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LIBERTY GENERAL INSURANCE LIMITED

COMMERCIAL VEHICLE PACKAGE POLICY - PASSENGER CARRYING VEHICLES PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
3) In the event of misrepresentation, fraud or non-disclosure of material facts, the company reserves the right to cancel the policy from inception.
Policy Issuing Office 10th Floor, Tower A Peninsula Business Park, Ganpath Rao Kadam Marg Lower Parel MUMBAI MAHARASHTRA - 400013 Phone: +91 22 6700 1313
Fax: +91 22 6700 1606
Policy Servicing Office Unit no 306 to 310, 3rd Floor, Naurang House, Plot no. 21, K.G. Marg, Connaught Place, New Delhi- 110001 CENTRAL DELHI 110001 DELHI PH: +91
11 61276200 FAX: +91 0 0

Period Of Insurance From 00:00 Hrs of

To Midnight of 15/02/2023

Policy No 2013-200101-22-7002492-00-000
Policy Issued On 15/02/2023 14/02/2024
Geographical Area India
Covernote 201320010122700249200000
Insured CHUNKEEVA .. No/Ecovernote No
Address W/O RAJJAN R/O MALKANA DELOURA KARVI CHITRAKOOT
Covernote Date
210204 CHITRAKOOT UTTAR PRADESH
RTO Location CHITRAKOOT DHAM Zone Zone-C
UIN CODES IRDAN150RP0033V01201213
Contact Number (M) +917464858808/ +8953407013 Customer ID 4110318306
Customer UIN
GSTIN No/State NA/UTTAR PRADESH
Name

Agent Name ZOPPER INSURANCE BROKERS PRIVATE LIMITED

Agent Code IMD1116790 Agent Contact No 7272803803
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Year of Licensed
Manufacture/Date Vehicle Trailer Carrying
Registration Trailer Trailer Make/Type of
Of Engine No. Chassis No. Vehicle Class Sub Registration Model CC/HP/KW GVW capacity
Mark & No. Registration/Invoice Chassis No. IDV Body
Class No. including
Date Driver
C1B PCV 3
RE MAXIMA
UP 96 T 2018/15-04- Wheeler not BAJAJ
BBYWJE37864 JWE82621 Z DSL 4 470 0 4
2574 2019/15-04-2019 exceeding 6 AUTO/Saloon
STR
passengers
IDV (INSURED'S DECLARED VALUE)
Chassis IDV Non Electrical Accessories Electrical/electronic
IDV of Vehicle Body IDV Trailer IDV Bi-Fuel kit (CNG/LPG) Total Value
Accessories
127000 127000 0 0 0 0 0/0 127,000.00
A-OWN DAMAGE B-LIABILITY
Own Damage Premium on vehicle and accessories Third Party Premium
Basic Cover Basic Cover

Basic - OD 640.08 Basic - TP 2,539.00

TOTAL OWN-DAMAGE PREMIUM (A) 640.00 Legal Liability

Legal Liability to Passenger 3,642.00

Legal Liability to Paid Driver(1) Cleaner (0) Conductor (0)-IMT 28 50.00

TOTAL LIABILITY PREMIUM (B) 6,231.00

Net Premium(A+B) Taxable Value 6,871.00

IGST(18% - UTTAR PRADESH) 1,236.78

TOTAL POLICY PREMIUM 8,108.00

Hire Purchase/ Lease /Hypothecated with BAJAJ FINANCE LIMITED-CHITRAKOOT

LIMITATIONS AS TO USE - The policy covers use only for carriage of passengers in accordance with the permits (contract carriage or stage carriage)
issued within the meaning of the motor vehicle Act.
The policy does not cover : 1) Use of organized racing, pace making, reliability trial or speed testing 2)Use whilst drawing a trailer,except the towing
(other than for reward) of any one disable mechanically propelled vehicle.
DRIVERS CLAUSE
Persons or Classes of Person entitled to drive:Any person including the insured provided that a person driving holds an effective driving license at the time of the accident and
is not disqualified from holding or obtaining such a license.Provided also that the person holding an effective learner's license may also 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 Vehicle Rules, 1989.
LIMITS OF LIABILITY
Deductible Compulsory Deductible : Rs Under Section II-I (i) of such amount as is Under Section II-I 750,000.00 P.A. cover for 0.00
under section 500/-, the policy (Death of or necessary to meet the (ii) of the policy owner- Driver
-I Imposed Excess : Rs 0/-, bodily injury): requirements of motor (Damage to third under section III :
Theft Excess : Rs /-. vehicle Act,1988 party property) CSI
Subject to I.M.T Endorsement Nos. IMT 21,IMT 28,IMT 7
NOMINATION DETAILS

Name of the Nominee Relationship with Insured Name of Appointee (if nominee is minor) Relationship with the Nominee

I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of chapter X and chapted
XI of M.V. Act, 1988.
In witness whereof this Policy has been signed at Mumbai on 15/11/2022
Receipt No: 10220010122100641198
In case of Claims, Please contact us at : Toll Free No - 18002665844,
email id - care@libertyinsurance.in
Date of Issue : 15/11/2022
Place : Mumbai
Consolidated Stamp duty has been paid as per letter of Authorization no.
CSD/05/2019/1892/19 dated 23/04/2019 issued by Main Stamp Office, Mumbai. ** Not
Applicable for the State of Jammu & Kashmir.
Invoice No. 0722011000400921
Branch GSTIN No : 07AABCL9950A1ZN
SAC Code : 997134; Description of Service : General
Insurance Service; Place of Supply : UTTAR PRADESH/09 For Liberty General Insurance Limited
IRDA Regn. No. 150 Signature
CIN No. U66000MH2010PLC209656 Authorised Signatory
Tax is not payable under reverse charge by the recipient
I/We hereby declare that though our aggregate turnover in any
preceding financial year from 2017-18 onwards is more than
the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the
provisions of the said sub-rule
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 be good.