This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: MILAP CHAND

Date: Tue, Oct 4, 2022 17:17:43 IST
Location: NOIDA
Reason: Signing Policy for OICL

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

PRIVATE CAR PACKAGE POLICY - ZONE B
Road Side Assistance included in this policy - Toll free No.18003091209
*Conditions Apply
Policy No : 233605/31/2023/1478 Prev Policy No : 233605/31/2022/1103
Cover Note No : - Cover Note Dt :

Insured's Code : 90089343 Issue Office Code : 233605

Insured's Name : SH. JAYANAT SHARMA S/O SH. Issue Office Name : BO KHANNA (GSTIN: 03AAACT0627R3Z7)
K.C.SHARMA (GSTIN: 0)

Address : H NO. 239, NAROTHAM NAGAR, KHANNA Address : G T ROAD

DISTT. LUDHIANA KHANNA

LUDHIANA PUNJAB 141401 PUNJAB 141401

Tel /Fax /Email : / / 9417642926 / [email protected] Tel /Fax /Email : 01628-230601, 230886, 9855522710 /
01628-506174 /
[email protected];233605@or
ientalinsurance.co.in
Lead/Breakin No : /

Agent/Broker Details
Dev.Off.Code : NY0000000577 SUKHWINDER SINGH
Agent/Broker :: BA0000077832 SH.MUSTKEEN
Address : H.NO.0384, WARD NO. 8, G.T.ROAD,,GHARANA GHEE MILL,
DORAHA,LUDHIANA,PUNJAB,141421
Tel /Fax /Email : 9417642926//NA

Period of Insurance : FROM 00:00 ON 05/10/2022 TO MIDNIGHT OF 04/10/2023

Collection No & Dt : CC 2125002013 - 04/10/2022 GST INVOICE NO :0321208710 UIN :0

Gross Premium : 4,805 GST : 864 Stamp Duty : .5 Total : 5,669

Geographical Area : INDIA Area Extension :

Particulars of Insured Vehicle:

Registration Mark Engine No. & Type Of Body Cubic Year Of Seating Capacity
& Place Chassis No. Make - Model Capacity Manf. (including Driver)
Type Of Fuel
PB 26 F 4005 20000168394 TATA MOTORS-TATA SALOON 1248 2011 4 + 1
INDIGO MANZA AURA
Khanna 017940
(ABS) QUADRAJET BS DIESEL
III

Limitations as to use:

1 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) Use in connection with Motor
Trade

Driver: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.

Limit of Liability:Under Section II-I(1) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-I(ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000
P.A. Cover under Section III for Registered Owner Cum Driver (CSI) : Rs. 1500000
*This insurance excludes all pre-existing damages

Place :
Date : 04/10/2022
Page 1 of 3
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: MILAP CHAND

Date: Tue, Oct 4, 2022 17:17:43 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 233605/31/2023/1478

Insured's Declared Value

For the Vehicle For Trailers Non Electrical Electrical Value of CNG Total Value
Accessories Accessories LPG Kit

1,98,000 0 0 0 1,98,000

SCHEDULE OF PREMIUM

A. OWN DAMAGE B. LIABILITY

BASIC OD COVER 6,791.00 BASIC TP COVER 3,416.00

MOTOR OD BASIC - NEW 2,037.60 BASIC TP TOTAL 3,416.00
LESS :HEAD OFFICE DISCOUNT 2,716.40 ADD :PA FOR OWNER DRIVER-GR36A 320.00
LESS :UNDERWRITER DISCOUNT 2,037.00 ADD :LL-PAID DRIVER, 50.00
BASIC OD TOTAL 2,037.60 CONDUCTOR,CLEANER-IMT-28
TP TOTAL 3,786.00
OD TOTAL 2,038.00
TOTAL PREMIUM 4,805.00
LESS :NO CLAIM BONUS-GR27 1,018.80
STAMP DUTY 0.50
MOTOR TOTAL OD 1,019.00
ADD :SGST 432.00
ADD :CGST 432.00
TOTAL AMOUNT 5,669.00

* NCB discount - 50 %

Deductibles under Section-I : Compulsory Deductible 1000

Subject to IMT Endorsement Printed herein/attached to : IMT-28 , IMT-22 , IMT-24 , IMT-16 , IMT-6

Details of IMT Endorsements are also available on the Company¿s Web Portal www.orientalinsurance.org.in

Hypothecation Agreement with: NIL

Hire Purchase/Lessor Agreement with: -

In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured will comply with
the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as well as company's website.
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC endorsements mentioned herein
above which are available on Company's website: www.orientalinsurance.org.in or on demand from the policy issuing office.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void
abinitio (from inception).
Claim is not admissible if Driving License is found fake or is not valid whether or not in the knowledge of the insured.
I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of
Chapter X and Chapter XI of Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at BO KHANNA
(GSTIN: 03AAACT0627R3Z7) on 04-OCT-22
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 MVAct, 1988 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

Place :
Date : 04/10/2022
Page 2 of 3
 This Document is Digitally Signed

The Oriental Insurance Company Limited Signer: MILAP CHAND

Date: Tue, Oct 4, 2022 17:17:43 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 233605/31/2023/1478

The Oriental Insurance Company Limited

Entered By : MRS. SUDESH KUMARI

Examined By : SUDEEP

Policy Printed By : OICL IP :

Policy Printed On : 04-OCT-22 17:17:42 Authorised Signatory

In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Place :
Date : 04/10/2022
Page 3 of 3