ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Liability Only Policy( Private Vehicle ) Proposal No. & Date R142512401 / 08-Nov-2021
Policy No. & Type 2319/64870769/00/000 Period of Insurance 09-Nov-2021 to 08-Nov-2022
Policy Issued On 08-Nov-2021 (00:00) Vehicle Identification No. MA3EZDE1S00214118
Insured Name Mr Tarlochan Lal Geographical Area INDIA
Invoice No 03MI210029842 Accounting Code of Service 997134
Insured Address S/O MOHAN LAL VPO SHAM 84 ,9872841335,
HOSHIARPUR-146001, Punjab
Insured State & Code Punjab-03 Place of Supply Punjab GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 0
Model & Variant New Alto K10 VXi/MARUTI ALTO K10 VXI Non Electrical Accessories 0
Registration No PB07AY2184 Electrical Accessories 0
Year of Manufacture 2015 CNG/ LPG Kit 0
Engine- Chassis No K10BN 7644337 - MA3EZDE1S00214118 Total IDV 0
Cubic Capacity 998
Seating Capacity 5
Type Of Body Saloon
RTO Location PB07AY2184 / HOSHIARPUR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 0 Basic Third Party Liability 2072
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [1 Year] 225
PACover for 0 Person of Rs (0) each (IMT- 16 )
Kit (IMT-25) 0
Legal Liability (WC) to Driver (IMT-28) 50
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Basic Premium 0 Legal Liability to Employees (IMT-29) 0
Geographical Area Extn. (IMT-1) NA Legal Liability to Passenger (IMT 46) 0
Lamp, Tyres etc. (IMT 23) 0 Driving Tuition Loading On TP Premium (60%) NA
Net Liability Premium (B) 2347
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 2347
Fiber Glass Tank 0 CGST @9% 211.23
Sub-Total Additions 0 SGST @9% 211.23
Deductibles Gross Premium Paid 2769
Voluntary Deductibles (IMT 22A) 0 MISP - HOSHIARPUR AUTOMOBILES, HOSHIARPUR
Anti-Theft Device (IMT-10) 0
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus 0 0
Discount for vehicles designed for handicapped NA 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 28,
Depreciation Waiver 0 6. Policy has been issued subject to valid Pollution Under Control (PUC) Certificate declared by you as
Engine Protector 0 an insured on or before the date of commencement of the Policy
Return To Invoice 0
Net own Damage Premium (A) 0
Nominee Details : Nominee Name GAGANDEEP Age 31 Relation Son
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 45276584 HSBC BANK LTD 2769
Financier Type Financed Financier Name HDFC BANK LIMITED. Financier Branch BR SHAM 84
Limitations as to Use : Stage carriage/ Contract Carriage/ Goods Carriage/ Private Service vehicle - The policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage falling
under sub-section (3) of Section 66 of the Motor Vehicles Act, 1988. The policy does not cover use for: a) Organised racing b) Speed testing.Private Service Vehicle and Non-Transport Vehicle - The policy covers use for
any purpose other than: a) hire or reward b)organised racing, or c) speed testing.
Driver's Clause : Stage carriage/ Contract Carriage/ Private Service vehicle - Any person including 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 the transport of passengers at the time of accident
and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limits of Liability Clause : Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of theMotor Vehicles Act , 1988. Under Section II - 1(ii) of the policy -
Damage to Third Party Property - Rs 7.5 lakhs. P.A. Cover for Owner - Driver under section IV (CSI) - Rs 1500000
Goods Carriage - Any person including insured: Provided that a person driving hold 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 the transport of goods at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central
Motor Vehicles Rules, 1989.
Non Transport Vehicles - Any person including 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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989
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 version will
hold good.
For information on ombudsman you may visit website http://www.gbic.co.in/ombudsman.html
I / We hereby certify that the Policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.
For Universal Sompo General Insurance Co. Ltd

Authorized Signatory
Policy Issuing Office:-First Floor, SCO 113, District Complex, Vishal Mega Mart Road, Ranjeet Avenue Amritsar-143001. Punjab.
GSTIN: 03AAACU8917F1ZG, CIN No.:U66010MH2007PLC166770
State Name : Punjab