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Go Digit General Insurance Ltd.

Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718
Name RABINDRA SHARMA Vehicle Registration No. WB40W3512
PHONEPE INSURANCE BROKING
Partner Name: SERVICES PRIVATE LIMITED
Address ,Bangalore-560063 1080493
N Partner Code:
Mobile xxxxxxxxx1484 Partner Mobile No. 9999999999
Email [email protected] Partner Email --
PB Aadhar No. -- For Claims,contact us at 1800-258-5956
YOUR POLICY DETAILS
Policy No. D148552727 / 22052024 Policy Issue Date 22-May-2024 Invoice No. IA134520273 Invoice Date 22-May-2024
Period of Policy Own Damage Cover and Add On(s) if Opted Third Party Liability Cover PA Owner Driver
BN From 24-May-2024 21:54:27 24-May-2024 21:54:27 --
To 23-May-2025 23:59:59 23-May-2025 23:59:59 --
Compulsory NCB % (Current Policy) 50 %
Deductible 100
(`)
Voluntary
Deductible (`) -- Additional Excess (`) --
Coverages Opted Digit Two Wheeler Package Policy Additional Deductible
Add On(s) Opted --
150
YOUR VEHICLE DETAILS
MA Model/Vehicle
G0 RTO Location Durgapur,WEST BENGAL Make HONDA CB UNICORN/ELEC ST DISC
Variant (Sub-
Engine No. 98674 Chassis No. 92209 BRAKE AWS
Type)
Year of
Regn/Year of
Body Type Motor Cycle Fuel Type Petrol Mfg. 2012/--
Odometer
Seating Capacity 2 Cubic Capacity 150 CC Reading (KM) --
YOUR VEHICLE IDV

Year Vehicle IDV Non-Electrical Accessories IDV Electrical Accessories IDV CNG/LPG IDV Total IDV PA Owner Driver
Year 1 19600 -- -- -- 19600 --
Year 2 -- -- -- -- 0 --
Year 3 -- -- -- -- 0 --
Year 4 -- -- -- -- 0 --
PB
Year 5 -- -- -- -- 0 --

OWN DAMAGE PREMIUM [A] (`) LIABILITY PREMIUM [B] (`)

G01
Own Damage Premium (`) 35.32 Basic Third-Party Liability (`) 714.00
Add-Ons Premium (`) 0.00 PA cover for Owner-Driver (`) --
NCB Discount Amount (`) -17.66 Legal Liability to Employees (`) --
17.66 Legal Liability to Paid Driver (`) --
196 17.66 PA cover for 2 unnamed passengers each (`) --
PA cover for Paid Driver (`) --
Total OD Premium (`) 17.66 Total Act Premium (`) 714.00
Net Premium (`) 731.66
IGST @ 18% = (`131.70) 131.70

Final Premium 863.36

(`)

3. Note:The above total OD premium is inclusive of all applicable loading / discounts viz (automobile association memberships, voluntary excess, anti-theft
handicap person, driver tuition, fiber glass, CNG/ LPG unit, imported vehicle etc., wherever applicable).
IG If the “Own Damage Cover” under your policy is cancelled during the policy period, then your policy shall be governed by the standard terms and conditions
of “Act only” policy for the Third Party Cover during the remaining period of policy

12
A ENDORSEMENT
Invoice Number Invoice Date Net Premium Igst Cgst Sgst Utgst Cess Gross Premium
A
17.66
IA134520273 2024-05-22 731.66 131.70 0.00 0.00 0.00 0.00 863.36

Policy No: D148552727

Page No: 1 of 6

Go Digit General Insurance Ltd, GST Reg No 29AACCO4128Q1ZW , PAN No:- AACCO4128Q, HSN: 997134/General Insurance Services, GSTIN Address
:Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road 5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095. Website :
www.godigit.com.
Corporate office Address : Atlantis, 95, 4thB Cross Road, Koramangala Industrial Layout, 5thBlock, Bengaluru, Karnataka, PIN – 560095, IRDAI Reg No. 158,
CIN – U66010PN2016PLC167410
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718

OTHER DETAILS
Previous Insurer Go Digit General Insurance Limited Previous Policy No. D102588582
Previous Policy 15-May-2024
IMT - Endorsements IMT-22 Expiry Date
GSTIN/UIN No. Unregistered State Code 19
Receipt No. RA164614649 Receipt Date 22-May-2024
Financier Details -- Nominee Details Legal Heir

01-Jan-1990
Other Details

Follow these rules like you follow the rules of the road.
Geographical Area: Any accidental loss, damage and/or liability caused, sustained or incurred within India shall be covered subject to Policy Terms and Conditions, unless specifically
agreed and endorsed. Limitation as to use The policy covers use of the vehicle for any purpose other than hire or reward, racing, pace making, reliability trial, speed testing and use
for any purpose in connection with the Motor Trade. Person or Class of persons entitled to drive: Any person including the insured 1) Provided that a person driving holds a valid &
effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. 2) Provided also that the person holding a valid & 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 and any subsequent amendment as
applicable. Limits of Liability: 1) Under Section I of the policy_ IDV as shown in the schedule. 2) 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 and any subsequent amendment as applicable. 3) Under Section II _ 1 (ii)of the policy: Damage to Third Party
Property(` 100000) 4) P.A. Cover for Owner Driver under Section III (CSI) (per annum) - (` 0)

Big Legal words

NCB Declaration: The premium has been charged and policy has been issued subject to NCB declared by you as an insured. In the event of NCB found wrongly declared at any point
of time during policy period, all benefits and coverages under the Policy in respect of section I of the Policy will stand forfeited. If there is any disagreement, write to us within 7 days
from the date of issuance of policy or before the start date of period of insurance whichever is earlier. PUC Declaration: The Policy has been issued subject to valid Pollution Under
Control (PUC) Certificate disclosed by you as an insured on or before the date of commencement of the Policy . Cheque dishonor / Non-receipt of payment: If premium paid through
Cheque, the policy is void ab-initio in case of dishonor of Cheque or non-receipt of payment. This policy is subject to the standard policy wordings, warranties and conditions
applicable for this product in addition to coverages and exclusions specified in the motor vehicle tariff published by IRDAI. 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 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”. Pre-existing Damages: All types of pre-existing
damages or cost of repair of such damage will be excluded at the time of claim settlement.Violation of Motor Vehicle Act: This policy is issued in accordance with the provision of
Chapter X and Chapter XI of MV act, 1988 and any subsequent amendment as applicable. Any violation will forfeit all benefits and coverages under the Policy. Important Notice: The
company may cancel the policy by sending 7 days notice in case of fraud, misrepresentation, non disclosure of material fact or non co-operation of the insured. This policy is subject
to the standard policy wordings, warranties and conditions applicable for this product in addition to Indian Motor Tariff. Break in Insurance: The policy is issued subject to acceptance
of risk after evaluation of the Vehicle Inspection report. Own Damage cover (Section - I) would not commence unless the satisfactory Vehicle Inspection report has been received by
us. If the Company does not receive the Vehicle Inspection report or the report is adverse, the Company, at its discretion, will cancel Policy as per the Motor Tariff
Note: The terms and conditions detailed in this policy schedule as well as the policy document sent by Digit shall prevail in case of any dispute

The Policy has been issued without Compulsory Personal Accident Cover to Owner Driver on the basis of your declaration that you do not hold a valid Driving License on or before the
date of commencement of this Policy / already have an alternate Personal Accident insurance cover of Rs. 15 Lakhs
For & On Behalf of Go Digit General Insurance Ltd.

In case of claim or any other query, please contact our 24-hour Call
Centre at 1800-258-5956 or email us at [email protected]
or visit our website www.godigit.com.
Praveen Bhat
Senior Vice President - Customer Experience
[email protected]
Authorized Signatory
Printed, Signed, and Executed at Bengaluru
Consolidated Stamp Duty has been paid as per Letter of
Authorization No.67-B/04/2017-18 Date: 30th May 2017
issued by Department of Stamps and Registration ,
Bengaluru- 560009 - KARNATAKA.
Hey, our document is now digitally signed
Click here to view the certificate.

Policy No: D148552727

Page No: 2 of 6

Go Digit General Insurance Ltd, GST Reg No 29AACCO4128Q1ZW , PAN No:- AACCO4128Q, HSN: 997134/General Insurance Services, GSTIN Address
:Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road 5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095. Website :
www.godigit.com.
Corporate office Address : Atlantis, 95, 4thB Cross Road, Koramangala Industrial Layout, 5thBlock, Bengaluru, Karnataka, PIN – 560095, IRDAI Reg No. 158,
CIN – U66010PN2016PLC167410
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718

Digit Two-Wheeler Package Policy

196
Proposal/Transcript Form
UIN: IRDAN158RP0006V01201718
Go Digit General Insurance Ltd
a. This proposal will be the basis of the insurance policy that we issue. You must disclose all facts relevant to
all person(s)/asset(s) proposed to be insured that may affect the Company’s decision to issue a policy or its
terms. Non-compliance may result in avoidance of the policy.
b. If you are in doubt, you can get in touch with your agent/intermediary or call us at 1800-258-5956 or e-mail
at [email protected]

*For Partner Use Only:

Partner Code Sub Partner Code Partner Name
PHONEPE INSURANCE BROKING
1080493 --
SERVICES PRIVATE LIMITED

Personal Details
MA
Proposer Name RABINDRA SHARMA Date of Birth 01-01-1990

Address ,Bangalore-560063 Pincode 713216

Profession -- Driving license issue year --

Mobile Number xxxxxxxxx1484 Email Id sxxxxxxxxxxxxxxxxx1@gxxxl.

com
PAN UIDAI NO
Are you an existing Go Digit
General Insurance Ltd.
GST Number Unregistered Customer (Digit): Yes / No. If --
yes, please mention the
N Policy No
01/
Vehicle Details
Registration No WB40W3512 Make HONDA
Date of Registration 2012 Model CB UNICORN
Chassis No 92209 Vehicle variant (sub type) ELEC ST DISC BRAKE AWS
Engine No 98674 Fuel Type Petrol
Year of Manufacture -- Cubic Capacity 150
*Finance Details *KM (Odometer) reading --

*Vehicle modified for

--
Physically Challenged

IDV Details
Policy No: D148552727
Page No: 3 of 6

Go Digit General Insurance Ltd, GST Reg No 29AACCO4128Q1ZW , PAN No:- AACCO4128Q, HSN: 997134/General Insurance Services, GSTIN Address
:Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road 5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095. Website :
www.godigit.com.
Corporate office Address : Atlantis, 95, 4thB Cross Road, Koramangala Industrial Layout, 5thBlock, Bengaluru, Karnataka, PIN – 560095, IRDAI Reg No. 158,
CIN – U66010PN2016PLC167410
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718
*Non-Electrical *Electrical / Electronic Sum Insured for PA
Year Vehicle IDV (Rs.) Total IDV (Rs.)
Accessories IDV (Rs.) Accessories IDV (Rs.) Owner Driver Cover

Year 1 19600 0 0 19600 --

Year 2 0 0 0 0 --

Year 3 0 0 0 0 --

Year 4 0 0 0 0 --

Year 5 0 0 0 0 --

Risk Coverage Details

Policy Period For From 24-May-2024 21:54:27 Voluntary Deductible --
Own Damage
cover and Add To 23-May-2025 23:59:59 Endorsement opted --
On(s) if opted
Policy Period for From 24-May-2024 21:54:27
Third Party
Liability To 23-May-2025 23:59:59

From -- --
Policy Period for
PA Owner Driver To -- --
Cover
--

Coverage Package
Consumable Cover No

--

Parts Depreciation Protect No --

--

Engine and Gear Box Protect No

Tyre Protect No
*Add on covers Breakdown Assistance No --

--
Return to Invoice No
--

--

--
Daily Conveyance Benefit No
--

--

Details of the Nominee for Personal Accident Cover for Owner-Driver

Name Legal Heir Relation
Age 01-Jan-1990 Appointee Name --

Appointee relation --

Vehicle Usage And Repair Information

Upto 5000 Km
Between 5001 & 10000 Km
Estimated Usage of the Vehicle During the Year
Between 10001 & 15000 Km
Above 15000 Km
Any Workshop
In the Event of Claim, where would You Prefer to Repair Your Vehicle
Digit Recommended Workshop Only

Previous Insurer Details

Policy No: D148552727
Page No: 4 of 6

Go Digit General Insurance Ltd, GST Reg No 29AACCO4128Q1ZW , PAN No:- AACCO4128Q, HSN: 997134/General Insurance Services, GSTIN Address
:Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road 5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095. Website :
www.godigit.com.
Corporate office Address : Atlantis, 95, 4thB Cross Road, Koramangala Industrial Layout, 5thBlock, Bengaluru, Karnataka, PIN – 560095, IRDAI Reg No. 158,
CIN – U66010PN2016PLC167410
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718
Go Digit General Insurance
Company Name Policy No
Limited D102588582
Policy Expiry Date 15-May-2024 NCB % 50
No of claims & claim amount --

Premium and Payment Details

Cheque No/NEFT Ref No P_VF2405222153505849647249
Bank Name

Date 22-May-2024
Amount (Including applicable taxes) 863.36

Declaration
• I/We, hereby declare that the statements and particulars given in this Proposal form are complete, true and
accurate and I/We agree that the Insurance company will not be liable under the insurance contract if it is found
that any of my/our statements or particulars or declarations in this proposal form or other documents are incorrect
/misleading /Fraudulent in any respect on any matter to the grant of a cover or submission of claim in future.
• I/We hereby agree to receive all monies due from the company by way of refund of premium, claims etc. into
my/our bank account / payment mode as specified in the instrument / electronic transaction tendered towards
insurance premium and such electronic transfer will constitute full and final discharge of the Company’s obligation.
• I/We hereby affirmatively warrant that the Assured named herein/owner of the vehicle insured holds a valid
Pollution Under Control (PUC) Certificate on the date of commencement of the Policy and the same has been
shown to the agent/authorized person of intermediary. I further undertake to renew and maintain a valid and
effective PUC Certificate during the duration of the Policy period.
• I / We declare that the rate of NCB claimed by me/us is correct and that no claim as arisen in the expiring
policy period (copy of the policy enclosed). I/We further undertake that if this declaration is found to be
incorrect, all benefits under the policy in respect of Section I of the Policy will stand forfeited.
• I/We, hereby agree that in Case of Break in Insurance, the policy would be issued subject to acceptance of
risk after evaluation of the Vehicle Inspection report. Own Damage cover (Section - I) would not commence
unless the satisfactory Vehicle Inspection report has been received by us. If the Company does not receive
the Vehicle Inspection report or the report is adverse, the Company, at its discretion, will cancel Policy as per
the Motor Tariff
• I/We further declare that l/we will notify in writing any change in the details so furnished hereinabove
occurring after the proposal has been submitted but before communication of the risk acceptance by the
Company.
• I/We authorize the Company to share information pertaining to my proposal for the sole purpose of proposal
underwriting and/or claims settlement and with any Governmental and/or Regulatory authority.
• I/We hereby undertake to inform the Company in case of change on account of addition of CNG/PNG kit
and ensure endorsement in my policy.
• I/We hereby agree and undertake that I/we are agreeable not to receive the hard copy of the Policy and related
documents Yes
Date: 22-May-2024
This proposal form has been electronically accepted
"By submitting your contact number and email ID, you authorize Go Digit General Insurance (Digit Insurance)
to call, send SMS, messages over internet-based messaging application like WhatsApp and email and offer
you information and services for the product(s) you have opted for as well as other products/services offered
by Digit Insurance. Please note that such authorization will be over and above any registration of the contact
number on TRAI’s NDNC registry."

Policy No: D148552727

Page No: 5 of 6

Go Digit General Insurance Ltd, GST Reg No 29AACCO4128Q1ZW , PAN No:- AACCO4128Q, HSN: 997134/General Insurance Services, GSTIN Address
:Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road 5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095. Website :
www.godigit.com.
Corporate office Address : Atlantis, 95, 4thB Cross Road, Koramangala Industrial Layout, 5thBlock, Bengaluru, Karnataka, PIN – 560095, IRDAI Reg No. 158,
CIN – U66010PN2016PLC167410
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Package Policy
UIN No.: IRDAN158RP0006V01201718

Insurance ACT 1938 Section 41- Prohibition of Rebates

No person shall allow or offer to allow either directly or indirectly, as an inducement to any person to take out
or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate
of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall
any person taking out or renewing a policy accept any rebate, except such rebate as may be allowed in
accordance with the published prospectus or tables of the insurer. ANY PERSON MAKING FAULT IN
COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE WHICH MAY
EXTEND TO TEN LAKHS RUPEES.

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5
Block, Bengaluru, Karnataka 560095, IRDAI Reg No. 158 CIN U66010PN2016PLC167410, GST Reg. No:
29AACCO4128Q1ZW, GSTIN Address: Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road
5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095 . Website: www.godigit.com

Policy No: D148552727

Page No: 6 of 6

Go Digit General Insurance Ltd, GST Reg No 29AACCO4128Q1ZW , PAN No:- AACCO4128Q, HSN: 997134/General Insurance Services, GSTIN Address
:Bengaluru Retail Business Centre,Atlantis No 95 4th B Cross Road 5th Block Koramangala Industrial layout,Bangalore,Karnataka,PIN-560095. Website :
www.godigit.com.
Corporate office Address : Atlantis, 95, 4thB Cross Road, Koramangala Industrial Layout, 5thBlock, Bengaluru, Karnataka, PIN – 560095, IRDAI Reg No. 158,
CIN – U66010PN2016PLC167410