Go Digit General Insurance Ltd.

Schedule/Certificate
Digit Private Car Liability Only Policy
UIN No.: IRDAN158RP0002V01201718

Name SURISETTY DAMODAR Vehicle Registration No. AP31DZ0543

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Flat 303 Sai Bhaskar Homes Peda Gantyada POLICYBAZAAR INSURANCE
Partner Name
Address Gajuwaka BROKERS PRIVATE LIMITED
Vizag,Visakhapatnam,Visakhapatnam-530026 Partner Code 1069216
Mobile xxxxxxxxx9822 Partner Mobile No. 91

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customerservice@pbpartners.c
Email dxxxxxxxx6@gxxxl.com Partner Email

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Aadhar No. -- For Claims,contact us at 1800-258-5956

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YOUR POLICY DETAILS

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Policy No. D071452627 / 27072022 Policy Issue Date 27-Jul-2022 Invoice No. IA070380290

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From 30-Jul-2022 00:00:01 Invoice Date 27-Jul-2022

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Period of Policy

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To 29-Jul-2023 23:59:59

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YOUR VEHICLE DETAILS

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Seating
RTO Location Visakhapatnam,ANDHRA PRADESH 5

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Capacity

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ECOSPORT/1.5 Ti- VCT Titanium
Make FORD Model/Vehicle Variant (Sub-Type)

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(MT)

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Engine No. 000HM28181 Chassis No. MAJAXXMRKAHM28181 Cubic Capacity 1497 CC

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Fuel Type Petrol Year of Mfg. 2017 Year of Regn. 2017
E FASTag Number NA
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IG FASTag NUMBER DECLARATION

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The Policy has been issued subject to your affirmative declaration that a valid FASTag has been affixed on the insured vehicle.
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614.
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Prime ENDORSEMENT
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Invoice Number Invoice Date Net Premium Igst Cgst Sgst Utgst Cess Gross Premium
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IA070380290 2022-07-27 3416.00 614.88 0.00 0.00 0.00 0.00 4030.88

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LIABILITY PREMIUM (`)

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Basic Third-Party Liability (`) 3416.00 PA cover for Owner-Driver (`) --

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PA cover for 5 passengers 0 (`) -- TP for Bi-fuel kit (`)

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Legal Liability for Operation / Maintenance (`) -- Legal Liability to Paid Driver (`) --
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PA Cover for Paid Driver (`)

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Net Premium (`) 3416.00

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IGST @ 18% = (`614.88) 3416

614.88
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Final Premium (`) 4030.88

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OTHER DETAILS
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Previous Insurer United India Insurance Co. Ltd.

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32060031210160039095 Previous Policy Expiry Date 29-Jul-2022

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Previous Policy No.

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IMT - Endorsements
G0 Unregistered
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GSTIN/UIN No. State Code 37

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Payment Mode Online Cheque/Transation No PB55353569

Bank Name IFSC/MICR No --
Receipt No. RA074925753 Receipt Date 27-Jul-2022

Nominee Details --
Financier Details --

Other details --
 Geographical Area: Any liability incurred within India shall be covered subject to Policy Terms and Conditions, unless specifically agreed and endorsed.. Limitation as to use: The
policy covers use of the vehicle for any purpose other than hire or reward, racing, pace making, reliability trial, speed testing and use for any purpose in connection with the Motor
Trade. Person or Class of persons entitled to drive: Any person including the insured. 1) Provided that a person driving holds a valid effective driving license at the time of the
accident and is not disqualified from holding or obtaining such a license. 2) Provided also that the person holding a valid & 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 and any subsequent amendment as applicable. Limits of Liability: 1) 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. 3) Under Section II - 1 (ii) of the policy:
Damage to Third Party Property - ` 750000 4) P.A. Cover for Owner Driver under Section III (CSI) - ` 0

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PA Owner Driver Declaration:The Policy has been issued without Compulsory Personal Accident Cover to Owner Driver on the basis of your declaration that you do not hold a valid

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Driving License on or before the date of commencement of this Policy / already have an alternate Personal Accident insurance cover of Rs. 15 Lakhs

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PUC Declaration:The Policy has been issued subject to valid Pollution Under Control (PUC) Certificate disclosed by you as an insured on or before the date of commencement of the

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Policy .

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Important Note: Please inform the Company in case of change on account of addition of CNG/PNG kit.

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Cheque dishonor / Non-receipt of payment premium paid through Cheque, the policy is void ab-initio in case of dishonor of Cheque or non-receipt of payment. Violation of Motor

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Vehicle Act: This policy is issued in accordance with the provision of Chapter X and Chapter XI of MV act, 1988 and any subsequent amendment as applicable. Any violation will
forfeit all benefits and coverages under the Policy. The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment made

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by the Company by reason of wider terms appearing in Certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the insured. See the Clause headed

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(Avoidance Of Certain Terms And Right Of Recovery) in the policy. This policy is subject to the standard policy wordings, warranties and conditions applicable for this product in

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addition to Indian Motor Tariff. Policy would be void on the ground that it was obtained by non- disclosure of material fact or by a representation of fact which was false in some
material particular.

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Note: The policy is issued in utmost good faith, relying on the information shared by insured at the time of obtaining the policy. The terms and conditions detailed in this policy schedule as
well as the policy document sent by Digit shall prevail in case of any dispute.

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For & On Behalf of Go Digit General Insurance Ltd.

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In case of claim or any other query, please

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contact our 24-hour Call Centre at 1800-258-

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5956 or email us at hello@godigit.com or visit
our website www.godigit.com

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Praveen Bhat
Senior Vice President-Customer Experience

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praveen.bhat@godigit.com
Authorized Signatory
20 Printed, Signed, and Executed at Bengaluru
Consolidated Stamp Duty has been paid as per Letter of
Authorization No.67-B/04/2017-18 Date: 30th May 2017
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issued by Department of Stamps and Registration ,

Bengaluru- 560009 - KARNATAKA.
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Hey, our document is now digitally signed

Click here to view the certificate.
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For instant resolution, you can ping us “Hi” on WhatsApp at

702 606 1234
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Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095. IRDAI Reg No. 158 CIN
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U66010PN2016PLC167410, GST Reg. No.:09AACCO4128Q1ZY HSN: 997134/General Insurance Services, GSTIN Address:Noida N Business Center,5th Floor, Halwaiyas
Commerce house, Habibullah Estate, 11 M.G Marg, Hazratganj,Lucknow,Uttar Pradesh,PIN-226001
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