Auto Secure Private Car Package Policy

NEWPOLICY-TrackOn-620454168773-25324311
Date : 18/10/2023

Name : NIRANJAN BAPURAO KAMBLE Your Policy Details

Policy Number : 6202075139 00 00
Address : A/P.WARORA ROAD B/H DATTA TEMPALE
Own Damage Policy Period : From 19/10/2023 to. Midnight of
GOHOKAR LAYOUT W NO 5 WANI
18/10/2024
TQ.WANI,DIST.YAVATMAL, -0
WANI
YAVATMAL Liability Policy Period : From 19/10/2023 to. Midnight of
MAHARASHTRA 18/10/2024
445304
PA Cover to Owner Driver Policy Period : From 19/10/2023 to.
Midnight of 18/10/2024

Phone : 9822731230 Premium Paid : `6,251.00

Dear NIRANJAN BAPURAO KAMBLE ,

Welcome to Tata AIG General Insurance Company Limited's Family & We
Thank you For Choosing our Auto Secure Private Car Package Policy for
your vehicle insurance.

We are enclosing Policy schedule cum certificate of insurance of your

vehicle. You are requested to visit our Website www.tataaig.com for
policy wording.

we would like to inform you that policy has been issued based on the
information and declaration provided by you.No Claim Bonus(NCB) if
shown on your policy schedule has been allowed as you had not reported
any claim in the previous policy.

Kindly go through the enclosed information/declaration provided by you

and in case your policy shows No Claim Bonus, for which you are not
entitled as explained above or any error/discrepancy then we request you
to get in touch with us within 15 days of receipt of the policy for correction
otherwise all particulars will be deemed to be correct.

You may reach us at our 24*7 helpline 1800 266 7780 for providing any
information or in case you desire to have a printed copy of policy wording.

we, thank you once again, for choosing Tata AIG General Insurance
Company Limited for insuring your vehicle.We asure you of our best
services at all times.Happy driving!

Sincerely ,
For TATA AIG General Insurance Company Limited

Authorized Signature

Tata AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001 Page 1 of 6
 Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent Name : MIALTUS INSURANCE BROKING PRIVATE LIMITED
Agent License Code : 674 Agent Contact No : 9152648187
Policy Type: Auto Secure Private Car Package Policy
Policy No: 6202075139 00 00
Cover Note No: Cover Note Issuance Date:
Policy Code : 00/00/3184/02 Period of Insurance
Name & Address of Insured
(Section - I Own Damage) From 00:00
Name : NIRANJAN BAPURAO KAMBLE Hours on 19/10/2023 To Midnight of 18/10/2024 .
Address : A/P.WARORA ROAD B/H DATTA TEMPALE,GOHOKAR
LAYOUT W NO 5 WANI TQ.WANI,DIST.YAVATMAL, -0,, (Section - II Liability) From 00:00
,WANI,YAVATMAL Hours on 19/10/2023 To Midnight of 18/10/2024 .
MAHARASHTRA 445304
Contact Number : 9822731230 (Section - III CPA Cover For Owner Driver) From 19/10/2023 To
Customer Id : 6147183834 Midnight of 18/10/2024
GSTIN :
Place of Supply : MAHARASHTRA ZONE : B
Supply Code : 27
Hire Purchase / Hypothecation / Lease With :
RTO LOCATION : YAVATMAL
Geographical Area : India Lessor GSTIN :

Contract/Loan/Reference No:

Licensed
Registration Make / Model / Body Trailer Registration No. carrying
Engine Number Chassis Number Mfg. Year CC/KW
Number Type / Chassis No. Capacity
including driver
HYUNDAI/GRAND
I10 MAGNA 1.2
G4LAFM74405 MALA851CLFM3
MH 29 AR 1582 KAPPA 2015 1197 5
2 09870G
VTVT/HATCH
BACK
Insured Declared Value (IDV) `
Electrical / Elec
Non Electrical Bifuel / CNG /
Year IDV Of Vehicle tronic Accesso Trailer Side car Total IDV
Accessories LPG Kit
ries
1 240000 0 0 0 0 240000
SCHEDULE OF PREMIUM
Section - I OWN DAMAGE (A) Section - II LIABILITY (B)

Own Damage Premium on Vehicle & Third Party Premium

Accessories Basic TP premium ` 3,416.00

Basic OD Premium ` 2,412.72 PA Benefits

Add: Repair Glass Fiber plastic ` 0.00 1 Year(s) Compulsory PA cover for Owner Driver ` 375.00
PA cover to unnamed passengers (IMT 16) No. of
Discount Under Own Damage Section ` 250.00
passengers: 5 CSI per passenger: 100000
Less: No claim bonus (50) ` 1,206.36
Legal Liability
TOTAL OWN DAMAGE PREMIUM (A) ` 1,206.36 Add: Legal liability to paid driver (IMT 28) Number of
` 50.00
persons: 1
TOTAL ADD ON PREMIUM (C) ` 0.00
TOTAL LIABILITY PREMIUM (B) ` 4,090.64
COMPREHENSIVE PREMIUM (A+B+C) ) ` 5,297.00
NET PREMIUM ` 5,297.00
CGST @9% ` 477.00
SGST/UGST @9% ` 477.00

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 2 of 6
 TOTAL POLICY PREMIUM ` 6,251.00
Drivers Clause: Persons or classes 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.

Limitations as to Use: The Policy covers use of the vehicle for any purpose other than : a) Hire or Reward other than for the purpose of driving tuitions 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

LIMITS OF LIABILITY
Under Such amount as Under ` 7,50,000.00 Number of claims
Under Section III
Section II - 1 is necessary to Section II - ` 15,00,000.00 covered under
:1
(i) of policy meet the 1 Depreciation
Year(s)
(Death of or requirements of (ii) of policy Reimbursement Cover:
Compulsory PA
bodily injury) the Motor (Third Party N/A
Cover for
Property Basis of claim settlement
Vehicles Act, OwnerDriver
Damage) for Tyre Secure cover :
1988.

Deductible
Under Section UIN Numbers: , IRDAN108RP0002V01200001/A0005V01200910(TA 08)
I

Compulsory Deductible : ` 1,000.00

Voluntary Deductible : ` 0.00
Imposed Excess: ` 0.00
Franchisee: ` 0.00

Subject to: A) IMT Endorsement Number : 16 , 22 , 28

B) TATA AIG Auto Secure Endorsement Number (TA): 08

NOMINATION DETAILS
Name of the Nominee Relationship with insured Name of Appointee (If nominee is minor) Relationship with Nominee
ARCHANA NIRANJAN KAMBLE Spouse NA NA
I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X
and Chapter XI of M.V. Act, 1988. For TATA AIG General Insurance Company LTD.
In witness whereof this Policy has been signed at MUMBAI on 18/10/2023

Receipt No.(s): 102001058538136 18/10/2023

The stamp duty of Rs0.50 paid in cash or demand draft or by pay order,vide
Receipt/Challan no:LOA/CSD/120/2023/3624/23 dated the 31/08/2023
Authorized Signatory

GSTIN :27AABCT3518Q1ZW MAHARASHTRAService Account Code: 997134

Policy Servicing Office : 2ND FLOOR, CITI TOWER, 61, DR. S.S.RAO ROAD,, NEXT TO M.G.M HOSPITAL, PAREL(E), MUMBAI - 400012 ,MUMBAI - 400012,
MUMBAI, MAHARASHTRA, 400012

Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness
certificate, as applicable, on the date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or
fitness Certificate, as applicable, during the subsistence of the Policy. Further, the Company reserves the right to take appropriate action in case
of any discrepancy in the PUC or fitness certificate.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 3 of 6
 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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed 'AVOIDANCE OF
CERTAIN TERMS AND RIGHT OF RECOVERY'. This policy does not cover pre existing damages as per Inspection photographs and Report

Note :This Schedule, Policy terms and conditions available on company website and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been
attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any amendments/modifications/alterations made on this system generated policy document is not
valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is
made to the Company and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company. You are advised to go
through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim Bonus or any other material
information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. You may visit company
website at www.tataaig.com for detailed benefits, terms & conditions & exclusions of the policy. 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. Our grievance redressal procedure and details about ombudsman is also available in our policy wording. Please note that any misrepresentation, non disclosure or withholding of material facts will
lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any. We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we
receive confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own damage section of the policy.

For Policy wordings, please scan the below QR code :

Disclaimer:
INSURANCE ACT 1938 Section 41 Prohibition of Rebates:
1. 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 or continuing a policy accept any rebate, except such rebate
as may be allowed in accordance with the published prospectus or tables of the Insurer.
2. ANY PERSON MAKING DEFAULT IN COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHED WITH A FINE WHICH MAY EXTEND TO TEN LAKHS RUPEES

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 4 of 6
 RECEIPT

Receipt No. 102001058538136 Receipt Date: 18/10/2023

Policy No: 6202075139

Received with thanks from NIRANJAN BAPURAO KAMBLE a sum of 6251 ( Rupees Six Thousand Two Hundred Fifty-One And Paise Zer
o Only ) vide Credit / Debit Card No 9999XXXXXXXX dated 18/10/2023 Name as in credit/debit card - drawn on PAYABLE AT PAR branch t
owards

Sl.No. Policy Number Total Premium ` Utilized from the receipt for policy ` Balance `

1 6202075139 6,251.00 6,251.00 0.00

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 realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.

GSTIN: 27AABCT3518Q1ZW MAHARASHTRA Service Accounting Code: 997134

Revenue (Consolidated) Stamp Duty paid vide challan No. LOA/CSD/47/2023/2581 date 22/05/2023 for applicable cases

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 5 of 6
 Auto Secure Private Car Package Policy

1 Name (Registered Owner of the Motor Vehicle)* : NIRANJAN BAPURAO KAMBLE

2 Address For Communication* : A/P.WARORA ROAD B/H DATTA TEMPALE,GOHOKAR LAYOUT W NO 5 WANI TQ.WANI,DIST.YAVATMAL,
-0,,,WANI,
YAVATMAL,MAHARASHTRA,445304.

3 Vehicle Details : Please refer policy schedule cum certificate

4 Fuel Type : PETROL
5 Insured’s Declared Value - Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number : 2302204977461100000
Date of inception of TP portion : 19/10/2022
Date of Expiry of TP portion : 18/10/2023
Type of Cover : Package
Name of the Insurer : HDFC ERGO
OD claim in previous year(YES/NO) : No
NCB in previous policy : 50
NCB claimed : 50
7 Own Damage period of insurance desired from* : 19/10/2023 to midnight of 18/10/2024
8 Liability period of insurance desired from* : 19/10/2023 to midnight of 18/10/2024
9 Compulsory PA cover forowner driver period of insurance desired from : 19/10/2023 to midnight of 18/10/2024
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Unnamed Persons Personal Accident Cover for seating capacity, including driver CSI : 100000

Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) :

Compulsory PA Cover for Owner Driver : ` 15,00,000.00 Term : 1 Years

Name of the Nominee : ARCHANA NIRANJAN KAMBLE Age : 48 RelationShip : Spouse

Name of Appointee (if Nominee is Minor) :NA Relationship to the Nominee : NA
Battery No :
Charger No :

12 Restriction of Cover/Discounts/Concessions/Extended Covers

Automobile association membership opted : No Third Party Property Damage Cover restricted to 6,000/ only : No
Is Voluntary Deductible opted : No Amount of Deductible opted : 0
Vehicle is fitted with Anti Theft Device approved by ARAI : N/A

13 Add on covers : N/A.

14 Bank Details (Required for Refund / Claims)

Name of the Account Holder : Name of Bank & Branch :

Account Number : IFSC Code of Bank :

15 Declaration for No Claim Bonus : N/A .

16 I hereby give my consent toreceive one page insurance policy.

17 AML Guidelines:
1. I/we hereby confirm that all premiums paid / payable in future will be from bonafide 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 for documents to
establish sources of funds and to cancel the insurance policy in case I / we are found guilty by any competent court of law under any of
the statutes, directly or indirectly governing the prevention of money laundering law in India.
2. I / we are not Politically Exposed Persons * nor are their close relatives. I / we shall keep the company informed 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 from time to time
18 We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:[email protected] website:www.tataaig.com Page 6 of 6
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001