S T A ND- A LO NE O W N DA MA G E P R IVA T E C A R P O LIC Y

Certificate cum policy schedule Status

MarutiBaleno Valid from Valid till (midnight)

OD33Z8351 04 DEC 21 03 DEC 22
Car owner Owner number Owner email
Rakesh Meher XXXXXX3848 rXXXXXXXXXXXs@gmail.com
Prime Plan Policy price Car value
Offer
Stand-Alone Own Damage with ₹ 9971.00 ₹ 430290
Consumables
Zero Depreciation

Please refer overlay for more details

WELCOME! We’re happy to have you at Acko, and promise to be there for you always. You’re now a part of the
Acko Advantage program, which takes care of everything if your car ever runs into trouble. Just call us
immediately on 1800 266 2256 when things go wrong and we’ll take it from there.

Acko No n -A c k o
Advant age* Advant age
Free car pick-up from
home, office or accident
site

Repairs at our network of

expert garages.

3-day repair guarantee.

Cab voucher** worth Rs.

500/day if there's a repair
delay.

Car drop at your doorstep.

Cashless and hassle-free

processing.

*Only applicable in selected cities provided you call us immediately - Ahmedabad | Bangalore | Chennai | Delhi | Hyderabad | Kolkata | Mumbai | Pune
**Cab vouchers available in the cities mentioned above. Please refer the Terms & Conditions for more details

Pleas e Note: Previous Policy document is required in case of claim within 30 days of Acko Policy Start Date.

If you are a workshop or garage staf f

Please call Acko for quick settlements on 1800 209 9910 [ GST# for workshop Invoice 27AAOCA9055C1ZJ ]

Acko Ge ne ral Ins urance Ltd.

Unit No. 301, E Wing, Lotus Corporate Park, Off Western Express Highway, Goregaon (E), Mumbai-
400063
Email: hello@acko.com | Phone: 18 00 266 2256 | www.acko.com
Product: Private Car Package Policy | CIN : U66000MH2016PLC28 738 5
IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ
UIN: IRDAN157RP0033V01201920, IRDAN157RP0024V012018 19, A0035V01201920, A0038 V01201920 Page 1 of 5
What’s Covered
A snapshot of all the coverages in this policy.

Accide nts Fire T he f t

Damages caused due to an accident are In case your car catches fire, resulting If your car is stolen, we will pay you the
covered. from self-ignition, explosion or lightning. value as per policy of your car.

C alamitie s C ar Owne r C o ve r C o ns umable s

Damage due to natural or man made Death and disability cover for the car Includes coverage for nuts, bolts etc
causes like earthquake, riots, etc. owner. during claims at no extra cost.

Ze ro de pre ciatio n
Covers the depreciation of parts which
are replaced during car repair.

What’s Not Covered

A snapshot of all the coverages that are not covered in this policy.

No n Accide ntal Damage s Indire ct Damage s o r T yre , T ube s & Engine Ille gal Driving
Wear & tear, breakdowns, Liability Damage to tyres, tubes, and Driving without a valid driving
failures, and deductibles are Indirect damages or liability engine is not covered unless license, or under the influence of
not covered. Also due to your car accident will they are damaged due to an alcohol and/or other illegal
consequential damages or not be covered. accident. substances will not be covered.
liabilities that arise due to car
accidents will not be covered.

Pre -e xis ting Damage s C o mme rcial Us age T hird Party Lo s s e s

Existing damages to the car Damages will not be covered Only covers damage caused
will not be covered. in case the car is used for to someone else's vehicle or
commercial purposes. property by your car. Theft or
damage to your car is not
covered.

The info rma tio n pro vide d he re in a bo ve is fo r the purpo s e o f illus tra tio n o nly. Fo r mo re de ta ils o n ris k fa cto rs , te rms ,
co nditio ns a nd e xclus io ns , ple a s e re a d the po licy wo rding s ( https ://www.a cko .co m/do wnlo a d ) ca re fully. Page 2 of 5
 S T A ND- A LO NE O W N DA MA G E P R IVA T E C A R P O LIC Y
Private Car Package Policy

P O L IC Y D E T AIL S VE HIC L E D E T AIL S

Insured Name: Rakesh Meher Registration Number: OD33Z8 351
Address/Pincode: 751030 Make/Model: MarutiBaleno
Period of Insurance: 04 Dec 21 (00:00 hrs) to 03 Dec 22 (23:59 Purchase Year: 2019
hrs) Engine CC: 1197
Policy Issuance Date: 02 Dec 21 Engine Number: K12MP1143928
Policy Number: ACOA00450371798 /00 Chassis No: MBHEWB22SKL395593

INS UR E D D E C L AR E D VAL UE ( ID V)
Ve hicle IDV (₹) Acce s s o rie s (₹) Bif ue l Kit (₹) T o tal IDV (₹)

430290 0 0 430290

P R E M IUM D E T AIL S ( ₹)
Own Damage Pre mium (A) Liability Pre mium (B)

Basic Own Damage ₹ 3621.0 PA for Owner Driver ₹ 399.0

Coupon Discount ₹ -249.0

Zero Depreciation Car ₹ 4562.0

Consumables ₹ 117.0

Net Own Damage Premium (A) ₹ 8 051.0 Net Liability Premium (B) ₹ 399.0

Total Package Premium ₹ 8 450.00

IGST (18 %) ₹ 1521.0

Total Premium ₹ 9971.00

Geographical Area: India Voluntary Deductible: ₹0 Hypothecation: Hdfc bank ltd

No-Claim Bonus: 0 Compulsory Deductible: ₹ 1000

L i m i t at i o n s As T o U se : The Po licy co ve rs us e o f the ve hicle fo r a ny purpo s e o the r tha n: a ) Hire o r Re wa rd b) Ca rria g e o f g o o ds (o the r tha n s a mple s o r pe rs o na l
lug g a g e ) c) Org a nize d ra cing d) Pa ce ma king e ) Spe e d te s ting f) Re lia bility Tria ls g ) Any purpo s e in co nne ctio n with Mo to r Tra de . Pe rso n s o r Cl ass o f Pe rso n s
e n t i t l e d t o d ri ve : Any pe rs o n ((including the ins ure d), pro vide d tha t a pe rs o n driving ho lds a va lid driving lice ns e a t the time o f the a ccide nt a nd is no t dis qua lifie d
fro m ho lding o r o bta ining s uch a lice ns e . Pro vide d a ls o tha t the pe rs o n ho lding a va lid le a rne r's lice ns e ma y a ls o drive the ve hicle a nd tha t s uch a pe rs o n s a tis fie s
the re quire me nts o f Rule 3 o f the Ce ntra l Mo to r Ve hicle s Rule s , 198 9. L i m i t s o f L i ab i l i t y. 1. P. A. Co ve r unde r Se ctio n III fo r Owne r - Drive r (CSI): Rs . 15 0 0 0 0 0 T e rm s,
Co n d i t i o n s & Exc l u si o n s: As pe r the India n Mo to r Ta riff. A pe rs o na l co py o f the s a me is a va ila ble fre e o f co s t o n re que s t & the s a me is a ls o a va ila ble a t o ur we bs ite .
I / We he re by ce rtify tha t the po licy to which the ce rtifica te re la te s a s we ll a s the ce rtifica te o f ins ura nce a re is s ue d in a cco rda nce with the pro vis io n o f cha pte r X, XI o f
Mo to r Ve hicle s Act, 198 8 . " The s ta mp duty o f Rs . 0 .5 0 pa id by e le ctro nic me dium vide GRAS De fa ce no . 0 0 0 164 92 0 0 2 0 2 12 2 da te d 12 /0 7 /2 0 2 1 a s pre s cribe d in
Go ve rnme nt No tifica tio n Re ve nue & Fo re s t De pa rtme nt No . Mudra nk - 2 0 17 /C.R.97 /M-1, da te d 0 9/0 1/2 0 18 . GSTN: 2 7 AAOCA90 5 5 C1ZJ. IMPO RT ANT NO T ICE: The
Ins ure d is no t inde mnifie d if the ve hicle is us e d o r drive n o the rwis e tha n in a cco rda nce with this Sche dule . Any pa yme nt ma de by the Co mpa ny by re a s o n o f wide r
te rms a ppe a ring in the Ce rtifica te in o rde r to co mply with the Mo to r Ve hicle s Act, 198 8 is re co ve ra ble fro m the Ins ure d. Se e the cla us e he a de d " AVOIDANCE OF
CERTAIN TERMS AND RIGHT OF RECOVERY" in the po licy wo rding s . Di sc l ai m e r: The Po licy s ha ll be vo id fro m ince ptio n if the pre mium che que is no t re a lize d. In the
e ve nt o f mis re pre s e nta tio n, fra ud o r no n-dis clo s ure o f ma te ria l fa ct, the Co mpa ny re s e rve s the rig ht to ca nce l the Po licy. The po licy is is s ue d ba s is the info rma tio n
pro vide d by yo u, which is a va ila ble with the co mpa ny. In ca s e o f dis cre pa ncy/no n re co rding o f re le va nt info rma tio n in the po licy, the ins ure d is re que s te d to bring the
s a me to the no tice o f the co mpa ny within 15 da ys . This Po licy is to be re a d in co njunctio n with the Po licy wo rding s (https ://www.a cko .co m/do wnlo a d) a va ila ble o n the
we bs ite o f the Co mpa ny. On re ne wa l, the be ne fits pro vide d unde r the po licy a nd/o r te rms a nd co nditio ns o f the po licy including pre mium ra te ma y be s ubje ct to
cha ng e .

INT E R M E D IAR Y D E T AIL S

Name C o ntact Email Addre s s

Amazon Pay (India) Private 18 00 266 2256 azcare@acko.com 8 th Floor, Brigade Gateway, 26/1, Dr. Raj Kumar
Limited Road Bangalore – 560055, Karnataka

Acko General Insurance Lt d .

Unit No . 3 0 1, E Wing , Lo tus Co rpo ra te Pa rk, Off We s te rn Expre s s Hig hwa y, Go re g a o n (E), Mumba i- 4 0 0 0 63
Ema il: he llo @ a cko .co m | Pho ne : 18 0 0 2 66 2 2 5 6 | www.a cko .co m
Pro duct: Priva te Ca r Pa cka g e Po licy | CIN : U660 0 0 MH2 0 16PLC2 8 7 3 8 5
IRDAI Re g No . 15 7 | HSN: 997 13 4 | GST: 2 7 AAOCA90 5 5 C1ZJ Fo r Acko Ge ne ra l Ins ura nce Ltd.
UIN: IRDAN15 7 RP0 0 3 3 V0 12 0 192 0 , IRDAN15 7 RP0 0 2 4 V0 12 0 18 19, A0 0 3 5 V0 12 0 192 0 , A0 0 3 8 V0 12 0 192 0 Duly Co ns titute d Atto rne y
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 P R EMIUM R EC EIP T

Received with thanks from Rakesh Meher a sum of ₹ 9971.00 towards premium on Car Insurance Policy

INS UR E D D E T AIL S INT E R M E D IAR Y D E T AIL S

Name of Insured: Rakesh Meher Name: AMAZON PAY (INDIA) PRIVATE LIMITED
Period of Insurance: 04 Dec 21 (00:00 hrs) to 03 Dec 22 (23:59
hrs)
Policy Number: ACOA00450371798 /00

P R E M IUM D E T AIL S ( ₹)
Gross Premium ₹8 450.00

IGST (18 %) ₹ 1521.0

Total Premium ₹9971.00

T E R M S & C O ND IT IO NS :
Issuance of this receipt does not amount to acceptance of the risk by Acko General Insurance Limited. The insurance cover for the risk shall be as
per the terms and conditions of the Insurance Policy if and when issued. * Cheque/DD/PO receipt is valid subject to realization of the instrument.

Acko Ge ne ral Ins urance Ltd.

Unit No. 301, E Wing, Lotus Corporate Park, Off Western Express Highway, Goregaon (E), Mumbai-
400063
Email: hello@acko.com | Phone: 18 00 266 2256 | www.acko.com
CIN : U66000MH2016PLC28 738 5 | IRDAI Reg No. 157 | HSN: 997134 | GST: 27AAOCA9055C1ZJ For Acko General Insurance Ltd.
UIN: IRDAN157RP0033V01201920, IRDAN157RP0024V012018 19, A0035V01201920, A0038 V01201920 Duly Constituted Attorney
Page 4 of 5
 PRO PO S AL FO RM

Dear Rakesh Meher,

We wish to inform you that the Insurance policy number ACOA004503 71798/00 has been issued on the
basis of the information and declaration given by you, the transcript whereof is mentioned below.

Please be informed that this Policy shall be construed to be void ab initio/invalid in the event we find that you have not disclosed
material or correct information required for the purpose of providing the below insurance cover and in case of any claim arising
under the policy in such a scenario, we shall be under no obligation whatsoever to settle such claim to you and the premium paid
by you under this policy shall stand fully forfeited.

P O L IC Y D E T AIL S P R E VIO US P O L IC Y D E T AIL S

Policy Number: ACOA00450371798 /00 Previous Policy Expired: Not Expired
Period of Insurance: 04 Dec 21 (00:00 hrs) to 03 Dec 22 (23:59 Previous Policy Insurer: Universal Sompo General Insurance Co.
hrs) Ltd.
Policy Issuance Date: 02 Dec 21 Previous Policy Number: None

C AR D E T AIL S C AR O W NE R D E T AIL S
Car Number: OD33Z8 351 Name: Rakesh Meher
Make/Model: MarutiBaleno Email Address: rXXXXXXXXXXXs@gmail.com
Type: Private Mobile Number: XXXXXX38 48
Fuel Type: petrol Address/Pincode: 751030
Registration Year: 2019
Registration Month: Dec
Insured Declared Value (IDV): 430290
Accessories (IDV): 0
Engine Number: K12MP1143928
Chassis Number: MBHEWB22SKL395593
Loan Provider: Hdfc bank ltd

NO M INE E D E T AIL S
Name: Lipika Bhol
Relationship with Insured: Spouse

C O VE R D E T AIL S
Add-o ns / Othe rs Include d Exclude d

PA Cover -

Car Protect -

Consumables -

Zero Depreciation -

T ERM S & C O N DIT IO N S :

" I/We de s ire to ins ure with Acko Ge ne ra l Ins ura nce Limite d in re s pe ct o f the ve hicle de s cribe d in this pro po s a l fo rm a nd co nfirm tha t the s ta te me nts co nta ine d in this
a pplica tio n a re my/o ur true a nd a ccura te re pre s e nta tio ns . I/We unde rta ke tha t if a ny o f the s ta te me nts a re fo und to be fa ls e o r inco rre ct, the be ne fits unde r this
po licy wo uld s ta nd fo rfe ite d. I/We a g re e tha t this a pplica tio n a nd de cla ra tio n s ha ll be pro mis s o ry a nd s ha ll be the ba s is o f the co ntra ct be twe e n me /us a nd Acko
Ge ne ra l Ins ura nce Limite d. I/We a g re e to the Co mpa ny ta king a ppro pria te me a s ure s to ca pture the vo ice lo g fo r a ll s uch te le pho nic tra ns a ctio ns ca rrie d o ut by
me /us a s re quire d by the pro ce dure s /re g ula tio ns inte rna l o r e xte rna l to the Co mpa ny a nd s ha ll no t ho ld the Co mpa ny re s po ns ible o r lia ble fo r re lying /us ing s uch
re co rde d te le pho nic co nve rs a tio n. In the e ve nt o f no nre a liza tio n o f the che que o r no n-re ce ipt o f the a mo unt o f pre mium by the Co mpa ny the po licy s ha ll be
de e me d ca nce lle d ‘a b-initio ’ a nd the Co mpa ny s ha ll no t be re s po ns ible fo r a ny lia bilitie s o f wha ts o e ve r na ture unde r this Po licy." I/We a g re e to re ce ive ‘Ce rtifica te o f
Ins ura nce o r Po licy Sche dule ’ o nly a nd s ha ll a cce s s the po licy te rms , co nditio ns a nd e xclus io ns o n the co mpa ny’s we bs ite .

P RO H IB IT IO N O F REB AT ED (S EC T IO N 4 1) O F T H E IN S U RAN C E AC T - 19 3 8 (AS AM EN DED)

1. No pe rs o n s ha ll a llo w o r o ffe r to a llo w, e ithe r dire ctly o r indire ctly a s a n induce me nt to a ny pe rs o n to ta ke o ut o r re ne w o r co ntinue a nd ins ura nce in re s pe ct o f a ny
kind o r ris k re la ting to live s o r pro pe rty in India , a ny re ba te o f the who le o r pa rt o f the co mmis s io n pa ya ble o r a ny re ba te o f the pre mium s ho wn o n the po licy, no r
s ha ll a ny pe rs o n ta king o ut o r re ne wing o r co ntinuing a po licy a cce pt a ny re ba te e xpe ct s uch re ba te a s ma y be a llo we d in a cco rda nce with the pro s pe ctus o r ta ble s
o f the Ins ure r.
2 . Any pe rs o n ma king de fa ult in co mplying with the pro vis io ns o f this s e ctio n s ha ll be lia ble fo r a pe na lty which ma y e xte nd to 10 la kh rupe e s .

Acko Ge ne ral Insurance Lt d.

Unit No . 301, E Wing, Lo tus C o rpo rate Park, Off We s te rn Expre s s Highway, Go re gao n (E), Mumbai- 40006 3
Email: he llo @acko .co m | Pho ne : 1800 26 6 2256 | www.acko .co m
C IN : U6 6 000MH2016 PLC 287385 | IRDAI Re g No . 157 | HS N: 9 9 7134 | GS T: 27AAOC A9 055C 1ZJ Fo r Acko Ge ne ral Ins urance Ltd.
UIN: IRDAN157RP0033V012019 20, IRDAN157RP0024V01201819 , A0035V012019 20, A0038V012019 20 Duly Constituted Attorney
Page 5 of 5