IRDAI REGN. NO.

- 137
SHRIRAM GENERAL INSURANCE COMPANY LIMITED
E-8,EPIP,SITAPURA INDUSTRIAL AREA,JAIPUR,
RAJASTHAN-302022
CONTACT(TOLL FREE): 1800 – 30030000, 1800 – 1033009

B
CERTIFICATE CUM POLICY SCHEDULE
PCCV-4 wheelers - carrying passengers-capacity NOT > 6 - Zone A
Branch Address 10003-Address-E - 8, RIICO INDUSTRIAL Branch Office Phone No.
AREA,, SITA PURA, JAIPUR, RAJASTHAN -
302022
CIN NO.U66010RJ2006PLC029979

Geographical Area INDIA 10003/31/24/290385

Policy No.
Insured's Code/ Name IN-25444028 / GANDIKOTA UDAY GSTIN No. Of Insured Unregistered
Insured Address BLOCK X 3RD FLOOR SADHARVALABAI PATEL NAGAR, BANJARA HILLS HYDERABAD
, SOUTH BANJARA HILLS
, HYDERABAD, TELANGANA
- 500033 FAX-TCHO1T111260001
Insured State Code 36 NCB Discount (%) 0
Executive IDHARMARAO - NC0000000011 Period of Insurance From 16:55 Hrs of 20/09/2023 To
Midnight Of 19/09/2024
Agent Details STFC LTD - CA0197 - BG0000000003- Mobile
No.-9878596587
PAN No. N.A
Prop No. - TR No. N.A - N.A Prop Issue Date N.A
Gross Premium 19003 IGST 3420
CGST 0 SGST/UTGST 0
Previous Insurer Reliance General Insurance Co Ltd Total 22423
Previous Policy No. 180122223380007051o Nominee for LAXMAMMA
Owner/Driver
Nominee Age 35 Nominee Relationship Mother
Appointee Name N.A Appointee Relationship N.A
REGISTRATION ENGINE NO. & CHASSIS NO. MAKE - MODEL TYPE OF BODY / CUBIC CAPACITY/ DATE OF SEAT CAP.
MARK & PLACE FUEL TYPE YEAR OF MANF. REGN. / (INCL.
DELIVERY DRIVER)
TS - 09 - UC - D13A3377959 & MARUTI SUZUKI - SEDAN / DIESEL 1248 / 2018 24/09/2018 4+1
1577 & MA3FJEB1S00B68441HJ DZIRE S TOUR
KHAIRTABAD
IDV FOR THE IDV FOR TRAILER
NON ELECTRICAL ELECTRICAL CNG/LPG kit SI TOTAL VALUE
VEHICLE ACCESSORIES ACCESSORIES
328000 0 0 0 0 328000
Own Damage Policy Period Liability Policy Period
From Date & Time 20/09/2023 To Date & Time 19/09/2024 23:59 From Date & Time 20/09/2023 To Date & Time 19/09/2024 23:59
16:55 Hrs Hrs of Midnight 16:55 Hrs Hrs of Midnight
SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY
OD TOTAL 6786.00 BASIC TP COVER 11852.00
TOTAL PREMIUM 19003.00 ADD :GR36A-PA FOR OWNER DRIVER 315.00
ADD : IGST 18.00% 3420.00 ADD :Legal Liability Coverages For Paid Driver 50.00
PREMIUM AMOUNT 22423.00 TP TOTAL 12217.00
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz ( Automobile Association, Voluntary Excess, Anti-Theft, Handicap Person,
Driver Tuition, Fibre Glass,CNG/LPG Unit, Geographical Extn, Imported Vehicle etc. wherever applicable ). PA Owner Driver CoverPeriod:- From 00:00
Hrs of 20/09/2023 To Midnight of 19/09/2024

CPA Policy number: N.A., CPA Sum Insured: 0.00, CPA Company Name: N.A., CPA Valid From: N.A., CPA Valid To: N.A.
Deductibles under Section-I : Compulsory Deductible Rs.500
Subject to IMT Endorsement Printed herein/attached to : IMT-22, IMT-40, IMT-7,
Hypothecation Agreement with: SHRIRAM FINANCE LIMITED
Hire Purchase/Lease Agreement with:
Limit of Liability :
Under Section II-1(i) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-1(ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 1500000
PreInspection Survey: Dented Part : N.A,Broken Part : N.A, Scratched Part : N.A ,Claim not payable for : N.A
Preinspection Report: Not Applicable
Driver's Clause
Any person including 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 accident and that such a personsatisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

PLACE : HEAD OFFICE-III

For and on behalf of
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the
Shriram General Insurance Co.Ltd.
expiry date of your policy. If you do not want us to contact you, kindly send an e-mail for the same on
dnd@shriramgi.com
Consolidated Stamp Duty paid vide order No. F7(77)Gen/2023/4956 dated 20/07/2023
For Policy Wordings, NEFT/RTGS/IMPS or any other online payment kindly visit our website
"www.shriramgi.com" Validity of policy is subject to KYC verification.
All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be
GSTIN No. 08AAKCS2509K1Z3 considered as delayed intimation.

Authorized Signatory

Page 1 of 2
IRDAI REGN. NO. - 137
SHRIRAM GENERAL INSURANCE COMPANY LIMITED
E-8,EPIP,SITAPURA INDUSTRIAL AREA,JAIPUR,
RAJASTHAN-302022
CONTACT(TOLL FREE): 1800 – 30030000, 1800 – 1033009

B
CERTIFICATE CUM POLICY SCHEDULE
PCCV-4 wheelers - carrying passengers-capacity NOT > 6 - Zone A
Limitations as to Use:
Use Only In Connection With The Insured'S Business. The Policy Does Not Cover 1) Use For Organised Racing, Pace-Making, Reliability Trial Or
Speed Testing. 2) Use Whilst Drawing A Trailer Except The Towing (Other Than For Reward) Of Any One Disabled Mechanically Propelled Vehicle. 3)
Use For The Conveyance Of Passengers For Hire Or Reward By Any Person To Whom The Motor Vehicle Is Hired.
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 insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms
attached.Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and thepolicy shall be void abinitio
(from inception). 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 JAIPUR-I

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".
POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION.
If policy is cancelled/Endorsed beyond the said date [i.e.31/10/2024],only the proportionate amount of premium would be refunded and any GST amount would
NOT be refunded owing to the restrictions prescribed under GST law.
Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.
In case of Claims/Grievance, Please contact us at: Toll Free No – 180030030000, 18001033009 Email id - chd@shriramgi.com
For instant renewal of your insurance policy, Log on to www.shriramgi.com or contact us at our Head office no. - 0141-4828400

PLACE : HEAD OFFICE-III

For and on behalf of
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the
Shriram General Insurance Co.Ltd.
expiry date of your policy. If you do not want us to contact you, kindly send an e-mail for the same on
dnd@shriramgi.com
Consolidated Stamp Duty paid vide order No. F7(77)Gen/2023/4956 dated 20/07/2023
For Policy Wordings, NEFT/RTGS/IMPS or any other online payment kindly visit our website
"www.shriramgi.com" Validity of policy is subject to KYC verification.
All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be
GSTIN No. 08AAKCS2509K1Z3 considered as delayed intimation.

Authorized Signatory

Page 2 of 2
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