HDFC ERGO General Insurance Company Limited

Certificate of Insurance cum Policy Schedule

Policy No. 2311 2016 1602 6401 000

Motor Insurance - Private Car Comprehensive Policy

Insured Name MR SRI PRANEY P RTO VISAKHAPATNAM PAN No.
Corr.Address/ 1-85-10/3, MVP CO;ONY SECTOR -5 VISAKHAPTANAM-530017
Place of Supply
Mobile Phone - E Mail [email protected] Registration No. AP31CH3646

Period of Insurance From Date & Time 19/01/2024 00:01hrs To Date & Time 18/01/2025 Midnight Policy Issuance Date 19/01/2024

Make Model - Variant Engine No Chassis No Mfg Yr Seats Body Type CC

SKODA FABIA ELEGANCE BNM40 TMBDEK5JBBA507282 10/2008 5 SALOON 1422
51KW,TDI 0622

Insured's Declared The Vehicle (`) For Trailer (`) Non Electrical Acc. Electrical Acc. (`) CNG/LPG Kit Total IDV (`)
Value (IDV) (`) (`)
1,46,000 0 0 0 0 1,46,000

Named Persons & Nominee (IMT-15)

Nominee for Owner driver Appointee

Premium Details
(`)
Own Damage Premium (a) Liability Premium (b)
Basic Own Damage: 9150 Basic Third Party Liability: 2863
LL to Paid Driver (IMT-28) 50
PA Cover for Owner Driver of ` 200000 100
Total Basic Premium 9150
PA Cover for Un-Named Persons of ` 40000 Each (for 5 Persons) (IMT-16) 100

Add on Coverages Net Liability Premium

Zero Depreciation
(b) Total Package
Emergency
Premium (a+b)
Assistance Cost of
GST 18% : Central Tax 9%( `2620.00)+ State Tax 9%( `2620.00)
Consumables
Total - Add on
Net Own Damage Premium (a) 9150 Total Premium 12263

Geographical India , Compulsory Deductible ` 1000.00 Voluntary Deductible (IMT- ` 0.00

Area (IMT-22) 22A)
Fund Transfer No.
Payment Details: Dated : 17/01/2024 Drawn on : Invoice No.: HSN Code: 9971
BizDirect MR1712303934
201616026401000

LIMITATIONS AS TO USE: 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. Persons or Class of Persons
entitled to drive: 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. Limits of Liability 1. 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. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 750000 3. P. A.
Cover under Section III for Owner - Driver(CSI): ` 200000 Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free
of cost on request and the same is also available at our website.
I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M.
V.Act 1988. "The stamp duty of
` 0.50 paid by Demand Draft,vide Receipt/Challan no. 4380520201718 dated 04/12/2017 as prescribed in Government Notification Revenue and Forest Department
No. Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004". Goods and Service Tax Registration No: 36AABCL5045N1Z9 . 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". Disclaimer: The Policy shall be void from inception if the premium cheque is not realized. In the event of misrepresentation, fraud or non-
disclosure of material fact, the Company reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared
accordingly. The existing damages to the vehicle as mentioned in the report shall not be paid by the Company. The policy is issued basis the information provided by
you, which is available with the company. In case of discrepancy or non recording of relevant information in the policy, the insured is requested to bring the same to the
notice of the company within 15 days. Goods and Service Tax for this invoice is not payable under reverse charge basis..
Branch : HYDERABAD - 2ND - 4TH FLOOR, BEING OFFICE NOS. 401 AND 402, KUCHKULLA HOUSE IN HIMAYATNAGAR,HYDERABAD. HYDERABAD, 500057.
Phone No. : +91-40-39883600

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400020. Policy Issuing/Customer Service Address: D-
301, 3rd Floor, Eastern Business District ( Magnet Mall), LBS Marg, Bhandup (West). MUMBAI - 400078. Maharashtra. Toll Free : 1800-2-700-700 (Accessible from India
only) | Fax : 91 22 6638 3699 | [email protected] | www.hdfcergo.com CIN : U66030MH2007PLC177117.| UIN : IRDAN125P0005V01200203
IRDAI Reg No. 146. (Formerly HDFC General Insurance Limited from September 14, 2016 and L&T General Insurance Company Limited upto September 13, 2016)
HDFC ERGO General Insurance Company Limited

Frequently Asked Question’s (FAQ’s) - Motor Insurance

WHAT ARE THE MAJOR COVERS UNDER THE POLICY? HOW DO I FILE A CLAIM?
Loss or Damage to the Insured Vehicle caused due to: For Accidental Damage to Insured Vehicle (Own Damage Claims):
a. Fire, explosion, self ignition or lightning. ¡ Mobile App: Simply download HDFC ERGO Mobile App - Insurance Portfolio Organizer
b Burglary, housebreaking or theft from Play Store. Link your policy by providing few simple details and register a claim.
c All act of God perils like earthquake, flood, cyclone etc ¡ Call Toll Free 1800 2700 700 (Accessible from India only) and provide your policy
d Accidental external means, terrorism, riot and strike number for reference and register a claim
Liability to Third Parties:
Provides cover for any legal liability arising out of the use of the vehicle for Please keep the following details handy while intimating a claim
a Accidental death / injury to any third party a. Policy Number
b Any damage to property owned by third party b. Registration Details / RC Copy
Personal Accident c. Drivers details at the time of accident including driving License Number
Cover: The policy provides for a mandatory Personal Accident cover for owner driver and d. FIR on a case to case basis
optional cover for passengers covering accidental death and permanent total e. Repair estimate
disability
WHAT IS THE CLAIM PROCESS?
WHAT ARE THE MAJOR EXCLUSIONS OF THE POLICY? 1. If your vehicle can be driven, take it to the nearest dealer / garage.
a. General aging, wear & tear, mechanical or electrical breakdown, failure, depreciation, 2. Get a repair estimate, fill up the claim form and attach a copy of the registration
any consequential loss certificate and driving license of the person driving at the time of the accident.
b. Damage by a person driving without a valid license 3. If the garage is within our network, you could avail of cashless claim facility. Pay for non
c. Damage by a person driving under the influence of liquor or drugs accident related repairs, depreciation and deductible. We would settle the rest.
d. Loss/damage attributable to war, mutiny, nuclear risks 4. If the garage is outside our network, you would have to get the claim reimbursed
e. Damage to tyres and tubes, unless damaged during an accident subsequently.
f. Usage on hire & reward (applicable for all classes except public commercial vehicles)
g. Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes, CLAIMS DOCUMENTS -
headlights, paint work (applicable for all commercial vehicles; unless opted FOR ACCIDENTAL DAMAGE TO INSURED VEHICLE
additionally) a. Duly filled and signed claim form & satisfaction voucher
h. Loss or damage resulting from overturning arising out of operation as a tool (applicable b. Registration Certificate (RC)
for mobile cranes, drilling rigs, mobile plants, navvies, shovels, grabs, rippers unless c. Driving license of the person driving at the time of the accident
opted for additionally) d. Policy Copy, original repair estimate, repair invoice
i. Loss of or damage to accessories by burglary housebreaking or theft unless the vehicle e. Payment receipt for non-cashless claims
is stolen at the same time (applicable to all commercial vehicles & two wheelers) f. Original repair invoice for cashless claims
g. AML documents for amount more than `1 lakh (PAN card, 2 passport size photo,
TRANSFER OF INSURANCE (INCASE VEHICLE IS residence proof)
SOLD) h. Form 35 & original NOC from financer incase of total loss where payment is made to
To place your request for Transfer of Insurance, visit Customer Support section on our insured
website www.hdfcergo.com. i. Acopy of police FIR/panchnama is required for TP injury / death / property damage

WHAT CHANGES CAN BE DONE IN MY POLICY ENDORSEMENT Additional documents required for commercial vehicles:
a. Spot survey b. Load challan c. Fitness certificate d. Route permit
To place your request for any ''Changes in Policy', visit Customer Support section on our
website www.hdfcergo.com. WHAT IS NCB?
CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT NO CLAIM BONUS (NCB):
NCB is provided for every claim free year basis the slab as provided by Tariff.
a. Duly filled and signed claim form & discharge voucher ( after loss settlement )
How can I get No Claim Bonus Reserving
b. Original Registration Certificate (RC) Letter? NCB Reserving letter can be provided only on Sale of vehicle evidenced by
c. Original Policy Copy transferred RC copy OR Sale Deed and Form 29 & 30. The OD section of the policy needs
d. Copy of FIR lodged at the nearest police station to be transferred to the new owner or cancelled.
e. All original keys & vehicle invoice copy
f. No trace report confirming that the stolen vehicle is not traceable HOW DO I RENEW MY POLICY?
g. Original NOC from financer incase of hypothecation / HPA
h. Intimation to RTO for theft of vehicle
i. Duly signed RTO transfer papers (Form 26, 28,29,30,35)
a. Visit www.hdfcergo.com to c. Visit our nearest branch / your agent
j. RC extract with stolen remark from the concerned RTO after the loss
renew instantly online
k. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence d. Send a copy of the renewal notice along
proof) b. SMS "RENEW <POLICY NO> " with premium cheque to our branch
l. Deed of subrogation cum indemnity on judicial stamp paper office /Corporate office
to 9999 700700
Disclaimer: Where it is brought to the notice of the Company, that
vehicle insured which is not a new vehicle but shown as a new HOW TO CONTACT US?
vehicle with a malafide intention, claims for total loss of such Visit Customer Support section on our website www.hdfcergo.com and avail
vehicle would not be admissible, if there is a gap of more than 10 host of services online which is easy, instant & convenient
days from date of invoice of vehicle and the proposal date.

Convenience at your fingertips

On the Customer Support section of our website, you can:
Ver.AUG 17

Get Policy Copy/ Make Changes Track Claim Update Contact

` 80D Tax Certificate on Policy Status Details
This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.