FUTURE GENERALI INDIA

Insurance Company Limited

MOTOR SECURE - PRIVATE CAR INSURANCE - COMPREHENSIVE POLICY
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989
: Future Generali India Insurance Company Limited, Neelyog Square, 104 and 105, 1st Floor, R.B.Mehta Road, Nr.Ghatkopar Railway Station,
Ghatkoper (East), Mumbai, Maharashtra, 400075, Tel_No:022-66894201
Policy and Certificate Number : 2014-V3383925-FPV
Period of Insurance
i : From 18:25 hrs of 06/11/2014 To midnight of 05/11/2015.

Policy Servicing Office

: Vishnu Sharma
: 56 Firdaus Bldg Ground Flr, Room No 06 Road
Marine Drive, Mumbai, Maharashtra, 400020

Insured
Address

Covernote No
Intermediary Name/Code
Telephone (Hom)
Email Id

:8H0224201zzzz Dated:z06/11/2014zzzzzzZone: A
: Samip Dilip Shah / 60025911
: 9892932137
: samip.shah@gmail.com

INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION

Registration No.,
RTA Location

Make/Model of Vehicle

Year of
Manufacture

Engine No.

Chassis No.

Cubic
Capacity

Seating
Capacity

Type of Body

MH04FZ7457
MUMBAI

HYUNDAI ACCENT GLE

2010

27975

76490

1495

Saloon

INSURED'S DECLARED VALUE

For Vehicle-Rs.

For Non-Electrical Accessories-Rs.

For Trailers-Rs.

For Electrical/Electronic Accessories-Rs.

For Bi-Fuel Kit (CNG/LPG)-Rs.

Total Value-Rs.

225,000

15,000

240,000

SCHEDULE OF PREMIUM
Rs. B-LIABILITY

A-OWN DAMAGE
Basic Premium on Vehicle
Add : Bi-Fuel Kit (CNG/LPG)

Total Own Damage Premium (A) (rounded off)

Total Annual Premium (A+B)

5,540.06
600.00

6,140.00
7,807.00

Rs.

Basic Premium Including Premium for TPPD

Add : Bi-Fuel Kit (CNG/LPG)
Add : Compulsory PA to Owner-Driver - Rs. 2 lacs
Add : PA to persons other than Owner/Driver
No. of persons 5 P.A. Limit - Rs. 50000 per person
Add : Legal Liablity to Paid Driver/Cleaner/Employees
No. of persons 1
Total Liability Premium (B)
Total Premium for the Policy Period
Service Tax (Including Cess)
Total Premium (rounded off)

1,332.00
60.00
100.00
125.00
50.00
1,667.00
7,807.00
966.00
8,773.00

Subject to Endorsement Nos. 22 ,25 ,16 ,28 ,15 ,

LIMITATIONS AS TO USE As per Motor Vehicle Rules, 1989 :- 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) Any purpose in connection with Motor Trade

DRIVERS CLAUSE :- 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
Learners License may also drive the vehicle and that such a person satisfies the
requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

Limits of Liability
Under Section II-I (i) : Death of or bodily injury Such amount as is necessary to meet the requirements
of Motor Vehicles Act, 1988

Under Section II-I (ii) : Damage to Third Party Property-Rs.

750000/- in respect of any one claim or series of claims arising
out of one event.

SPECIAL CONDITIONS

Under Section III : PA Owner

Compulsory
Driver as per premium computation Deductible Under
table
Sec I - Rs. 1,000.00
ADDITIONAL EXCESS

The nominee for Compulsory PA to owner driver cover is 01) LEGAL HEIR, aged: 21 Years, Relationship: Legal Executor, Nomination %: 100%
IMPORTANT - 1. All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2. In case of payment by cheque, in the event of dishonor of cheque for any reason
whatsoever, insurance cover provided under this document automatically stands cancelled from the inception irrespective of whether a seperate communication is sent or not.
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 FUTURE GENERALI INDIA INSURANCE CO. LTD.
Receipt No : Z4623128
Date of Issue : 13/11/2014
Place of Issuance : Mumbai*

*Address as mentioned below.

This policy is not valid unless it is countersigned by an authorised signatory
For registration of your Motor claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable)

(Authorised Signatory)

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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed AVOIDANCE OF CERTAIN TERMS AND RIGHT OF
RECOVERY. For legal interpretation English verison will be good.
For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this schedule.
Not with standing anything mentioned herein to the contrary it is agreed and declared that the cover under this policy does not extend to those parts mentioned as
damaged/scratched/dented noted in the photographs/inspection report number 20-ATL-061114-138266 dated 05/11/2014
The stamp duty of Rs. 0.50 paid by GRAS DEFACE NO.0001994581201415, dated 13/10/2014.Mudrank 2004/4125/CR/690/M-1,dated 31/12/2004.

Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013, Maharashtra
Care Lines:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in, Website: www.futuregenerali.in
IRDA Regn. No 132, CIN - U66030MH2006PLC165287, Service Tax Registration Number: AABCF0191RSD002