Date: 18/10/2017

Policy Number : FPV/I1751160/71/10/003251

Client ID: 12897265
MR KISHORBHAI B HANSORA
SNEH GAYATRI NAGAR
OPP GEB OFFICE
PORBANDAR
AHMEDABAD-363641
GUJARAT
Dear MR KISHORBHAI B HANSORA,

We thank you for choosing Bharti Axa General Insurance as the preferred choice of your insurance needs. We value your patronage.

Your Smart Drive Private Car Insurance Policy No (FPV/I1751160/71/10/003251) is enclosed.The terms,conditions,guidelines and other relevent details of your
Isurance are availbale in the enlsoed policy document.

Bharti AXA General Insurance combines the reputation of Bharti, India leading Business Conglomerate and the financial expertise of AXA, one of the largest
insurers worldwide with operations in 56 countries, into an entity than seeks to redefine standards in the area of General Insuarnce.

Bharti AXA GI has over 116 points of presence across india and is today amongst the fastest growing insurnace companies in the country,with the premium
income of more than Rs.300 crore in the current financial year.

We are the 1st Insurance Company to come with the dual ISO 9001:2008 and ISO 27001:2005 certifications so that we could offer our customers best in class
service standards.

Our bouquet of 56 products covers all your insurance needs whether it be health,Motor,Personal Accident, Home Insurance or any other insurance pertaining to
your business activities. Our service network extends to cashless facilities in 2700 hospitals and 1800 garages across india where you can avail of preferential
service.

We take pride in going the extra line in our service and look forward to a lasting relationship.

Should you require any assistance/clarification on your policy or any information pertaining to our products, please contact us at the numbers below:

Toll free Number: 1 800 103 2292

Advisor Name: LANDMARK INSURANCE BROKERS PVT
Contact : 08042060100
Warm Regards,

Authorized Signature

BHARTI AXA GENERAL INSURANCE COMPANY LIMITED

1st Floor,Ferns Icon,Survey No.28,Doddanakundi, Bangalore 560037. INDIA. IRDA Regn.No.139
Tel:91 80 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
BHARTI AXA GENERAL INSURANCE COMPANY LIMITED
4th Floor Smart Drive Private Car Insurance Policy
401 & 402
3rd Eye situated at Panchvati Cross Roads
CERTIFICATE OF INSURANCE AND SCHEDULE
C. G. Road RENEWAL
Original
Form 51 of the central motor vehicle rules,1989
CERTIFICATE/POLICY NO. : FPV/I1751160/71/10/003251 Account No.: 71000115
Policy Type : Private Car - Comprehensive Insurance Policy
Period Of Insurance : From 00:00 Hours On 24/10/2017 To Midnight On 23/10/2018
Premium Paid(Incl. S.Tax) : INR 27429
Name of Policy Holder : MR KISHORBHAI B HANSORA
Address : SNEH GAYATRI NAGAR
OPP GEB OFFICE
PORBANDAR
AHMEDABAD-363641
Under Hire Purchase : GUJARAT Agent Details
/Hypothecation/Lease Agent Name : LANDMARK INSURANCE BROKERS PVT
with
Geographical Area : 0 Tel No - Mobile No: 08042060100
Regn. No. : GJ25J0504 Place of Regn. : PORBANDAR
Make/Model : VOLKSWAGEN VENTO (DIESEL)
Year of Manufacture : NULL
2012 Body Type :
Seating Capacity(Incl.Driver) : 5 Engine C.C : 1598
Public Carrier/Private Carrier : Private Car
Chassis No. : 14953 Engine No. : 16273
IDV of the Vehicle : INR 568097

Total Insured Declared Value of the : INR 568097

Vehicle
Schedule of Premium
A.Own Damage Premium B.Liability Premium
Premium for (Vehicle and Non : INR 19940 Basic : INR 7890
Electrical Accessories)
Comp.PA : INR 100
Capital
Add: PABenefits
Benefits as Per Endt. IMT 16 :: INR
INR 100000
250
No Of Passengers : 5
Add:Legal Liability to Paid Driver as per Endt. : INR 50
Load/Discount : INR -4985 IMT 28
Add On Cover Premium

A. Total Own Damage Premium : INR 14955 B. Total Liability Premium : INR 8290

Net Annual Premium (A+B) : INR 23245

GST : INR 4184
TOTAL ANNUAL PREMIUM : INR 27429

BHARTI AXA GENERAL INSURANCE COMPANY LIMITED

1st Floor,Ferns Icon,Survey No.28,Doddanakundi, Bangalore 560037. INDIA. IRDA Regn.No.139
Tel:91 80 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
BHARTI AXA GENERAL INSURANCE COMPANY LIMITED
Smart Drive Private Car Insurance Policy
4th Floor
401 & 402
CERTIFICATE OF INSURANCE AND SCHEDULE
3rd Eye situated at Panchvati Cross Roads RENEWAL
C. G. Road Original
Driver's Clause:Persons or Classes of Persons entitled to Drive
Any Person including the insured:Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from holding
or obtaining such a licence.Provided also that the person holding an effective Learner's Licence may also drive the vehicle 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 the use of the vehicle for any purpose other than
(a)Hire or Reward (b)Carriage of goods(other than samples of personal luggage)
(c) Organized Racing (d)Pace Making
(e)Speed Testing (f)Reliability Trial
(g) Use in connection with motor trade

Limits of Liability
Under Section II-1 (i) of the policy (Death of or bodily injury):Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988
Under Section II-1 (i) of the policy(Damage to third party property) : INR 7,50,000.00
P.A Cover for Owner - Driver Under Section III :CSI : INR 2,00,000.00
Deductible Under Section-I
Compulsary Deductible : INR 2000

Subject to Indian Motor Tariff Endorsement(nos)

IMT22-IMT15-IMT16-IMT28-
I/We hereby certify that the policy to which this certificate relates as well as this certificate of Insurance are issured 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 : 2657047

Service Tax Registration No. : AADCB2008DST001

For detailed policy wordings, inclusions, exclusions and other terms governing your policy, please log onto www.bharti-axagi.co.in
BHARTI AXA GENERAL INSURANCE COMPANY LTD

Authorized Signature
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 - LANDMARK INSURANCE BROKERS on 18/10/2017 22:45 IP Address - 202.131.96.98
PVT

BHARTI AXA GENERAL INSURANCE COMPANY LIMITED

1st Floor,Ferns Icon,Survey No.28,Doddanakundi, Bangalore 560037. INDIA. IRDA Regn.No.139
Tel:91 80 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