Policy Schedule

3t1912018

ICICI Lombard General Insurance co. Ltd.

CERTIFICATE CUM POUCY SCHEDULE CUM RECEIPT
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
3OO5rN - 7262L6O7 / OO / OOO Proposal No. & Date PT6801281, 19 Mar 2018
Policy No
19 Mar 2018 5:55PM Tenure 1 Year Period of Insurance 19 Mar 2018 5:55PM to 18 Mar 2019 11:59PM
Policy Issued On
Insured Name MR. RNESH GANTA Previous Policy No. NA
D.NO.5.211 TELAPROLU UNGUTURU MDL,
Insured Add. UNGUTURU , ANDHRA PMDESH.521109 ,GSTIN Previous lnsurer NA
No:N/A
Nominee Name G RAVI Age 27 Relation BROTHER
F-6 Fourth Floor, The Landmark, Sampath Vinayak Temple Road, Vishakaptnam, AndhE PEd6h 530003, , , , ANDHM PMDESH-530003
Seryicing office of Insurer; (State Code-37)
PAN NA GSTIN: 37A,4'ACI79O4GLZM

Make Model-variant Cubic caDaciw Manufacturing Year Seatinq GDaciw

t STAR CITY + ES MAG WHL REF 110 2018 2

Body Type Redistration No. RTO HvDoth€tion/Lease* FueI TYD€ Chassis llo.
SOLO New VUYYURU PETROL MD625FF17J14371r5
Enoine No. Invoice Date Vehicle IDV Elec. Acessories Non-Elec, AGsris Total IDV
FF1AJ1677036 19 Mar 2018 49244 0 0 49244

Own Damtq€ Premium (A) Liability PEirm (B)

Basic Premium B6ic Third F.fi Liabilitv (includins TPPD ) 720

Vehicle a2( PA Covq lsOvner Driver of Rs I L€kh 50

Non Electsi@l Ae6sri6 L€sal Liabilis For Paid Dliver (lMT - 2E) 0

Eletical Accessris (tMT - 24) PA Covd ( 0 Ps Pe$on) for 0 Pe6om 0

Sub Total (Basic Premium) 82 Geo@hiel Am Extsnsion 0

IMT 33 Sub Totrl (P,l Covcr)

Cov@96
A.dd Oo NA Li.brifi ar?Fd r e (-6)

hfr:l Am Er@io (IMT - I ) Tol PBium (A + 59(

aza ;GST(t/t t44

Sub Totel Addition
SGST (t4) t44
Deductibls
y Muctibles (0) (lMT - 22A) G|6l|EiumP3id 1884

Anti Thefi Device (lMT - I 0) N&: l-?lcy bsurnce is subject to reilizstioo of cbeque
2 Cms|'li}-ad staop duty paid b sbte exchequer
AA MembffihiD(tMT - t) 3 Thc Frtct is sbj@( to compulsory deduc[ible oi Rs. | 00 (Iltf[-2])
No Claim BonN (opl.) 4 G@gra52l Am- lndia
Dismt (IMT-12)
*Subjd b IMT Endt Nos & Memo€ndum:7.j522
Sub Total (Deduciibl6)
Pluiu (A) a26
Insured sdEdi€ ofaqewi* insured dedared(IDv) as shown in the bdd table is applicable for the purpe Thefl/Cdr*utive Total
Loss(TVCTL) dairc q*y m bais of 16 date fallng in the rEpective year. A vehicle will be ssdered to be a CTL, where tlE aggtEgEte @st of retrleval and/or repai of the
dtE
Tenur€ 19M-2oltb ltMd2019
49244 0 0
TDV
Limitations as to us The @veE u* of the vehide fq any p.Jrpoe other than (1 Hire q Reward (2) Cariage cf gpods (other than samples or persdld !ggage.) (3)
poaic]/
Organized racing (4)Pa@ mking (5) Sped testing (6) Reliability triab (7) Any purpose in oryredion with motor trad€-
orils,s clausi: qny p* lntuaing the insureJ: prcvided that the rern drivinq holds an €!ffedive drivinq li@r d ttE time of the accident and is not dsqr*fied frm holding
q ohining such licenie. provided ali that the person holding an effective leamer's license nEy d$ drive tie vehile L ttEt such a peEon satlsfies the rc+isrErts d tuJe 3 of
UE Cmtral Motor vehide Ruls, 1989.
Linits ot Liability clau*: under Section If -1(i) of tt€ policf Death of q bodily injury: Sudr ront as is necsy to met the requirements of the MoF \r€ri* Lt 1988-ljnder
S€din U-l (ii) of the policy-Damage to third party prcpsty is Rs1.O lalf,E lakhs PA Cover urds S€ction IU fq OrrrE-Oriver is Rs. 1.olakhs.
||o Ct im Bonusr No Claim Bonus is subject to rc daim m th€ prwids policy, Benefits undsttE policy sbnds fo.ftitrd if claim islwas made in previG pdiLY
€rirc clausei For resolution of any query d gridze, IGured may @ntact the rspediE brandr offe dttE @mpany or may call at(18002666 ) 6 mat tib a mail at
(h6rtpamar@icicilombard.com). In cse tie iEred is mt sbsfied with the response of tlE ofn@, iNred nray @ntact the Grievance Officer of tlE CdrpttY aa
jurisdiction, approdr tlE Ire
ihqnai-pamar@icicilombard.comj.In the event d uffitishdory response from the Grievare Office, hdstE nrat, $bject to vested
omhrdg;- fur the redressal of grievance. Details of InsuGne ombudsman offices are avail* * IRDA rEfr+:ffi.irda.org , or on the website of Gffid Iffi council:
ww,irda.trg q on the company website (ffi.i(ifrmbard.com).
The Pol'f,y wdinq is available on request at fr* d @st. The Same can be downloaded from ot WeisiE m.ijcilombard'com.
Hypothstim Details: CAPITAL FIRST LIr.{TED , - VLIAYAWADA
MISP Name: CASA MOToRS PYT. LTII , XISP Code: AB-MTSOOO247 , MISP PAN Numba IAGCCIOT9,
Important Notie: The insured is not iridmified, if the vehicle is used or driven othemi* ttE ir addc with the schedule. Any payment ma& bt ttE mpany by teasons of
wider tems app€aring in the Gtifiote in ordsto comply wlth the Motor Vehide Act, 1988 b ffiatl€ from the insured. See the clause headed 'A\fi)IDAI(- OF CERTAIN TERMS
& RIGHT OF RECOVERY' Fq legd interpretatim, English version will hold good.
530003,
SAC :997134, Descriptad of SeruicerMotor I6ur;ncePlace of Supplyif-6 Fourth Fffi, The |'3ndmrk, SamiFth Vinayak Temple Road, vishal3ptnam, Andhra Pradesh
, ,, ANDHM PMDESH-530003 (State Code-37) ,Invoice No.: 180318353982 XI ol
I/we hereby certify that the policy to which this certificate relates as well as this certifi6te of in accordance with the provisions oF Chapter X and Chapter
Motor Vehicle Act, 1988
For & (lD B€ha[of Iclcl t obard GeDerrl I$unD.c Ca IJ.L

ai-ba SigDilorY

Emker Name & Add : Aditya Birla lnswce BrokeE Limited, Ge Idildls m, Towtr-I, l4th Flm( Jupit*mill compoud,841, Senapati Bapat Mdg qiDdotre Road, MUMBAI- 4m013 L&C'dc :

t0000001926
RsiptNo.- 1803it3539t2 P.)ueotllode-
For ReneweVCleims osistrc-F&: qhcl Itrsuratreco/Broker tbrough : CASA MOTORS PVT LTD st 086G65271ll