Bundled Two-Wheeler Insurance Policy

Policy Number: Issued at HERO INSURANCE BROKING INDIA PVT LTD.

SBI General Insurance Company Limited IRDA Registration No.: 649
HERO/1694471
Second Floor, Raj Complex, Old Pahargaon,Dollygunj Port Toll-Free No.: 1800 102 4376
Blair, Nicobar, Andaman and Nicobar Islands, 744103 264, Okhla Ind. Estate, Phase-III, Delhi-110020
Tel:1800-102-1111,1800-22-1111
customer.care@sbigeneral.in

Insured Business/Profession Address of The Insured TP Valid From TP Valid To

C O ABDUL KADER,VILL-LAKSHMIPUR,PO-LAKSHMI
24-11-2023
Mr SELIM MIA Skilled worker PUR,PS-TAPON , DAKSHIN DINAJPUR 733142 MALD Midnight of 23-11-2028
16:15:41
A WEST BENGAL 733142
Cubic GSTIN No.
Vehicle Regn No. Engine No. Chassis No. Make & Model Year of Mfg
Capacity (Customer)
Hero MotoCorp Passion
New HA11E1PHH84576 MBLHAW266PHH30322 2023 100
Plus I3S DRS CAST
Declared Value (IDV) of Side Car IDV Non-Electrical Electrical Accessories CNG/LPG/Bi- Total IDV
Vehicle Accessories IDV IDV Fuel IDV
73712.00 NA 0.00 0.00 0.00 73712
Place of Regn. Body Type HP/Lease/Hire-Purchase Branch Office of Seating Premium
Agreement With HP/Lease/Hire-Purchase Capacity
Muthoot Capital Services
DAKSHIN DINAJPUR Solo --- 2 5127.00
Ltd, HPA
Section A B. Liability Premium Computation (Section II) in Rs.
Basic OD Premium : 494.00 Basic Third Party Liability : 3851.00
Non-Electrical-Fitting Premium : 0.00 TPPD Discount : 0.00
Electronic & Electrical Accessories : 0.00 Total : 3851.00
Bi-Fuel Kit : 0.00 CNG/LPG/Bi-Fuel Kit : 0.00
Geographical Extension : 0.00 Geographical Extension : 0.00
Less : Add
Handicapped Discount : 0.00 Compulsory PA Cover (Owner Driver) : 0.00
For Anti-Theft Discount : 0.00 Optional PA Cover(Un Named Passenger) : 0.00
NCB : 0.00 Optional PA Cover(Un Named Driver) : 0.00
Total Own Damage Premium(A) : 494.00 Legal Liability Cover (Paid Drivers, Cleaners) : 0.00
Legal Liability Cover (Per Licensed Passenger) : 0.00
Total Liablity Premium (B) : 3851.00
Total Premium (A + B) : 4345.00
For any other extra : 0.00
CGST @ 9.00% : 391.00
SGST @ 9.00% : 391.00
Gross Premium : 5127.00
IRDAI'sRegnNo.:144||LicenceNo.:144||CINNo.:U66000MH2009PLC190546||PANNo.:AAMCS8857L||HSN/SAC:997134|| GSTIN No.:19AAMCS8857L1Z9 ||UIN No.-IRDAN144
RP0007V02201819
24-11-2023 To 23-11- 24-11-2024 To 23-11- 24-11-2025 To 23-11- 24-11-2026 To 23-11- 24-11-2027 To 23-11-
OD Policy Period
2024 2025 2026 2027 2028
IDV 73712 NIL NIL NIL NIL
CPA Sum Insured(NODL) NIL NIL NIL NIL NIL
Sum Insured of Optional PA Cover:-Sum Insured of Optional PA Cover "Unnamed Passenger"-NA and "Unnamed Driver"-NA
LIMITATIONS AS TO USE:--The Policy covers use of the vehicle for any purpose other than: a) Hire Or Reward b) Carriage of goods (other than samples or
personal luggage) c) Organized Racing d) Pace Making e) Speed Testing f) Reliability Trials g) Any purpose in connection with Motor Trade.
DRIVER: Any person including insured: Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from
Holding or obtaining such a licence.Provided also that the person holding an effective Learner's Licence may also drive the vehicle and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
LIMIT OF LIABILITY: Limit of the amount of the Company's liability under the Section II-I(i) in respect of any one accident as per M.V. Act 1988. Limit of the
amount of the Company's liability under Secion II-I(ii) in respect of any one claim or series of claims arising out of one event : Upto Rs - 100000/
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 RIGHTS OF RECOVERY'
I/We certify that the policy to which the certificate relates as well the certificate of insurance are issued in accordance with this provisions of Chapter X & XI of M.V. Act 1988
Broker : Hero Insurance Broking India Pvt. Ltd.
Received Vide
Premium of Rs. 5127.00 CASH
Cash/Cheque No.
ABDUL The policy is subject to a compulsory excess of Rs. 100/- &
Dated Nominee Name Depreciation is applicable as per policy terms & conditions*
MIA
Drawn on Nominee Age 48 (Please turn overleaf for details)
Consolidated stamp duty paid to state exchequer IMT - 22,5
Acknowledgement 24-11- Nominee Relation Father
Dt 2023
FOR RENEWALS CONTACT: PRINCE HERO Ph.No- 09832-484551 On behalf of SBI General Insurance Company Limited

24-Nov-2023
Date & Signature of NH-34, GABGACHI,JADUPUR,MALDA
proposer

Dealer's Stamp & Signature Duly Constituted Attorney

# : Received with Thanks Rs 5127.00 from Mr SELIM MIA as premium against the money receipt no 020000001694471
Regd. & Head Office : SBI General Insurance, 101,'Natraj', Junction of Andheri-Kurla Road & Western Express Highway, Andheri East, Mumbai,
400069 Consolidated stamp duty paid to state exchequer
For further information about motor insurance policy please also visit www.irdai.gov.in >> Grievances >> Policyholder Handbooks