Auto Secure - Liability Only Policy Date: 13/11/2021 Name MR Tosi Khatek Your Policy Details ‘Asdross” 48 Macchibejar Songadh- 8 SONGADH Policy Number 017919073 SOTO GUNARAT Policy Period = From 00:00 Hrs on 14/11/2021 To midnight of Phone 9104868860 13/11/2022 Premium Paid Rs. 3801 Doar Ni Tosi Kata, Welcome to Tata AIG General Insurance Company Limitod's family & we tnank you for choosing our palicy for your motor vehicle insurance, We are enclosing Policy schedule cum certiiate of insurance of your vehicle. You re requested to visit our website ww tatasig com for policy wording, ‘Your policy has been issued based onthe information and declaration provided by you. Kindly go through the enclosed informaton/dectartion provided by you and in case your policy shows any erroridscrepancy then we request you to got in touch with us vithin 15 days of receipt of tho policy or correction otherwise all particulars will be deemed tobe cocrect. ‘You may reach us at our24°7 helpline 1800 266 7780 for providing any information orn case you desire to have a printed copy of policy wording We assure you of our best servoes a limes. Happy diving! Sinoeraly For Tata AIG General Insurance Company Limited Mabe ‘Authorized Signatory Cree Lasso SMS “CLAIMS' to 5616181 or Peete sna neh @ cuss © ware rous 7 con cor vooeseere | NAgon an fee aagheAuto Secure - Liability Only Policy P—— Cerificate of insurance and Policy Schedule form 61 of the Gentral Motor Vehicle Rules 1989, ‘Agent/Broker/Producer Name: PROBUS INSURANCE BROKER PRIVATE LIMITED Agent/Broker License Code: 150; Agent/Broker Contact No.: 1126521101 = — F SAo oa ae SCTE COREAT WON SOTO For TATA A General nsranceComsay tinted ‘autnonzed signatory aragcacnrAuto Secure - Liability Only Policy Transcript of Proposal for Auto Secure - Liability Only Poliey 4. Name (Registered Owner of the Motor Vehicle)" MR Tos Khataki 2, Address tor Communication’48 Maechibalar Songedh - § SONGADH 394870 GUJARAT 3, Vehicle Details: Please refer policy schedule eum certificate, 4. Voice Purchased is ‘Roll Over 5. Vehicle Type :inaigenous 6. Fuel Type :Petrol 7. ingurec's Declared Value - Please reer policy schedule cum certificate, 8, Previous Insurance Particulars* Policy Number: 123456 Date of Expiry": 1310712021 Type of Cover : Liability Only Name of the Insurer” : LAT GENERAL INSURANCE CO. LTD. ‘Accident inthe previous policy period : No NCB in previous poliey:0% NCBeelaimed : 0% 9. Period of insurance Desired trom’: 00:00 Hrs on 14/1/2021 to midnight of 15/11/2022 410. Financiers Detalls:Pease refer policy schedule cum certieate, 11. Extra Benefits opted Un-Named Persons Personal Accident Cover for seating capacity, including driver: C81. NIA ‘Wider Legal Liability to Paid Driver (As per workmen Compensation Act, Fatal Accident Act & Common Law):NO PA Owner Driver Capital Sum Insured:0)- based on insureds declaration that he/she already has a 24 hour Personal Accident cover ‘against Death and Permanent Disability (Total and Partial) for Capital Sum Ineured of at least 18 lakh 12. Restriction of CoverDiscountsiConcessions/Extended Covers Name of Automobile: NIA Membership no : NIA ‘Third Party Property Damage Cover restricted to Rs, 6,000 only :NO 413, Add on covers - Please refer policy schedule cum certitieate Specified Person Details. ‘SP Certcate No: NIA SP Name: NA “4. Bank Detall (Required for Refund / Claims) Name of the Account Holder: MR Tosi Khatakl Name of Bank & Branch: & AHMEDABAD ‘Account Number: IFSC Code of Bank:16. hereby give my consent to receive one page insurance policy. 16, AML Guidelines: 1. llwe hereby confirm that all premiums have beenill be paid from bonafide sources and no premiums have been'will be paid out of proceeds of crime related to any ofthe offence listed in Prevention of Money Laundering Act, 2002. 2. understand that the Company has the right to call for documents to establish sources of funds. 3.The insurance company has right to cancel the insurance contract in case | am/have been found guilty by any competent court of law Under any of the statutes, cirecly or indirectly governing the prevention of money laundering in India.