ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Commercial Vehicle - Passenger Carrying ) Proposal No. & Date R123985196 / 02-Jan-2022
Policy No. & Type 65300031201345774789 Period of Insurance 02-Jan-2022 to 01-Jan-2022
Policy Issued On 02-Jan-2022 (00:00) Vehicle Identification No. MA3FJEB1S00C2010GK
Insured Name Mr. Venna Sagar Geographical Area INDIA
Invoice No 4131204581754 Accounting Code of Service 997134
Insured Address S/O.MR.KRISHNA VENNA, 4-7-67 Kowkur, Muncipal ground, bharath nagar Alwal,,
RANGAREDDY-500010, Telangana
Insured State & Code Telangana-36 Place of Supply Telangana GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE(IDV) (in Rs.)
Make Maruti Vehicle 454752
Model & Variant TOUR S DIESEL/MARUTI TOUR S DIESEL Non Electrical Accessories 0
Registration No TS08UH0622 Electrical Accessories 0
Year of Manufacture 2019 CNG/ LPG Kit 0
Engine- Chassis No D13A- 3537723 - MA3FJEB1S00C20109 Total IDV 454752
Cubic Capacity 1248
Seating Capacity 5
Type Of Body Saloon
RTO Location TS08UH0622 / RANGAREDDY
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 6094 Basic Third Party Liability 11320
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium to Owner-Driver (1 Year) 275
PACover for Paid Driver of Rs (200000) each (IMT- 17 ) 120
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 6094 Legal Liability to Employees (IMT-37) 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) 11765
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 19299
Fiber Glass Tank 0 CGST @9% 1736.91
Sub-Total Additions 0 SGST @9% 1736.91
Deductibles Gross Premium Paid 22773
Voluntary Deductibles (IMT 22A) 0 MISP - THE MITHRAAGENCIES, HYDERABAD
Anti-Theft Device (IMT-10) 152
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus (20%) 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 152 3. The Policy is subject to a compulsory Deductible of Rs 500 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10, 28, 17,
Nil Depreciation Plus 1592 6. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from NCB to
Engine Protect 0 Non-NCB, the recoverable amount may be more than the NCB amount.
Invoice Protect 0
Net own Damage Premium (A) 7534
Nominee Details : Nominee Name VENNA SANTHOSH Age 33 Relation Brother
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail 40815122 22773
Auto Debit HSBC BANK LTD
Financier Type Financed Financier Name MAHINDRA & MAHINDRA FINANCIAL SERVICES LTD. Financier Branch KHARKHANA BRANCH.
Persons or Classes of Persons entitled to drive Anyperson including insured: Provided that a person driving holds an effective driving license at the time ofthe accident and is not disqualified from holding or obtaining
such a license. Provided also that the person holding an effective learner's license mayalso drive the vehicle when not used for the transport of passengers at the time of the accident and that such a person satisfies the
requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
LIMITATIONS AS TO USE: The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor Vehicle's Act 1988.The
Policy does not cover use for: (1) Organised racing, (2) Pace Making (3) Reliability Trials, (4) Speed Testing (5) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled mechanically
propelled vehicle.
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(ii) of the Policy - Damage
to Third Party Property - Rs. 7.5 lakhs (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Personal Accident cover for Owner - Driver under section IV: Capital Sum Insured (CSI) - Rs.
1500000 Deductible under Section-I: 500 (Compulsory Deductible Rs. 500 and Imposed Deductible Rs. 0 )
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if no claim is made or pending during the preceding year (s), as per the: The preceding year/20%,
Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50% of NCB on OD Premium. No Claim Bonus will only be
allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
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 National Insurance Company Limited

Authorized Signatory
Policy Issuing Office:-Tarnaka Division, Second Floor, 12-13-60/13, Vamsi Shopping Complex, Tarnaka, Secunderabad, Dist: Hyderabad, Andhra Pradesh
GSTIN: 36AAACN9967E6ZZ, CIN No.:U10200WB1906GOI001713
State Name : Telangana