This Document is Digitally Signed

Signer: MILAP CHAND

Date: Fri, Jan 14, 2022 14:16:22 IST
Location: NOIDA
Reason: Signing Policy for OICL

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

STANDALONE OWN DAMAGE(OD)-PRIVATE CAR POLICY - ZONE B
UIN: IRDAN556RP0001V01201920

Policy No : 261493/31/2022/832 Prev Policy No : 11876304

Cover Note No : - Cover Note Dt :

Insured's Code : 149522887 Issue Office Code : 261493

Insured's Name : SATYAM COTTEX INDIA PVT LTD (GSTIN: Issue Office Name : BC, SAMALAKHA (GSTIN:
06AABCS0133N1ZI) 06AAACT0627R1Z3)

Address : OPP BABA PEER Address : Shop No. 837, First Floor, Near Matu Ram
G T ROAD Petral Pump
G.T. Road Samalkha
SEWAH, PANIPAT
PANIPAT HARYANA 132103
HARYANA 132101
Tel /Fax /Email : 9034494276 / / 9034494276 / NA Tel /Fax /Email : 0180-2570160 / /
261493@orientalinsurance.co.in
Lead\Breakin No :

Agent/Broker Details
Dev.Off.Code : NA0000009398 DIRECT
Agent/Broker :: BA0000124143 MR.NAFIS
Address : S/O.SH.ALI HASSAN, H.NO.31, VPO NAMUNDA,TEH.SAMALKHA,
PANIPAT,KARNAL,HARYANA,132101
Tel /Fax /Email : //9467127979//NA

Period of Insurance : FROM 00:00 ON 18/01/2022 TO MIDNIGHT OF 17/01/2023

Collection No & Dt : DC_I_IND 8956001277 - 14/01/2022 GST INVOICE NO :0620209299 UIN :0

Gross Premium : 19,110 GST : 3,440 Stamp Duty : .5 Total : 22,550

Geographical Area : INDIA Area Extension :

Particulars of Insured Vehicle:

Registration Mark Engine No. & Type Of Body Cubic Year Of Seating Capacity
& Place Chassis No. Make - Model Capacity Manf. (including Driver)

HR 06 AX 6343 M165932 HYUNDAI-CRETA 1.5 OTHERS 1493 2021 4 + 1

CRDI MT S BS VI
RTO Painpat MM122687

Limitations as to use: C.P.A Cover Owner Driver(CSI):Rs 0

1 The policy covers use of the vehicle for any purpose other than hire or reward ,tuition,organized racing,pace making,reliability
trial,speed testing,carriage of goods(other than samples or personal luggage) or use for any purpose in connection with Motor Trade.

Limit of Liability: As per policy terms/conditions

Details of TP insurance
Name of Insurer & Address Policy No Period of Insurance
BAZAZ ALLIANZ 11876304 18/01/2021 TO MIDNIGHT OF 17/01/2024

If the TP Insurance declaration provided above by the Insured is found incorrect/or the policy does not exist/ lapsed/Cancelled due to any
reason, then subject policy becomes Null and Void from the date TP coverage has ceased to exist.
*This insurance excludes any loss/liability arising out of Third Party or personal accident.

*This insurance excludes all pre-existing damages

Place :
Date : 14/01/2022
Page &f_4 of &f_3
 This Document is Digitally Signed

Signer: MILAP CHAND

Date: Fri, Jan 14, 2022 14:16:22 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261493/31/2022/832

Insured's Declared Value

For the Vehicle For Trailers Non Electrical Electrical Value of CNG Total Value
Accessories Accessories LPG Kit

9,30,000 0 0 0 9,30,000

SCHEDULE OF PREMIUM

BASIC OD COVER 29,676.00 TOTAL PREMIUM 19,110.00

ADD :ENGINE PROTECT COVER 2,046.00 STAMP DUTY 0.50
LESS :HEAD OFFICE DISCOUNT 11,870.00 ADD :SGST 1,720.00
LESS :UNDERWRITER DISCOUNT 8,903.00 ADD :CGST 1,720.00
LESS :CC IS 1500CC OR LESS AND IDV 307.00 TOTAL AMOUNT 22,550.00
RS.10LACKHS OR LESS
BASIC OD TOTAL 10,642.00
ADD :Add on cover Consumables 930.00
ADD :ADD-ON COVER NIL DEPRECIATION 5,935.00
POLICY
ADD :ADD ON COVER FOR RETURN TO 2,790.00
INVOICE
LESS :Motor Add on Cover 1,187.00
Discount(Nil.Depreciation)
OD TOTAL 19,110.00
MOTOR TOTAL OD 19,110.00

Please note the coverage under this policy is restricted to Own Damage section only and no other liability in connection with the
vehicle

Deductibles under Section-I :

Subject to IMT Endorsement Printed herein/attached to : IMT-22 , OIC-1:Nil Depreciation Cover , IMT-20 , IMT-17 , IMT-6

Details of IMT Endorsements are also available on the Company¿s Web Portal www.orientalinsurance.org.in

Hypothecation Agreement with: ICICI BANK LTD, PANIPAT

Hire Purchase/Lessor Agreement with: -

In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured will comply with
the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as well as company's website.
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC endorsements mentioned herein
above which are available on Company's website: www.orientalinsurance.org.in or on demand from the policy issuing office.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void
abinitio (from inception).
Claim is not admissible if Driving License is found fake or is not valid whether or not in the knowledge of the insured.
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 Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at BC, SAMALAKHA
(GSTIN: 06AAACT0627R1Z3) on 14-JAN-22

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 MVAct, 1988 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

Place :
Date : 14/01/2022
Page &f_4 of &f_3
 This Document is Digitally Signed

Signer: MILAP CHAND

Date: Fri, Jan 14, 2022 14:16:22 IST
Location: NOIDA
Reason: Signing Policy for OICL

Attached to and forming part of policy number 261493/31/2022/832

For and on behalf of

The Oriental Insurance Company Limited
Entered By : JAIPAL JAIN

Examined By : RAJENDER KUMAR CHHABRA

MILAP CHAND
Policy Printed By : 060577 IP : General Manager
Policy Printed On : 14-JAN-22 14:12:13 Authorised Signatory

This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees

Place :
Date : 14/01/2022
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