Auto Secure - Liability Only Policy

Name : Mrs.MRS PO O NAM | +91 8826150737 | Valid to

Valid f rom
[email protected]
Address : MUNDIAN PO SUNDRAH, MAHENDERGARH, MAHENDERGARH Haryana
123029,
TP Cover Period 03 Sep ' 23 (00:01Hrs) 02 Sep ' 24 (Midnight)
MAHENDRAGARH- 123029,
HARYANA

Premium Amount : ₹ 843.00

Dear Mrs MRS PO O NAM

Welcome to Tata AIG General Insurance Company Limited f amily & we thank you f or choosing our policy f or your motor vehicle insurance. Your Policy No.6100213587 has
been issued based on the inf ormation and declaration provided by you. You are requested to visit our website www.tataaig.com f or f ull policy wordings

Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Policy Details Vehicle Details

Policy No & Certif icate No : 6100213587-00 Registration no : HR 34 H 4644

Insured Name: Mrs.MRS PO O NAM Registration Authority : MO HINDERGARH HR34

Address : MUNDIAN PO SUNDRAH, MAHENDERGARH, MAHENDERGARH Haryana Make/Model : HO NDA / ACTIVA

123029,
MAHENDRAGARH- 123029, Fuel Type : PETRO L
HARYANA,
Variant : 125 DISC DLX
India.
Engine Number : JF49E82079150
TP Cover period : 03 Sep ' 23(00:01Hrs) to 02 Sep ' 24(Midnight) Chassis Number : ME4JF495EH8048693
Policy Issuance Date : 02 Sep ' 23 Engine/Battery Capacity(CC/KW) : 125
Customer/Lessor GSTIN : Seating Capacity (including driver) : 2
Customer ID : Mf g Year : 2017
Customer Contact Number : 8826150737 Date of Registration : 24/05/2017
Proposal Number : PR/23/6100267873 Body Type : SCO O TER
Covernote/Issuance Date : NA Trailer Regn No/Chassis No : NA
Alternate Policy No : NA HP/HYP/Lease : NA

Zone : B

Geographical Area : INDIA

Schedule of Premium

Section - I Liability (B)

Third Party Premium

Basic TP premium 714.00

Total Liability Premium (B) 714.00

Net Premium (B) 714.00
IGST @ 18 % 129.00

Total Policy Premium ₹ 843.00

Agent Name : QUICKINSURE INSURANCE BROKERS Agent License Code : 579 • Agent Contact No. : 2069791000 (or
PVT LTD Landline)
 Auto Secure - Liability Only Policy

Drivers Clause : Persons or classes of persons entitled to drive: Any person including the insured. Provided that a person driving holds an ef f ective driving license at the
time of the accident and is not disqualif ied f rom holding or obtaining such a license. Provided also that the person holding an ef f ective Learner' s License may also drive
the vehicle and that such a person satisf ies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limitations as to use :The Policy covers use of the vehicle f or any purpose other than : a) Hire or Reward other than f or the purpose of driving tuitions b) Carriage of
goods (other than samples or personal luggage) c) O rganized racing d) Pace Making e) Speed testing f ) Reliability Trials g) Any purpose in connection with Motor Trade

Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certif icate, as applicable, on the date of commencement of
the Policy and undertakes to renew and maintain a valid and ef f ective PUC and/or f itness Certif icate, as applicable, during the subsistence of the Policy.

Limits of Liability :: Under Section II-1 (i) of policy (Death of or bodily injury) : Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988
Under Section I-1 (ii) of policy (Third Party Property Damage) : ₹100,000.00 Under Section III :

Subject to: (A) IMT Endorsement No. :

GSTIN : HARYANA Service Accounting Code : 997134
TATA AIG Auto Secure endorsement No. (TA):

For & O n Behalf of Tata AIG General Insurance Company Ltd.

I/We hereby certif y that the Policy to which this Certif icate relates as well as this Certif icate
of Insurance are
issued in accordance with provisions of Chapter X and XI of Motor Vehicles Act, 1988.
In witness whereof this Policy has been signed at Mumbai on: Receipt (s) : PD300003951743
02/09/2023

Consolidated Stamp Duty has been paid to the State Exchequer

Policy Number : 6100213587/00/00 • GSTN Number : 27AABCT3518Q 1ZW - MAHARASHTRA

Authorized Signatory

Policy Servicing O f f ice :3RD FLO O R,THE O RIO N KO REGAO N PARK RO AD O PP. ST. MIRA' S CO LLEGE FO R GIRLS, ARJUN MANSUKHANI PATH, PUNE, MAHARASHTRA. , PUNE ,
MAHARASHTRA , 411001 • Tel No :91 - 2067449596

Important Notice

The Insured is not indemnif ied 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 Certif icate in order to comply with the Motor Vehicles Act, 1988 is recoverable f rom the Insured. See the clause headed “AVO IDANCE O F CERTAIN TERMS AND
RIGHT O F RECO VERY”.
Note : You are advised to go through the policy schedule cum certif icate of insurance which is issued based on inf ormation and declaration provided by you. Transcript of
Inf ormation & Declaration is also provided herewith to enable you to go through the same again and if any error/discrepancy is f ound in respect of vehicle details, No
Claim Bonus or any other inf ormation provided by you, it should be brought to our notice within 15 days of receipt of this policy f or necessary correction along with the
supporting documents, otherwise it will be deemed to be correct. You may visit the company website at www.tataaig.com f or detailed benef its, terms & conditions and
exclusions of the policy issued and held by you. You may also reach us at our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of policy wording. O ur
grievance redressal procedure and details about ombudsman are available at the company website www.tataaig.com. You may also reach us at our 24*7 helpline 1800 266
7780 f or grievance redressal procedure and details about ombudsman. Please note that any misrepresentation, nondisclosure or withholding of material f acts will lead to
cancellation of policy ab initio with f orf eiture of premium and non consideration of claim, if any. We will specif ically seek conf irmation on No Claim Bonus availed by you
f rom your previous insurer. In case we receive conf irmation that you had lodged claim with them then we will intimate you to pay the No claim Bonus Amount within 20 days.
In case we don’t receive the No Claim Bonus recovery then it will be adjusted against claim amount payable to you if any. This Schedule, Policy terms and conditions
available on the company website and Endorsements mentioned herein above shall read together and word or expression to which a specif ic meaning has been attached
to/in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any amendments/modif ications/alterations made on this system
generated policy document is not valid and the Company shall not be liable f or any liability whatsoever arising f rom such changes unless written request is made to the
Company and the Company accepts the requested amendments/modif ications/alterations and records the same through separate endorsement.

Receipt

Receipt No. : PD300003951743 Receipt Date : 02/09/2023 Policy No : 6100213587 00 00

Sr. No. Policy Number Mode of Payment Total Premium (₹) Utilized f rom the receipt f or policy (₹) Balance (₹)

1 6100213587 00 00 onlinePayment 843.00 843 0

Payer Name : MRSPO O NAM

Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void.
3. Amounts received by cheque shall be subject to realization.
4. Any amount received in excess of the Premium is being/shall be ref unded by the Company.

GSTIN : HARYANA Service Accounting Code : 997134

Revenue (consolidated) Stamp Duty duly paid vide challan No. date f or applicable cases.
Issuance of this receipt does not amount acceptance of the risk by Tata AIG General Insurance Company Limited. The insurance cover f or the risk shall be as per the terms
and` conditions of the insurance policy if and when issued.
 Auto Secure - Liability Only Policy

Transcript of Information/Declaration

Insured and Vehicle details

1. Name (Registered O wner of the Motor Vehicle)* : MRS PO O NAM

2. Vehicle Details : HO NDA ACTIVA,
3. Address f or Communication* : MUNDIAN PO SUNDRAH, MAHENDERGARH, MAHENDERGARH Haryana 123029,MAHENDRAGARH- 123029 HARYANA, India
4. Vehicle Type : SCO O TER
5. Fuel Type : PETRO L
6. Insured’s Declared Value : ₹ 0
7. Date of Registration : 24/05/2017
8. Proposed Period of Insurance
TP cover Period : 03 Sep ' 23 (00:01Hrs) to 02 Sep ' 24 (Midnight)

Previous Insurance Details

1. Policy Number : NA
2. Date of Expiry : 09/09/2022
3. Type of cover : LiabilityO nly
4. Name & address of the Insurer : NA,
5. Claim in Previous Policy Period : No
6. NCB in previous policy : 0%
7. NCB Claimed : 0%
8. Period of Insurance
O D cover Period : NA
TP cover Period : NA

Declaration f or No Claim Bonus (If NCB Conf irmation is not submitted but NCB claimed)

I hereby give my consent to receive one page insurance policy.

AML Guidelines :

I/we hereby conf irm that all premiums paid / payable in f uture will be f rom bonaf ide sources and not paid out of proceeds of crime and that such premiums are not
disproportionate to my/our income. I / we understand that the Company has the right to call f or documents to establish sources of f unds and to cancel the insurance
policy in case I / we are f ound guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money laundering law in
India.

I / we are not Politically Exposed Persons * nor are their close relatives. I / we shall keep the company inf ormed if we subsequently become a Politically Exposed Person.
“Politically Exposed Persons” shall have the meaning assigned to it under sub clause (xii) of 3(b) of Chapter I of Master Direction – Know Your Customer (KYC)
Direction, 2016 issued by Reserve Bank of India (RBI), as amended f rom time to time.

Disclaimer : Insurance is the subject matter of solicitation. For more details on benef its, exclusions, limitations, terms & conditions, please ref er sales brochure/ policy
wordings on www.tataaig.com caref ully, bef ore concluding a sale. Purchase of Tata AIG General Insurance Company Limited products are purely on voluntary basis.

Prohibition of Rebates - Section 41 of Insurance Act, 1938 as amended by Insurance Laws I Amendment) Act, 2015.
1. No person shall allow or of f er 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 or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the
insurer
2. Any person making def ault in complying with the provisions of this section shall be liable f or a penalty which may extend to ten lakh rupees.

Grievance Redressal Procedure : As per Regulation 17 of IRDA of India (Protection of Policyholders Interests) Regulation, 2017.

Section 64 VB of the Insurance Act 1938 :Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited

Auto Secure - Liability O nly Policy - UIN : IRDAN108RP0008V01200001

Tata AIG General Insurance Company Limited

Registered O f f ice : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013. • 24X7 Toll Free No : 1800 266 7780 • Email :
[email protected] • website : www.tataaig.com • IRDA of India Registration No: 108 • CIN: U85110MH2000PLC128425 • Company PAN No. : AABCT3518Q

TAGIC/PS/MRTW/Feb 22/05 Ver1/All 2547