To, Date : 21/11/2021

Mr RAM CHANDRA
KESHAVPURI DAISHWALA ,DOIWALA,DEHRADUN,
Dehradun City,Dehradun,
Uttarakhand-248001,
India
Contact Details: 9675606557

Subject : Policy Number: P03090921412478

Dear Customer,

Welcome to SBI General. Thank you for choosing SBI General¶s ³Commercial Motor Goods Carrying´policy. We are delighted to
have you as our esteemed customer.With this, we enclose the following documents pertaining to your policy:

‡Policy Schedule
‡Policy clauses & wordings
‡Premium Receipt
‡Grievance redressal letter

We have taken care that the documents reflect details of risk and coveras proposed by you. We request you to verify and confirm that

the documents are in order .Please ensure safety of these document as they form part of our contract with you. for all your future

correspondence you may have with us, kindly quote your Customer ID and Policy No.

Your Customer ID : 0

Your Policy No : P03090921412478

The Postal Address of your SBI General Branch that will service you in future is:

SBI General Insurance Company Limited

Natraj,101,201,301, Junction of Western Express Highway and Andheri-Kurla Road,
Andheri East,Mumbai,Mumbai,
Maharashtra-400069,
India

In case of any queries or suggestions, please do not hesitate to get in touch with us. You can contact us at
[email protected] or call our Customer Care Number 1800-22-1111 (MTNL/BSNL user) and 1800-102-1111 (for other
users)

We look forward to a continuing and mutually beneficial relationship.

Yours sincerely,

Authorized Signatory

SBI General Insurance Company Limited

Registered and Corporate Office: ³Natraj´101,201&301,Junction of Western Express Highway & Andheri Kurla±Road, Andheri(East),Mumbai±

Page 1 of 17
 COMMERCIAL GOODS CARRYING VEHICLE CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE

Important Note: 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization of the premium cheque. 2) This Insurance Policy cover is valid
subject to availability of Complete and Correct Registration Number within 15 days from the Date of Commencement of this Policy.

Policy Issuing Office ³Natraj´ Junction of Western Express Highway & Andheri Kurla ±Road, Andheri (East), Mumbai ±
Policy No : P03090921412478 Policy Servicing Branch : HO
Insured Name : Mr RAM CHANDRA
Address : KESHAVPURI DAISHWALA ,DOIWALA,DEHRADUN,
: Dehradun City,Dehradun,
: Dehradun-248001,
: Uttarakhand
Customer Contact Details : 9675606557
Period of Insurance : From : 11/09/2021 00:00:00 Hours to Midnight of: 10/09/2022
Geographical Area : India

INSURED MOTOR VEHICLE DETAILS INSURED TRAILER DETAILS

Make & Model MAHINDRA & MAHINDRA , BOLERO Trailer Registration No:
Year of Manufacturing 2018 Trailer Chassis No:
Registration Number UK-07-CB-5258 Trailer Type
Engine Number TBJ1L98614
Chassis Number MA1ZN2TBKJ1L95602
Cubic Capacity 2523
Carrying Capacity 2
Type of Body PICK-UPS
RTO Location Name DEHRA DUN | UK-07
GVW of the Vehicle 2975

INSURED¶S DECLARED VALUE (IDV)

Vehicle - (Rs.) Body Value -(Rs.) Trailer Value -(Rs.) Non Electrical Electrical Bi fuel kit Value ±(Rs.) Total IDV
Accessories - (Rs.) Accessories - (Rs.)
525000 0 0 0 0 0 525000

LIMITATION AS TO USE : As per Motor Vehicle Rules, 1989, The Policy covers use of the vehicle for any purpose other than : : a) Organized racing, b) Pace Making,
c) Reliability Trials, d) Speed Testing, e) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle (only
for Passenger Carrying Vehicles).

PERSONS OR CLASSES OF PERSONS ENTITLED TO DRIVE: Any person including Insured

STAGE CARRIAGE/CONTRACT CARRIAGE/ PRIVATE SERVICE VEHICLE:Provided that the person driving holds an effective driving license at the time of the
accident and is not disqualifiedfrom holding or obtaining such a license.

GOODS CARRIAGE: 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 a license. Provided also that the person holding an effective learner¶s license may also drive the vehicle when not used for the transport of passengers at the
time of the accident and that such a person satisfies the requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.

NON-TRANSPORT VEHICLES: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 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: 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
or the insured up to the limits specified Rs. 750000/- (c) PA Cover for owner-drive under Section-III CSI - Rs. 1500000/-.

Deductible under Section-I: (i) Compulsory deductible Rs.500/- (ii) Additional Compulsory deductible Rs. /-.

WARRANTY: Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as
applicable, on the date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable,
during the subsistence of the Policy. Further, the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate.
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), as follows:
The preceding year ±Preceding two consecutive years ±Preceding three consecutive years ±Preceding four consecutive years ±Preceding
five consecutive years ±
The No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.

Page 2 of 17
 INTERMEDIARY DETAILS
Intermediary Name : Rajkishor Singh Bisht Intermediary Code : 0047038
Contact Details : Mobile No : -9758619407 Landline No :

NOMINATION DETAILS

Name of the Nominee Date of Birth Relationship with Proposer Name of Appointee (in Nominee is Minor)

TRILOK SINGH 21/12/1991 Employee

Page 3 of 17
 Premium Computation Table
OWN DAMAGE SECTION LIABILITY SECTION
A. OWN DAMAGE SUM INSURED PREMIUM (Rs.) A. LIABILITY PREMIUM (Rs.)
Section
Basic TP Premium 15746.00
Total Own Damage
Premium (including all 525000.00 2745.00
Tariff Add-on, Discount &
Additional Covers
Loadings )
IMT 23 412.00 Personal Accident Sum Insured Nos of Persons Premium (Rs)
Cover
NCB Details
PA for Owner driver 1500000 325.00
No Claim Bonus 20% - Rs 631.00
Legal Liability Cover

LL to paid driver 1 50.00

LL to 1 50.00
cleaner/conductor
and coolies
(A) TOTAL OWN DAMAGE PREMIUM 2526.00 (B) TOTAL LIABILITY PREMIUM 16171.00
Subject to IMT Nos: IMT-21 IMT-23 IMT-28 IMT-7 TOTAL POLICY PREMIUM (A+B) 18697.00
Taxes as applicable 2421.00
SBIG Add Nos :
Kerala Flood Cess @ 1%
Total Premium Collected 21118.00
Hire Purchase/ Lease /Hypothecated with : Hypothecation HDB FINANCIAL SER LTD NA

Premium Collection details: Receipt No.: C0909211039644 , Receipt Date: 09/09/2021

For claims, Please contact us at Toll Free number

MTNL/BSNL users ±Other users ±
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 and on behalf of SBI General Insurance Co. Ltd

Authorized Signatory

Consolidated Stamp Duty Rs. 0.5 paid towards Insurance Policy Stamps vide Order No: 261 Dated: 2014-11-17 16:16:32.0of General Stamp Office,
Mumbai

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 he Insured.
See the clause headed³AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY´For legal interpretation English version will be good.

Page 4 of 17
Policy printed by: 0047038 on Date: 11 September 2021 Time 15:47:28

Disclaimer : Please examine this Policy including attached Schedules / Annexure if any. In the event of any discrepancy please contact the office of the Company
immediately, it being noted that this Policy shall be otherwise considered as being entirely in order. Please find claims settlement & grievance redressal procedure
document attached herein for ready references.

Page 5 of 17
 Branch Office Address:
Reference No:
Natraj,101,201,301,Junction of Western Express Highway and

Andheri-Kurla Road,Andheri East, Mumbai,

OF Receipt No: C0909211039644
Mumbai, India,

Maharashtra-400069.
Date: 09/09/2021

Branch Code: 00022

Party/Depositor ID:

RECEIPT

Received with thanks from RAM CHANDRA

an amount of Rs.21118 (And twenty-one thousand one hundred eighteen)
by online
No:
ACD Acc No:
ACD TransactionNo/InstrumentNo :
Dated : 09/09/2021
Drawn on Bank :
Branch: ,

Amount(Rs.)
Party ID Quote/Policy/Claim No. Name of Party

P03090921412478 RAM CHANDRA 21118

TOTAL 21118

Disclaimer

1)Receipt subject to realisation of instrument submitted

2)Kindly refer to the policy document for time of commencement of cover

For and on behalf of

SBI General Insurance Co. Ltd.

Authorized Signatory

SBI General Insurance Company Limited

Registered and Corporate Office: ³Natraj´101,201&301,Junction of Western Express Highway & Andheri Kurla±Road, Andheri(East),Mumbai±

Page 6 of 17
 COMMERCIAL VEHICLE CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE

ENDORSEMENT WORDINGS
Attached to and forming part of the Schedule to the Policy No: P03090921412478
ENDORSEMENT DESCRIPTION

IMT21- Special Exclusion & Compulsory Deductible

Notwithstanding anything to the contrary contained herein it is hereby understood and agreed that

(a) Special Exclusions

except in the case of Total Loss of the vehicle insured, the insurer shall not be liable under Section I of the policy for loss of or damage to lamps tyres tubes mudguards
bonnet side parts bumpers and paint work.

(b) Compulsory Deductible.

in addition to any amount which the insured may be required to bear under para (a) above the insured shall also bear under section I of the policy in respect of each and
every event (including event giving rise to total loss/constructive total loss) the first Rs.......* of any expenditure(or any less expenditure which may be incurred) for which
provision is made under this policy and/or of any expenditure by the insurer in the exercise of its discretion under Condition No.4 of this policy.

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such amount shall be repaid by the insured to the insurer
forthwith.

For the purpose of this Endorsement the 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.

.* to insert amount as appropriate to the class of vehicle insured as per GR.40 of the tariff.

IMT23- Inclusion of IMT 23

(For all Commercial Vehicles) In consideration of payment of an additional premium of Rs 412.00 *, notwithstanding anything to the contrary contained in the Policy it is
hereby understood and agreed that subject to conditions (a) (b) and (c) hereunder loss of or damage (excluding theft under any circumstances) to lamps tyres/tubes
mudguards bonnet/side parts bumpers headlights and paintwork of damaged portion only is covered provided the vehicle is also damaged at the same time.

Subject to:
(a) Depreciation as per schedule provided in Section 1 of the Policy. It is further understood and agreed that in respect of paint work for the damaged portion only (as referred
to above) shall also be as per schedule provided in Section 1 of the Policy.

(b) In addition to any amount which the Insured may be required to bear under para (a) above, the Insured shall also bear 50% of the assessed loss in respect of each and
every claim under this Endorsement.

(c) It is also understood that no deductible other than those mentioned in (a) and (b) above shall be applicable in respect of a claim which become payable under this
Endorsement.

Subject otherwise to the terms conditions limitations and exceptions of this Policy.

* To insert the sum arrived at as per the provisions of G.R.40. NB.3. of the Tariff

IMT28- Legal Liability to Driver

In consideration of an additional premium of Rs. 50/- notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insurer shall
indemnify the insured against the insured¶s legal liability under the Workmen's Compensation Act, 1923 ,the Fatal Accidents Act, 1855 or at Common Law and subsequent
amendments of these Acts prior to the date of this Endorsement in respect of personal injury to any paid driver and/or conductor and/or cleaner whilst engaged in the service
of the insured in such occupation in connection with the vehicle insured herein and will in addition be responsible for all costs and expenses incurred with its written consent.

Provided always that

(1) this Endorsement does not indemnify the insured in respect of any liability in cases where the insured holds or subsequently effects with any insurer or group of insurers
a Policy of Insurance in respect of liability as herein defined for insured¶s general employees;

(2) the insured shall take reasonable precautions to prevent accidents and shall comply with all statutory obligations;

*(3) the insured shall keep record of the name of each paid driver conductor cleaner or persons employed in loading and/or unloading and the amount of wages and salaries
and other earnings paid to such employees and shall at all times allow the insurer to inspect such records on demand.

(4) in the event of the Policy being cancelled at the request of the insured no refund of the premium paid in respect of this Endorsement will be allowed.

Subject otherwise to the terms conditions limitations and exceptions of the Policy except so far as necessary to meet the requirements of the Motor Vehicles Act,1988.

*In case of Private cars/ motorised two wheelers (not used for hire or reward) delete this para.

Page 7 of 17
IMT 7- Hypothecation

Vehicles subject to Hypothecation Agreement It is hereby declared and agreed that the vehicle insured is pledged to / hypothecated with HDB FINANCIAL SER LTD
(hereinafter referred to as the Pledgee) and it is further understood and agreed that the Pledgee is interested in any monies which but for this Endorsement would be payable
to the insured under this policy in respect of such loss or damage to the vehicle insured as cannot be made good by repair and / or replacement of 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 discharge to the insurer in respect of such loss or
damage. It is further declared and agreed that for the purpose of the Personal Accident Cover for the owner-driver granted under this policy, the insured named in the policy
will continue to be deemed as the owner-driver subject to compliance of provisions of the policy relating to this cover. Save as by this Endorsement expressly agreed that
nothing herein shall modify or affect the rights or liabilities of the Insured or the Insurer respectively under or in connection with this Policy or any term, provision or condition
thereof. Subject otherwise to the terms exceptions conditions and limitations of this policy.

Page 8 of 17
 GST TAX INVOICE

GST Invoice GST Invoice Date: 09/09/2021

No:

GSTIN/Unique
No: (SBI 27AAMCS8857L1ZC SBI General State Maharashtra
General)

SBI General SBI General Insurance Company Limited

Branch Natraj, 301, Junction of Western Express Highway and Andheri-Kurla Road,
Address: Andheri East,Mumbai,Mumbai,
Maharashtra-400069,
India
Details of Policy Holder:

Name: Mr RAM CHANDRA

Address: KESHAVPURI DAISHWALA DOIWALA DEHRADUN,Dehradun City,Dehradun,Uttarakhand-248001,India
Policy Holder Uttarakhand
State

GSTIN/Unique Policy Number P03090921412478

No:

Insurance HSN Code Premium CGST SGST/UTGST IGST

Product Name (without Taxes)

Rate Amount Rate Amount Rate Amount

- 18697.00 - - - - - -

Total Invoice
Value (In
Figures)
21118.00

Taxes 2421.00
Applicable

Kerala Flood Authorized Signatory

Cess @ 1%

SBI General C0909211039644 Receipt Date 09/09/2021

Receipt No:

Page 9 of 17
 COMMERCIAL VEHICLE INSURANCE ±POLICY PACKAGE

POLICY WORDINGS

Where as the Insured by aproposa land declaration dated as stated in the Schedule which shall be the basis of this contract and is deemed to be incorporated herein has
applied to SBI GENERAL INSURANCE COMPANY LIMITED (hereinafter called ³the Company´for the insurance hereinafter contained and has paid the premium mentioned
in the Schedule as consideration for such insurance in respect of accidental loss or damage occurring during the period of insurance.
NOW THIS POLICY WITNESSETH:

That subject to the Terms Exceptions and Conditions contained herein or endorsed or expressed hereon
SECTION I ±LOSS OF OR DAMAGE TO THE VEHICLE INSURED
1)The Company will indemnify the Insured against loss or damage to the vehicle insured hereunder and / or its accessories whilst thereon
i. by fire explosion self-ignition or lightning ;
ii. burglary housebreaking or theft ;
iii. by riot and strike;
iv. by earthquake (fire and shock damage);
v. by flood typhoon hurricane storm tempest inundation cyclone hailstorm frost;
vi. by accidental external means;
vii. by malicious act;
viii. by terrorist activity;
ix. whilst in transit by road rail inland-waterway lift elevator or air;
x. by landslide rockslide.
Subject to a deduction for depreciation at the rates mentioned below in respect of parts replaced:
(1) For all rubber/ nylon / plastic parts, tyres , tubes,batteries and air bags - 50%
(2) For fibre glass components ±
(3) For all parts made of glass - Nil
(4) Rate of depreciation for all other parts including wooden parts will be as per the following schedule.

AGE OF THE VEHICLE % OF DEPRECIATION

Not exceeding 6 months NIL
Exceeding 6 months but not exceeding 1 year 5%
Exceeding 1 year but not exceeding 2 years 10%
Exceeding 2 years but not exceeding 3 years 15%
Exceeding 3 years but not exceeding 4 years 25%
Exceeding 4 years but not exceeding 5 years 35%
Exceeding 5 years but not exceeding 10 years 40%
Exceeding 10 years 50%

(5) Rate of Depreciation for Painting: In the case of painting, the depreciation rate of 50% shall be applied only on the material cost of total painting charges.In case
of a consolidated bill for painting charges, the material component shall be considered as 25% of total painting charges for the purpose of applying the depreciation.
2. The Company shall not be liable to make any payment in respect of

(a) consequential loss,depreciation,wear and tear,mechanical or electrical break down,failures or breakages nor for damage caused by overloading or strain of
the insured vehicle nor for loss of or damage to accessories by burglary, housebreaking or theft unless such insured vehicle is stolen at the same time.
(b) damage to Tyres and Tubes unless the vehicle is damaged at the same time in which case the liability of the Company shall be limited to 50% of the cost of
replacement. and
(c) any accidental loss or damage suffered whilst the Insured or any person driving the vehicle with the knowledge and consent of the Insured is under the
influence of intoxicating liquor or drugs.
3. In the event of the vehicle being disabled by reason of loss or damage covered under this Policy the Company will bear the reasonable cost of protection and removal
to the nearest repairer and re-delivery to the Insured but not exceeding Rs.750/- for three wheeled vehicles, Rs.1500/- for taxis and Rs. 2500/- for other commercial
vehicles in respect of any one accident.
4. The Insured may authorise the repair of the vehicle necessitated by damage for which the Company may be liable under this Policy provided that:
(a) the estimated cost of such repair including replacements, if any, does not exceed Rs.500/-;
(b) the Company is furnished forthwith with a detailed estimate of the cost of repairs; and
(c) the Insured shall give the Company every assistance to see that such repair is necessary and the charges are reasonable.

SUM INSURED ±INSURED¶S DECLARED VALUE (IDV)

The Insured¶s Declared Value (IDV) of the vehicle will be deemed to be the µSUM INSURED¶for the purpose of this Policy which is fixed at the commencement of each
Policy period for the insured vehicle. The IDV of the vehicle (and accessories if any fitted to the vehicle) is to be fixed on the basis of the manufacturer¶s listed selling price of
the brand and model as the vehicle insured at the commencement of insurance/renewal and adjusted for depreciation (as per schedul below). The schedule of age-wise
depreciation as shown below is applicable for the purpose of Total Loss/Constructive Total Loss (TL/CTL) claims only

THE SCHEDULE OF DEPRECIATION FOR FIXING IDV OF THE VEHICLE

AGE OF THE VEHICLE % OF DEPRECIATION FOR FIXING IDV

Not exceeding 6 months 5%
Exceeding 6 months but not exceeding 1 year 15%
Exceeding 1 year but not exceeding 2 years 20%
Exceeding 2 years but not exceeding 3 years 30%
Exceeding 3 years but not exceeding 4 years 40%
Exceeding 4 years but not exceeding 5 years 50%

Page 10 of 17
IDV of vehicles beyond 5 years of age and of obsolete models of the vehicles (i.e. models which the manufacturers have discontinued to manufacture) is to be determined on
the basis of an understanding between the Company and the Insured. IDV shall be treated as theµMarket Value¶through out the policy period without any further depreciation
for the purpose of Total Loss(TL)/Constructive Total Loss (CTL) claims.

The insured vehicle shall be treated as a CTL if the aggregate cost of retrieval and / or repair of the vehicle, subject to terms and conditions of the Policy, exceeds 75% of the
IDV of the vehicle.

SECTION II ±LIABILITY TO THIRD PARTIES

1. Subject to the limits of liability as laid down in the Schedule here to the Company will in demnify the Insured in the event of anaccident caused by orarising out of the use of
the vehicle against all sums which the Insured shall become legally liable to pay in respect of :
i) death of or bodily injury to any person caused by or arising out of the use (including the loading and/or unloading) of the vehicle.
ii) damage to property caused by the use (including the loading and/or unloading) of the vehicle.

Provided always that :

(a) The Company shall not be liable in respect of death, injury damage caused or arising beyond the limits of any carriage way or thoroughfare in connection with the
bringing of the load to the insured vehicle for loading the reonor the taking away of the load from the insured vehicle after unloading there from.
(b) Except so far as is necessary to meet the requirements of the Motor Vehicle Act the Company shall not be liable in respect of death or bodily injury to any person in
the employment of the Insured arising out of and in the course of such employment.
(c) Except so far as is necessary to meet the requirements of the Motor Vehicles Act in relation to the liability under the Workmen's Compensation Act 1923 the
Company shall not be liable in respect of death or bodily injury to any person (other than a passenger carried by reason of or in pursuance of a contract of
employment) being carried in or upon entering or mounting or alighting from the insured vehicle at the time of occurrence of the event out of which any claim arises.
(d) The Company shall not be liable in respect of damage to property belonging to or he ldin trust by or in the custody of the Insured or a member of the Insured's
household or being conveyed by the insured vehicle.
(e) The Company shall not be liable in respect of damage to any bridge and/or viaduct and/or to any road and/or anything beneath by vibration or by the weight of the
insured vehicle and/or load carried by the insured vehicle.
(f) Except so far as is necessary to meet the requirements of the Motor Vehicles Act the Company shall not be liable in respect of death and/or bodily injuryto any
person(s) who is/are not employee(s) of the Insured and not being carried for hire or reward, other than owner of the goods or representative of the owner of goods
being carried in or upon or entering or mounting or alighting from the insured vehicle described in the Schedule of this Policy.

1. The Company will pay all costs and expenses incurred with its written consent.
2. In terms of and subject to the limitations of the indemnity granted by this Section to the Insured, the Company will in demnify any driver who is driving the vehicle on
the Insured's order or with Insured¶s permission provided that such driver shall as though he/she was the insured observe fulfill and be subject to the terms exceptions
and conditions of this Policy in so far as they apply.
3. The Company may at its own option
a. Arrange for representation at any Inquest or Fatal Inquiry in respect of any death which may be the subject of indemnity under this Policy and
b. Undertake the defence of proceedings in any Court of Law in respect of any act or alleged offence causing or relating to any event which may be the subject of
indemnity under this Policy.
4. In the event of the death of any person entitled to indemnity under this Policy the Company will in respect of the liability incurred by such person indemnify his/her
personal representative in terms of and subject to the limitations of this Policy provided that such personal representative shall as though such representative was
the insured observe fulfill and be subject to the terms exceptions and conditions of this Policy in so far as they apply.

SECTION III - TOWING DISABLED VEHICLES

The Policy shall be operative whilst the insured vehicle is being used for the purpose of towing any one disabled mechanicallypropelledvehicleandthe indemnity provided
by Section II of this Policy shall subject to its terms and limitations be extended to apply in respect of liability in connection with such towed vehicle;

Provided always that

(a) such towed vehicle is not towed for reward
(b) the Company shall not be liable by reason of this Section of this Policy in respect of damage to such towed vehicle or property being conveyed thereby.

SECTION IV ±PERSONAL ACCIDENT COVER FOR OWNER-DRIVER

Subject otherwise to the terms exceptions conditions and limitations of this Policy, the Company under takes to pay compensation as per the following scale for bodily
injury/death sustained by the owner-driver of the vehicle indirect connection with the vehicle insured or whilst mounting into/dismounting from or traveling in the insured
vehicle as a co-driver, caused by violent accidental external and visible means which independent of any other cause shall within six calendar months of such injury result
in:

Nature of injury Scale of compensation

(i) Death 100%
(ii) Loss of two limbs or sight of two eyes or one limb and sight of one eye 100%

(iii) Loss of one limb or sight of one eye 50%

(iv) Permanent total disablement from injuries other than named above 100%

Provided Always that:

1. Compensation shall be payable under only one of the items (i) to (iv) above in respect of the owner-driver arising out of any one occurrence and the total liability of
the Company shall not in the aggregate exceed the sum of Rs. 2 lakhs during any one period of insurance.
2. No compensation shall be payable in respect of death or bodily 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 directly to the Insured or to his/her legal representatives whose receipt shall be the full discharge in respect of the injury to the
Insured.

Page 11 of 17
4. This cover is subject to
(a) the owner-driver is the registered owner of the vehicle insured herein;
(b) the owner-driver is the Insured named in this Policy.
(c) the owner-driver holds an effective driving license, in accordance with the provisions of Rule 3 of the Central Motor Vehicles Rules, 1989,at the timeof the
accident.

AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY

Nothing in this Policy or any endorsement hereon shall affect the right of any person indemnified by this Policy or any other person to recover an amount under or by virtue of
the provisions of the Motor Vehicles Act, 1988.

But the Insured shall repay to the Company all sums paid by the Company which the Company would not have been liable to pay but for the said provision.

GENERAL EXCEPTIONS
(Applicable to all Sections of the Policy)

The Company shall not be liable under this Policy in respect of

1. Any accidental loss or damage and/or liability caused sustained or incurred outside the geographical area;

2. Any claim arising out of any contractual liability;

3. Any accidental loss damage and/or liability caused sustained or incurred whilst the vehicle insured herein is

(a) being used otherwise than in accordance with the µLimitations as to Use¶or
(b) being driven by or is for the purpose of being driven by him/her in the charge of any person other than a Driver as stated in the Driver's Clause.

4(a) any accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising there from or any consequential loss
(b)any liability of whatsoever nature directly orindirectly caused by or contributed to by orarising from ionising radiations or contamination by radioactivity fromany nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception combustion shall include any selfsustaining process of nuclear fission.
5. Any accidental loss or damage or liability directly or indirectly caused by or contributed to by or arising from nuclear weapons material.

6. Any accidental loss damage and/or liability directly or indirectly or proximately or remotely occasioned by contributed to by or traceable to or arising out of or in
connection with war, invasion, the act of foreign enemies, hostilities or warlike operations (whether before or after declaration of war) civil war, mutiny rebellion, military
or usurped power or by any direct or indirect consequence of any of the said occurrences and in the event of any claim here under the Insured shall prove that the
accidental loss damage and/or liability arose independently of and was in noway connected with oroccasioned by or contributed to by or traceable to any of the said
occurrences or any consequences thereof and in default of such proof, the Company shall not be liable to make any payment in respect of such a claim.

DEDUCTIBLE

The Company shall not be liable for each and every claim under Section-I (loss of or damage to the vehiclei nsured) ofthisPolicy in respect of the deductible stated in the
Schedule.

CONDITIONS
This Policy and the Schedule shall be read together and any word or expression to which a specific meaning has been attached in any part of this Policy Or of the Schedule
shall bear the same meaning wherever it may appear.

1. Notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage in the event of any claim and thereafter the insured
shall give all such information and assistance as the Company shall require. Every letter claim writ summons and/or process or copy thereof shall be forwarded to the
Company immediately on receipt by the Insured. Notice shall also be given in writing to the Company immediately the Insured shall have knowledge of any impending
prosecution, inquest or fatal inquiry in respect of any occurrence which may give rise to a claim under this Policy. In case of theft or criminal act which may be the
subject of a claim under this Policy the Insured shall give immediate notice to the police and cooperate with the Company in securing the conviction of the offender.

2. No admission offer promise payment or indemnity shall be made or given by or on behalf of the Insured without the written consent of the Company which shall be
entitled if it so desires to take over and conduct in the name of the Insured the defence or settlement of any claim or to prosecute in the name of the Insured for its own
benefit any claim for indemnity or otherwise and shall have full discretion in the conduct of any proceedings or in the settlement of any claim and the Insured shall give
all such information and assistance as the Company may require.
3. At any time after the happening of any event giving rise to a claim under Section II of this Policy the Company may pay to the Insured the full amount of the Company's
liabilityunder the Section and relinquish the conduct of any defence settlement or proceedingsand the Company shall not be responsible for any damage alleged to
have been caused to the Insured in consequence of any alleged action or omission of the Company in connection with such defence settlement or proceedings or of the
Company relinquishing such conduct; nor shall the Company be liable for any costs or expenses whatsoever incurred by the Insured or any claimant or other person
after the Company shall have relinquished such conduct.

4. The Company may at its own option repair reinstate or replace the vehicle or part thereof and/or its accessories or may pay in cash the amount of the loss or damage
and the liability of the Company shall not exceed:

(a) For total loss / constructive total loss of the vehicle - the Insured's Declared Value (IDV) of the vehicle (including accessories thereon) as specified
In the Schedule less the value of the wreck.

(b) For partial losses, i.e. losses other than Total Loss/Constructive Total Loss of the vehicle - actual and reasonable costs of repair and/or replacement of parts
lost/damaged subject to depreciation as per limits specified.

Page 12 of 17
5. The Insured shall take all reasonable steps to safeguard the vehicle from loss or damage and to maintain it in efficient condition and the Company shall have at all
times free and full access to examine the vehicle or any part there of or any driver or employee of the Insured. In the event of

any accident or breakdown, the vehicle shall not be left unattended without proper precautions being taken to prevent further damage or loss and if the vehicle bedriven
before the necessary repairs are effected any extension of the damage or any further damage to the vehicle shall be entirely at the Insured's own risk.
6. The Company may cancel the Policy by sendings even days notice by recorded delivery to the Insured at Insured¶s last known addressand in such event will return to
the Insured the premium paid less the prorataportion there of for the period the Policy has been in force or the Policy may be cancelled at any time by the Insured on
seven days¶notice by recorded delivery and provided no claim has arisen during the currency of the policy, the Insured shall be entitled to a return of premium less
premium at the Company's Short Period rates for the period the Policy has been in force. Return of the premium by the Company will be subject to retention of the
minimum premium of Rs. 100/- (or Rs.25/- in respect of vehicles specifically designed/modified for use by blind/handicapped/mentally challenged persons). Where the
ownership of the vehicle is transferred, the Policy cannot be cancelled unless evidence th at the vehicle is insured elsewhere is produced

7. If any dispute or difference shall arise as to the quantum to be paid under this Policy (liability being otherwise admitted), such difference shall independent of all other
questions be referred to the decision of a sole arbitrator to be appointed in writing by the parties to the dispute or if they cannot agree upon a single arbitrator within 30
days of any party invoking Arbitration, the same shall be referred to a panel of three arbitrators comprising two arbitrators one to be appointed by each of the parties to
the dispute / difference, and a third arbitrator to be appointed by such two arbitrators who shall act as the presiding arbitrator and Arbitration shall be conducted under
and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.

It is clearly agreed and understood that no dispute or difference shall be referable to Arbitration as here inbeforerovided, if the Company has disputed or not accepted
liability under or in respect of this Policy.
It is hereby expressly stipulated and declared that it shall be condition precedent to any right of action or suit upon this Policy that the award by such arbitrator/
arbitrators of the amount of the loss or damage shall be first obtained.
It is also here by further expressly agreed and declared that if the Company shall disclaim liability to the Insured for any claim here under andsuchclaim shall not, within
twelve calendar months from the date of such disclaimer have been made the subject matter of a suit in a court of law, then the claim shall for all purposes be deemed
to have been abandoned and shall not thereafter be recoverable hereunder.

8. The due observance and fulfillment of the terms, conditions and end or sements of this Policy in so far as they relate to any thing to be done or complied with by the
Insured and the truth of the statements and answers in the said proposal shall be conditions precedent to any liability of the Company to make any payment under this
Policy.
9. If at the time of occurrence of an event that gives rise to any claim under this Policy there is in existence any other insurance covering the same liability,
The Company shall not be liable to pay or contribute more than its ratable proportion of any compensation, cost or expense.
10. In the event of the death of the sole Insured, this Policy will not immediately lapse but will remain valid for a period of three months from the date of the death of
Insured or until the expiry of this Policy (whichever is earlier). During the said period, legal heir(s) of the insured to whom the custody and use of the Motor Vehicle
passes may apply to have this Policy transferred to the name(s) of the heir(s) or obtain a new insurance policy for the Motor Vehicle.
Where such legal heir(s) desire(s) to apply for transfer of this Policy or obtain a new policy for the vehicle such heir(s) should make an application to The Company
accordingly within the aforesaid period. All such applications should be accompanied by:

a) Death Certificate in respect of the Insured

b) Proof of title to the vehicle
c) Original Policy

RULES APPLICABLE TO TANKERS CARRYING HAZARDOUS CHEMICALS

Rule129±A-Spark arrester six month from the date of commencement of Central Motor Vehicles (Amendment) Rules 1993,every goods carriage carrying goods of dangerous
or hazardous nature to human life, shall be fitted with a spark arrester.

Rule 131- Responsibility of the consignor for safe transport of dangerous or hazardous goods.
(1) It shall be responsibility of the consignor intending to transport any dangerous or hazardous goods listed in Table II, to ensure the following, namely :

(a) the goods carriage has a valid registration to carry the said goods
(b) the vehicle is equipped with necessary first-aid, safety equipment and antidotes as may be necessary to contain any accident;
(c) that transporter or the owner of the goods carriage has full and adequate information about the dangerous or hazardous goods being transported; and
(d) that the driver of the goods carriage is trained in handling the dangers posed during transport of such goods.
(2) Every consignor shall supply to the owner of the goods carriage, full and adequate information about the dangerous or hazardous goods being
transported as to enable owner and its driver to
(a) Comply with the requirements of rules 129 to 137 (both inclusive) of these rules and
(b) be aware of the risks created by such goods to health or safety or any person;
(3) It shall be the duty of the consignor to ensure that the information is accurate and sufficient for the purpose of complying with the provisions of rules 129 to 137 (both
inclusive) of these rules.
Rule 132- Responsibility of the Transporter or owner of goods carriage.
(1) It shall be the responsibility of the owner of the goods carriage transporting any dangerous or hazardous goods to ensure the following, namely:
(a) that the goods carriage has a valid registration to carry the said goods and the said carriage is safe for the transport of the said goodsand
(b) the vehicle is equipped with necessary first-aid, safety equipment, tool box and antidotes as may be necessary to contain any accident.
(2) Every owner of a goods carriage shall, before undertaking the transportation of dangerous or hazardous goods in his goods carriage, satisfy himself that the
information given by the consignor is full and accurate in all respects and correspond to the classification of such goods specified in rule 137.
(3) The owner of goods carriage shall ensure that the driver of such carriage is given all the relevant information in writing as given in goods entrusted to him for transport
and satisfy himself that such driver has sufficient understanding of the nature of such goods and the nature of the risks involved in the transport of such goods and is
capable of taking appropriate action in case of an emergency.

Page 13 of 17
 (4) The owner of the goods carriaged angerous or hazardous good sand the consignor of such goods shall lay down the route for each trip which the driver shall be
bound to take unless directed or permitted otherwise by the Police Authorities. They shall also fix a time table foreach trip to the destination and back with reference
to the route so laid down.
(5) It shall be the duty of the owner to ensure that the driver of the goods carriage carrying dangerous or hazardous goods holds a driving license as per provisions of
rule 9 of these rules.

(6) Notwithstanding anything contained in rules 131 and 132, it shall be sufficient compliance of the provisions of these rules if the consignor transporting dangerous or
hazardous goods and the owner of the goods carriage or the transporter abide by these conditions within six month after the date of coming into force of the Central
Motor Vehicles (Amendment) Rules, 1993.

Rule 133- Responsibility of the driver

(1) The driver of a goods carriage transporting dangerous or hazardous goods shall ensure that the information given to him in writing under sub-rule(3) ofRule 132 is
kept in the driver's cabin and is available at all times while the dangerous or hazardous goods to which it relates, are being transported.

(2) Every driver of a goods carriage transporting any dangerous or hazardous goods shall observe at all times all the directions necessary for preventing fire, explosion
or escape of dangerous or hazardous goods carried by him while the goods carriage is in motion and when it is not being driven he shall ensure that the goods
carriage is parked in a place which is safe from fire, explosion and any other risk, and at all times the vehicle remains under the control and supervision of the driver
or some other competent person above the age of 18 years.

Sub-rule(1) of rule 9 of the principal rules :

(1) One year from the date of commencement of Central Motor Vehicles (Amendment) Rules, 1993 any person driving a goods carriage carrying goods of dangerous or
hazardous nature to human life shall, in addition to being the holder of a driving license to drive at ransport vehicleal so have the ability to read and write at least one
Indian Language out of those specified in the VII schedule of the Constitution and English and also possess a certificate of having successfully passed a course
consisting of following syllabus and periodicity connected with the transport of such goods.
Period of training 3 days
Place of training At any institute recognized by the State Government Syllabus

Defensive driving

Questionnaire Cause of accidents Accidents statistics Driver¶s personal fitness Car condition Breaking distance Highway driving Road/Pedestrian crossing Railway
crossing Adapting to weather Head on collision Rear end collision Night driving Films and discussion Duration of training for A& B ±1st and 2nd day

B) Advanced driving skills and training

(i) Discussion
Before starting -check list -outside/below/near vehicle -product side -inside vehicle
During driving -correct speed/gear-signaling -lane control -overtaking/giving side-speed limit/safe distance -driving on slopes
Before Stopping -safe stopping place, -signaling, road width, -condition.
After stopping -preventing vehicle movement -wheel locks -Vehicle attendance Night driving
ii) Field test/training-1 driver at a time.

C) Product safety
UN panel -UN classification Duration of training -Hazchem code for C)-3rd day -Toxicity, Flammability, other definitions. Product Information ±TREMCARDS ±CISMSDS -
importance of temperature pressure, level.
Emergency procedure -Explosive limits -Knowledge about equipment -Communication -Spillage handling -Use of FEE -Fire fighting -First aid -Toxic release control -
protection of wells, rivers,lakes, etc. -Use of protective equipment -knowledge about valves etc.

Page 14 of 17
CLAIM SETTLEMENT

The Company will settle the claim under this Policy with in 30 days from the date of receipt of necessary documents required for assessing the claim.In the event that

the Company decides to reject a claim made under this Policy,the Company shall do so with in a period of thirty days of the Survey Report or the additional Survey

Report, as the case may be, in accordance with the provisions of Protection of Policyholders¶Interest Regulations 2002.

GRIEVANCE REDRESSAL PROCEDURE

Dear Customer

We value your relationship and are committed to offer you best in class customer service.However if you are dissatisfied with the services rendered by us during any of your
interactions with us or on resolution provided by us on your service request or complaint, we request you to register your concern with our Customer Care Team by following
the steps mentioned below.We will acknowledge receipt of your concerns within next 72 working hours & will respond to you as soon as possible upon completion of the
investigation.

Step 1:

Call us at Toll free nos: 1800 - 102- 1111 & 1800-22-1111 from Monday to Saturday (08.00 am - 8.00 pm) or write to us at [email protected] you don¶t hear
from us within 48 hrs please follow step 2

Step 2:

If you are dissatisfied with the resolution provided, please Email to Head±customer careat [email protected]

If after having followed Steps 1& Step 2 your issuere mains unresolved for more than 30 days from the date of filing your first complaint, you may approach the Insurance
Ombudsman for Redressal of your Grievance.

The list of Insurance Ombudsman offices along with their area of jurisdiction is attached here with.

Names of Ombudsman and Addresses of Ombudsmen Centres

Office of the Insurance Ombudsman, Shri Raj Kumar Srivastava,

2nd Floor, Ambica House, Office of the Insurance Ombudsman,
Nr. C.U. Shah College, Ashram Road, 2nd Floor, Janak Vihar Complex,
AHMEDABAD-380 014. 6, Malviya Nagar,Opp. Airtel, Near New Market,
Tel.:- 079-27545441/27546139 Fax : 079-27546142 BHOPAL(M.P.)-462 003.
Email: [email protected] Tel.:- 0755-2769201/9202 Fax : 0755-2769203
Email: [email protected]

Shri B.N. Mishra, Shri Manik Sonawane

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman,
62, Forest Park, S.C.O. No.101-103,2nd Floor,
BHUBANESHWAR-751 009. Batra Building, Sector 17-D,
Tel.:- 0674-2596455/2596003 Fax : 0674-2596429 CHANDIGARH-160 017.
Email: [email protected] Tel.:- 0172-2706468/2705861 Fax : 0172-2708274
Email: [email protected]

Shri Virander Kumar, Smt. Sandhya Baliga,

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman,
Fathima Akhtar Court, 2/2 A, Universal Insurance Bldg.,
4th Floor, 453 (old 312), Asaf Ali Road,
Anna Salai, Teynampet, NEW DELHI-110 002.
CHENNAI-600 018. Tel.:- 011-23237539/23232481 Fax : 011-23230858
Tel.:- 044-24333668 /24335284 Fax : 044-24333664 Email: [email protected]
Email: [email protected]

Insurance Ombudsman, Shri G.Rajeswara Rao,

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman,
³JeevanNivesh´5th Floor, 6-2-46, 1st Floor, Moin Court,
Near PanbazarOverbridge, S.S. Road, A.C. Guards, Lakdi-Ka-Pool,
GUWAHATI-781 001 (ASSAM). HYDERABAD-500 004.
Tel.:- 0361-2132204/5 Fax : 0361-2732937 Tel : 040-65504123/23312122 Fax: 040-23376599
Email: [email protected] Email: [email protected]

Shri P.K.Vijayakumar, Shri K.B. Saha,

Office of the Insurance Ombudsman, Office of the Insurance Ombudsman,
2nd Floor, CC 27/2603, Pulinat Bldg., Hindustan Building. Annexe,
Opp. Cochin Shipyard, M.G. Road, 4th Floor, C.R. Avenue,
ERNAKULAM-682 015. KOLKATA-700 072.
Tel : 0484-2358759/2359338 Fax : 0484-2359336 Tel : 033-22124339/22124340 Fax : 033-22124341
Email: [email protected] Email:[email protected]

Page 15 of 17
 Shri N.P. Bhagat, Shri A.K. Dasgupta,
Office of the Insurance Ombudsman, Office of the Insurance Ombudsman,
Jeevan Bhawan, Phase-2, 3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz(W),
6th Floor, Nawal Kishore Road, MUMBAI-400 054.
Hazaratganj, Tel : 022-26106928/26106552 Fax : 022-26106052
LUCKNOW-226 001. Email: [email protected]
Tel : 0522 -2231331/2231330 Fax : 0522-2231310
Email: [email protected]

Shri A.K. Jain, Shri A.K. Sahoo,

Office of the Insurance Ombudsman, 2nd Floor, Jeevan Darshan,
Ground Floor, JeevanNidhi II, N.C. Kelkar Road, Narayanpet,
Bhawani Singh Road, PUNE ±
Jaipur ± Tel: 020-32341320
Tel : 0141-2740363 Email: [email protected]
Email: [email protected]

Shri M. Parshad, OFFICE OF THE GOVERNING BODY OF INSURANCE COUNCIL

Office of the Insurance Ombudsman, Smt. RammaBhasin, Secretary General,
24th Main Road, Jeevan Soudha Bldg. Shri Y.R. Raigar, Secretary
JP Nagar, 1st Phase, 3rd Floor, Jeevan Seva Annexe,
Bengaluru ± S.V. Road, Santacruz(W),
Tel No: 080-22222049/22222048 MUMBAI ±
Email: bimalokpal.bengaluru @gbic.co.i Tel : 022-26106889/6671
Fax : 022-26106949
[email protected]

Address and contact number of Governing Body of Insurance Council

Secretary General
Governing Body of Insurance Council
JeevanSevaAnnexe, 3rd Floor (Above MTNL)
S. V. Road, Santacruz (W),Mumbai ±
Tel: 022-6106889
Fax: 022-6106980, 6106052
Email:[email protected]

Integrated Grievance Management System

IRDA has launched the Integrated Grievance Management System (IGMS). IGMS is a grievance redress monitoring tool for IRDA. Policyholders who have grievances should
register their complaints with the Grievance Redress Channel of the Insurance Company first. If policyholders are not able to access the insurance company directly for any
reason, IGMS provides a gateway to register complaints with insurance companies.

Complaints shall be registered with insurance companies first and only if need be, be escalated them to IRDA (Consumer Affairs Department).

Website:http://www.policyholder.gov.in/Integrated_Grievance_Management.aspx

Toll Free Number of IRDA Grievance Call Centre: 155255

Timings: 8 AM to 8 PM -- (Monday to Saturday)

Page 16 of 17
To, Date : 21/11/2021
Tata AIG General Insurance Co. Ltd
Dear Sirs,

Sub: Confirmation of No Claim Bonus (NCB) Declaration

Ref: Our Policy Number-P03090921412478

We have received a Motor Insurance Proposal, which was earlier insured by your organization as informed by the Proposer to us.
Insured Name Mr RAM CHANDRA NCB % applied on 20 %
your policy
Vehicle MAHINDRA & MAHINDRA BOLERO PICK UP Vehicle UK-07-CB-5258
Insured FB 1.2 5T Registration
Number

Type of Cover Package Your Policy No. / 01612303380000

Covernote No.
Policy Start 9/11/2020 12:00:00 AM Policy End Date 10/09/2021
Date

The proposer has declared his entitlement for 20% on his previous policy with you and he has not filed any claim in the expired policy. How ever, as the proposeris unable
to furnish NCB reserving letter from your office as proof of NCB Entitlement that may be availed as per provisions of the India Motor Tariff. We have accepted the proposal
and permitted the claimed NCB as per declaration submitted to us by the proposer.
Accordingly, we would request you to:

Confirm that the information mentioned above is correct: Yes / No

If No, please state nature of incorrect information and the actual position thereof:

State whether any claim under OD/Liability has been reported: OD/Liability Claim

If Yes, date & amount of claim lodged:

This letter is being sent as per GR27 of India Motor Tariff. We request you to kindly provide us with the desired in formation by filling up the same in the original & sending
it to us.
An early response will be highly appreciated. Please note you are required to respond to this letter within 30 days of receipt of this letter. In case we do not receive a
response from you within this time frame, it shall be deemed that you have confirmed that the information provided by the Proposer (as contained herein) is true and
correct.
Yours faithfully
For SBI General Insurance Company Limited

Authorised Signatory

NCB Confirmation by previous insurer

Previous Policy No.:01612303380000

Reference: SBI General Policy No: P03090921412478
To,

The Manager,

SBI General Insurance Co. Ltd

Natraj, 101,201,301, Junction of Western Express Highway and Andheri-Kurla Road

Andheri East ,
Mumbai,
Mumbai
Maharashtra
India -
400069
We confirm that the insured is eligible / Not Eligible (Strike Out) for 20 % NCB at renewal
For & On Behalf of

Seal, Name & Designation of the Officer

Page 17 of 17