Date : 29/06/2021

Policy No : FCV/SA632085/A2/06/004551

Client ID : 7982853

MR MARAIAH CHALLARI
S/O RAJA
DNO. 3
AKKIREDDYGUDEM
MUSUNURU
KRISHNA DT
ANDHRA PRADESH
Contact Number :
Email Id :

Dear MR MARAIAH CHALLARI

Welcome to Bharti AXA General Insurance Co. Ltd

Congratulations! You have made the right choice by selecting the Bharti AXA Smart Drive Commercial Vehicle Insurance Policy. Your Policy No ( FCV/SA632085/
A2/06/004444 ) will be your friend in need. Bharti AXA, with its world-class service, will reach out to you with a range of benefits, including a fast, fair and friendly claims-
settlement experience. We will be at your side, providing quality solutions and convenience at every step. By going in for this policy, you have bought yourself peace of mind!

The policy guidelines and the details of your insurance coverage are available in the enclosed policy document. Should you have any questions, please contact your Bharti
AXA insurance advisor or call our toll free number 1 800 103 2292. You can also e-mail us at customer.service@bharti-axagi.co.in or register your query in the support
section at www.bharti-axagi.co.in. We are there to help you.

We thank you for reposing faith in Bharti AXA General Insurance Co. Ltd and look forward to adding value to our relationship by providing more services and benefits in the
years to come.

Should you require any assistance or clarification on your insurance or any information pertaining to our other products, you can call us on 1 800 103 2292 or get in touch
with
(A2000624) at
Warm regards,

Authorized Signatory

Bharti AXA GENERAL INSURANCE COMPANY LTD

1st Floor, Ferns Icon, Survey No.28, Doddanakundi, Bangalore 560037. INDIA. IRDA Regn.No.139
Tel: 080 40260100 Fax: 80 40260101 Email: Customer.service@bharti-axagi.co.in

For redressal of your grievance, if any, you may approach any one of the offices- 1.Policy issuing office 2.Corporate Office. In case, you are not satisfied with our own grievance redressal mechanism; you
may also approach Insurance Ombudsman. Details of Insurance Ombudsman offices are available at IRDA website: www.irda.gov.in, or on the website of General Insurance Council: www.gicouncil.in or
on the company website www.bharti-axagi.co.in

Tax Invoice will be followed after the Policy Certificate

 Smart Drive Commercial Vehicle Insurance Policy, CERTIFICATE OF INSURANCE AND SCHEDULE, NEW
Bharti AXA General Insurance Company Limited, , ,
BUSINESS, ORIGINAL
Form 51 of the Central Motor Vehicle Rules ,1989
Certificate / Policy No : FCV/SA632085/A2/06/008642 Account Number : A2000624
Policy type : Commercial Vehicle - Passenger - COMPREHENSIVE INSURANCE POLICY
Period of Insurance : From 14:00 Hours on 29/06/2021 To Midnight on 28/06/2022
Premium Paid (incl. S. Tax) :
: MR MARAIAH CHALLARI
Policy holder's Name
:
Address : S/O RAJA
: DNO 3
: AKKIREDDYGUDEM,MUSUNURU
: KRISHNA DT
: ANDHRA PRADESH
:
Under Hire purchase/Hypothecation/Lease with
Geographical Area : INDIA
Agent Details
Agent Name : NERUKONDA SAI MUNIKUMAR
Tel No - Mobile No : 9951521652
Regn.No : AP16TC6558 Place of Regn : RTA VIJAYAWADA
Make / Model : PIAGGIO - APE AUTO D3S
Year of Manufacture : 2011 Body Type :
Seating Cap. (Incl.Driver) :4 Engine C.C : 436
Public / private Carrier :
Chassis No. : MBX0000ZFNH355712 Engine No. : R1G2992608
IDV of the Vehicle : INR 100000.00
Bi-Fuel(CNG/LPG) :
Total Insured Declared Value of the Vehicle : INR 100000.0
Schedule of Premium
A)Own Damage Premium B) Liability premium
Premium for (Vehicle and non Electrical Accessories) : INR 1260.00 Basic : INR 6318.00
CNG/LPG Kit (IMT 25) : INR 0 Restricted TPPD : INR 0
Comp. PA : INR 100
Geographical Area : INR 0
Fibre Glass Tank : INR 0 No. of Passengers :
IMT - 23 : INR 0
Own Premises : INR 0 Add: legal Liability to paid Driver as per Endt. IMT 28 : INR 50
NCB 20 % : INR 252 CNG / LPG(IMT 25) : INR 0
Load /Discount : INR -504 LL others : INR 0
LL Non-Fare : INR 0
A. Total Own Damage premium : INR 504.0 B. Total Liability Premium : INR 6468.0
Net Annual
: INR 6972.0
Premium (A+B)
GST : INR 1254.96
Total Annual Premium : INR 8226.96
Driver's clause: Persons or Classes of person 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 when not used for transport of passengers at the time of accident and that such a person satisfies the requirements of Rule 3 of the central Motor Vehicle
Rules , 1989
Limitation As to Use
The Policy covers use only for carriage of passengers in accordance with the permits(contract carriage or stage carriage) issued within the meaning of Motor Vehicles Act.Policy does not cover: 1)Use for Organised
racing ,pace making,reliability trial or speed testing. 2)Use whilst drawing a trailer,except towing(other than for reward)of any one disabled mechanically propelled vehicle.
Limits of Liability
Under Section II-1 (i) of the policy (Death or bodily injury) : such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988.
Under Section II-1 (ii) of the policy
(Damage to third party Property) : INR 750000
P.A Cover for Owner - Driver Under Section
III: CSI : INR 200000
Compulsory Deductible Seating Capacity not exceeding 17 Passengers : INR 500.00
Seating Capacity not exceeding 17 but not 36 Passengers : INR 1000.00
Seating Capacity not exceeding 36 Passengers : INR 1500.00
Taxis and Three Wheelers rated as Commercial Vehicles
(Cubic Capacity not exceeding 1500 CC) : INR 500.00
Taxis and Three Wheelers rated as Commercial Vehicles
(Cubic Capacity exceeding 1500 CC) : INR 1000.00
Name of Nominee : NA Age of Nominee : NA
Driver Nominee Relationship : FATHER Name of Appointee :
Appointee Nominee Relationship :
Subject to Indian Motor Tariff Endorsement (nos)
IMT28-
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 XI of Motor Vehicle Act, 1988. In witness of this policy
has been signed at _______________ on _______________ in lieu of covernote no. dated
Receipt No. :0
Service Tax Registration no. : AADCB2008DST001
BHARTI AXA GENERAL INSURANCE COMPANY LTD.

Authorized 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's Act , 1988 is recoverable from the insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY"
The Schedule, the attached Policy 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.
Issued By - NERUKONDA SAI MUNIKUMAR On 29/06/2021 IP Address - 103.69.80.172
This motor policy is generated and issued online therefore the stamp duty payable on this policy is paid separately.

Bharti AXA GENERAL INSURANCE COMPANY LTD

1st Floor, Ferns Icon, Survey No.28, Doddanakundi, Bangalore 560037. INDIA. IRDA Regn.No.139
Tel: 080 40260100 Fax: 80 40260101 Email: Customer.service@bharti-axagi.co.in

For redressal of your grievance, if any, you may approach any one of the offices- 1.Policy issuing office 2.Corporate Office. In case, you are not satisfied with our own grievance redressal mechanism; you
may also approach Insurance Ombudsman. Details of Insurance Ombudsman offices are available at IRDA website: www.irda.gov.in, or on the website of General Insurance Council: www.gicouncil.in or
on the company website www.bharti-axagi.co.in

Tax Invoice will be followed after the Policy Certificate