IFFCO-TOKIO GENERAL INSURANCE CO. LTD.

Issuing Office:
Regd. Office: IFFCO SANDAN, C1 Distt centre, Saket, New Delhi-110017 ITGI-STRATEGIC BUSSINESS
UNIT:LUCKNOW
8, GOKHLE MARG
LUCKNOW-226001
Policy Schedule Cum Certificate of Insurance

Two wheeler Policy

Insured’s Name: MR. SUNIL KUMAR GAUTAM Policy No. :75569988
Address: S/O SURESH KUMSR R/O VILL BERUKAHI Date of Issuance :22/04/2017
POST- MAHRAUD Period of insurance : From 00:00 hrs on :22/04/2017
GHAZIPUR UTTAR PREDESH PIN CODE: UP
To Mid Night on :21/04/2018
Phone number: C/N: -- Agent No: 12000003
Geographical Area : Within India Only
ITG

Insured Moter Vehicle Detail & Premium Calculation

Registration Year of Type of Body Coverage IDV in Rs. Engine No. Seating
Mark & No. Manuf cc 08834 Capacity
Make of vehicle ACT Only Chassis No. 2
100
HERO HONDA SPLENDOR 11172

Insures Declared Values (Rs) Gross Premium Rs.

Two Wheeler Side Car Accessories Elec./Elec/Acc. Bi-Fuel Kit Total Value
514.00
B. Won Damage Amount Rs. A. Third Party Amount
Basic Premium Basic Premium Rs. 464.00
Electrical/Electronic Accessories(IMT 24) Bi Fuel Kit (IMT 25) -
Accessories (IMT 33) PA Owner: Driver CSI RS. 10000 50.00
Bi Fuel Kit (IMT 25)
Add: -
Add: Legal Liability to Driver (IMT 28) -
Rallies (IMT 31) Legal Liability to employees (IMT 29) -
Foreign Vehicle Loading (IMT 10) PA to Passenger(IMT 16) -
Geogtaphical Area Ext(IMT1 ) Rallies (IMT 31) -
Less: Geographical Area Extention (IMT1) -
Voluntary Express Less 0% (IMT 226) Less:
Side Car Discount Third Party Property Damage (IMT 20)
Anti theft Device(IMT 10) Limit of Liability Under Section
Automobile Association (IMT12) 1000
Handicap Discount (IMT 12)
Vehicle Use (IMT 13)
No Claim Bonus - %
Any Other Loading/Discount Any Other Loading/Discount -
Net (A) Net (B) 514.00
Name type % Total Premium 514.00
Co-insurance
Service Tax 64.00
Detail Premium Paid
578.00

Under Hire Purchase/Hypo/Lease Agreement With

Subject to IMT Endorsement Nos. Printed herein/Attached
Hereto
Limitation as to use: Driver Clause:
Use only for social, domestic and pleasure and for the insured’s business Any person including insured, provided that the person driver holds
or profession. The policy does not cover use for hire reward, tuition, an effective driving license provided also that the person holding an
racing, pace-making reliability trail, speed testing, carriage of goods(other effective learner’s license may also driver the vehicle and that such a
than sample or personal luggage)in connection with any trade or business person satisfied the requirements of Rule 3 of the central motor
or use for any purpose in connection with motor trade. vehicle Rules 1989.
No claim Bonus. The insured is entitle for a no. Claim bonus (CNB) on own damage section of the policy, if no claim or pending year(s)as per the following rule:

Period of insurance percentage of NCB on KOD premium Under Section ||-|(i) – such amount as is necessary to meet the
THE Preceding Year 20% requirement of the Motor Vehicle Act,1988.
Preceding 2 consecutive year 25% Under section ||-||(ii) – As per premium computation table.
Preceding 2 consecutive year 35% Under Section III- PA Owner – Driver as per premium computation
Preceding 2 consecutive year 45% table deductible under section 1 – Rs. 50/-
Preceding 2 consecutive year 50%

No claim Bonus will only be allowed, provide the policy is renewed within 90 days of the expire of the previous policy.

I/W hereby certify that the Policy to which this certificate related as well as this certificate of For IFFCO-TOKIO General Insurance co. ltd.
insurance are issued in according with the provision of chapter X and chapter XI of M.V. Act.
1988.

Service Tax No. : D-:IST/R-IV/GEN INS/01/03

Authorized Signatory