less : Anti Theft Not Opted
58 Less : Vehicles Specially Designed/Modified For Not Opted
Handicapped Persons
59 Less : Use confined to own premises Not Opted
60 Less : Automobile Association Membership Not Opted
61 Less : Vintage Car Not Opted
62 Less : Voluntary Deductible-₹. 0 Not Opted
63 Add : Add-on Premium Not Opted
Nominee Details
64 Nominee Name -
65 Nominee Relationship with Insured -
66 Nominee Age in Y or M --
67 Nominee % -
68 Appointee Name -
69 Relationship of Appointee with Nominee -
On examination of the Policy, if you notice any mistake, please return the Policy to the Company immediately for correction.
Any modification(s) in the policy resulting in additional premium, will be applicable from the inception of the policy and this has
to be paid by you immediately to keep the policy coverage intact.
In case of Disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please
contact our Help Line numbers & register your objections/changes/disagreement to the contents of this transcript or you may also
send us email or written correspondence at the below address within a period of 15 days from date of receipt of this transcript or
the policy start date whichever is earlier.

Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 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)

Future Generali India Insurance Company Limited, Registered and Corporate Office address: 801 and 802, 8thFloor, Tower C, Embassy 24X7 Park,
L.B.S. Marg, Vikhroli - West, Mumbai, Maharashtra - 400083 Care Line:- 1800-220-233,1860-500-3333,022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287