This Document is Digitally Signed

Signer: SUNITAGUPTA
Date: Sun, Oct 29, 2023 14:54:37 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 : 433100/31/2023/1728 Prev Policy No : 433100/31/2022/1850
Cover Note No : - Cover Note Dt :

Insured's Code : 167644348 Issue Office Code : 433100

Insured's Name : SANDAKONDA RAJASEKHARA BABU Issue Office Name : BO PARK ROAD KURNOOL (GSTIN:
(GSTIN: 0) 37AAACT0627R4ZV)

Address : S/O.SANDAKONDA RAMAIAH, H.NO. 4- Address : # 40-383, BHUPAL COMPLEX,

120,PEDDAPADU, KALLUR M KURNOOL
PARK ROAD,
PREVIOUS 433100/31/2022/1850 IDV
19/12/2021/ TO 18/12/2022 KURNOOL.
KURNOOL ANDHRA PRADESH 518001
KURNOOL ANDHRA PRADESH 518003

Tel /Fax /Email : 9966599663 / / 9966599663 / NA Tel /Fax /Email : 08518 220671 / 223019 / 9441811213 / 08518
225141 /
[email protected] /
[email protected]
Lead/Breakin No : /

Agent/Broker Details
Dev.Off.Code : NG0000000327 T SIVA SANKAR REDDY - BUSINESS ASSOCIATE
Agent/Broker :: BA0000042849 A. VENKATA RAMANA
Address : 49/50-A-515, SRIRAM NAGAR, KURNOOL,KURNOOL,ANDHRA PRADESH,518001
Tel /Fax /Email : 9160830069/A.VENKATA RAMANA//NA

Period of Insurance : FROM 00:00 ON 20/12/2022 TO MIDNIGHT OF 19/12/2023

Collection No & Dt : DC_I_IND 5195002121 - 19/12/2022 GST INVOICE NO :3721161424 UIN :0

Gross Premium : 10,273 GST : 1,850 Stamp Duty : .5 Total : 12,123

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
AP-21-CJ-6431 MWD4C17884 MAHINDRA & MM SUV 2179 2013 6 + 1
MAHINDRA-SCORPIO
Kurnool MA1TA2MWND2C39 DIESEL
LX TURBO 2.6 CRDE-
522
2WD 7S SF BS3

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 : KURNOOL
Date : 19/12/2022
Page 1 of 3
 This Document is Digitally Signed

Signer: SUNITAGUPTA
Date: Sun, Oct 29, 2023 14:54:37 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 433100/31/2023/1728

Insured's Declared Value

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

3,24,000 0 0 0 3,24,000

SCHEDULE OF PREMIUM

A. OWN DAMAGE B. LIABILITY

BASIC OD COVER 11,372.00 BASIC TP COVER 7,897.00

MOTOR OD BASIC - NEW 11,372.00 BASIC TP TOTAL 7,897.00
BASIC OD TOTAL 1,706.00 ADD :PA FOR OWNER DRIVER-GR36A 320.00
LESS :SIP DISCOUNT 9,666.00 ADD :PA-UN-NAMED-GR36B2 300.00
OD TOTAL 1,706.00 ADD :LL-PAID DRIVER, 50.00
MOTOR TOTAL OD 1,706.00 CONDUCTOR,CLEANER-IMT-28
TP TOTAL 8,567.00
TOTAL PREMIUM 10,273.00
STAMP DUTY 0.50
ADD :SGST 925.00
ADD :CGST 925.00
TOTAL AMOUNT 12,123.00

Deductibles under Section-I : Compulsory Deductible 2000

Subject to IMT Endorsement Printed herein/attached to : IMT-5 , IMT-16 , IMT-22 , IMT-28

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

Hypothecation Agreement with: -

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 PARK ROAD
KURNOOL (GSTIN: 37AAACT0627R4ZV) on 19-DEC-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 : KURNOOL
Date : 19/12/2022
Page 2 of 3
 This Document is Digitally Signed

Signer: SUNITAGUPTA
Date: Sun, Oct 29, 2023 14:54:37 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 433100/31/2023/1728

Entered By : R.RAVIKUMAR

Examined By : REDDY BHARATH KUMAR D

Policy Printed By : OICL IP :

Policy Printed On : 29-OCT-23 14:55:17 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 and through other digital
platforms including Whatsapp (Send "Hi" to 9560711200)

Place : KURNOOL
Date : 19/12/2022
Page 3 of 3