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    WB40Y8555

    Uploaded by

    Aqil
    INSURANCE

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    WB40Y8555

    Uploaded by

    Aqil
    4 views3 pages
    INSURANCE

    Original Title

    WB40Y8555 (1)

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    © © All Rights Reserved

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    INSURANCE

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    4 views3 pages

    WB40Y8555

    Uploaded by

    Aqil
    INSURANCE

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 3

    “A” Policy for Act Liability Insurance (Private Carrier)-Policy Schedule

    Policy Number : 131522223120037635 Proposal/Covernote No : R20112032218

    Insured’s Name : Period of Insurance:


    SK TIPU From 00:01 Hrs on 30 May 2024 to 23:59 Hrs of 30 May 2025

    Communication Address : Policy Servicing Branch :


    7C, GOLAM JILANI KHAN ROAD ATWAL REAL ESTATE , ATWAL COMPLEX 1ST FLOOR, M S TOWER 1,
    KOLKATA WEST BENGAL 700039 O T ROAD, INDIA KHARAGPUR WEST MIDNAPORE WEST BENGAL
    721305

    Tax Invoice No. & Date : R20112036009 & 30 May 2024


    Mobile No :NA
    GSTIN/UIN & Place of Supply:
    Email-ID : NA

    Nominee Name: NA

    Insured Vehicle Details


    2013
    Registration No. WB40Y8555 Mfg. Month & Year
    Make / Model FORD 1.5 TITANIUM CC/HP/Watt 1498

    5
    Engine No./Chassis No. 29593/29593 Seating Capacity of side car (if any) including driver
    5674
    .00
    Type of Body/LCC SALOON Total Premium
    RTO Location NA Total IDV NA

    Hypothecation/Lease NA

    Insured Declared Value (IDV)

    Vehicle Trailer
    Electrical / Electronic Accessories Total Cover SI 0.0
    NA
    Non Electrical Accessories Total IDV

    Premium Summary
    Own Damage Amount ( ) Liability - Section II Amount( )
    Basic OD 0.00 Basic Liability (TPPD 1) 4654.00
    Total Basic Liability Premium 4654.00
    PA Benefits - Section III
    TOTAL LIABILITY PREMIUM 4654.00
    TOTAL PACKAGE PREMIUM (Sec I + II + III) 4654.00
    CGST (@9.00 %) 510.00
    SGST (@9.00 %) 510.00

    TOTAL PREMIUM PAYABLE( ) 5674.00

    GSTIN :19AABCR6747B1ZD, HSN :9971, Subject to I.M.T.Endt.Nos.


    Description of services : Motor vehicle Insurance Service
    Limits of liability (a) 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 or control of the insured up to the limits specified- (TPPD 1 Sum Insured- 1,00,000/-,
    TPPD 2 Sum Insured- 6000/-). (iii) PA cover for-diver under section III CSI 0.0/-
    Limitations as to use The Policy covers use for any purpose other than: (a) Hire or Reward, (b) Carriage of goods (other than samples or
    personal liggage), © Organized racing, (d) Pace making, (e) Speed testing, f() Reliability trials, (g) Any purpose in
    connection with Motor Trade
    Persons/Classes of persons Any person including the Insured provided that a person driving holds a valid driving license at the time of the accident and is
    entitled to drive not disqualified from holding or obtaining such a license. Provided that the person holding a valid Learner’s License may
    drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.

    Page 1 of 3
    Page 2 of 3
    Declaration by Insured

    I/We hereby declare that the statements made by me/us in this Proposal Form are true to the best of my/our knowledge and beli ef and I/We hereby agree that,
    this declaration shall form the basis of the contract between me/us and RELIANCE General Insurance Company Limited. I/We also declare that, if any additions or
    alterations are carried out after the submission of this proposal form, then the same would be conveyed to the i nsurers immediately. I/We hereby declare that the
    contents of the form and documents have been fully explained to me/us and that I/We have fully understood the significance of the proposed contract. I/We agree
    to accept a policy subject to the condition prescribed by the company. I/We here by state that the above mentioned address shall be taken as address on record
    for the purpose of GST. I/We hereby agree to be notified by insurer on my registered mobile number/ email id through mail or SMS or any such mode, information
    about various insurance policy services.
    Place: Date: Signature of Proposer
    Note: Copy of RC Book should be submitted along with the proposal form. Prohibition of rebates - Section41 of the Insurane

    Act, 1938 as amended by Insurane Laws (Amendment) L Act, 2015


    1. No person shall allow or offer to allow directly or indirectly as an inducement to any person to take out or renew or continue an insurane in respect
    of any kind of risk relating to lives or properly in India, any rebate of the whole or part of the commission payble or any rebate of the prmium shown on
    the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate as may be allowed in accordance with the published
    prospectuses or tables of the insurer.
    2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.

    Page 3 of 3

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