The Certificate of Insurance Page 1 of 3

ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Stand-alone OD Policy ( Private Vehicle ) Proposal No. & Date SR13108638 / 21-Mar-2023
Policy No. & Type 98000031222012959595 Period of Insurance 25-Mar-2023 to 24-Mar-2024
Policy Issued On 21-Mar-2023 (00:00) Vehicle Identification No. MBHCZCB3SNC977402
Insured Name Mr. Parmita Das Geographical Area INDIA
Invoice No 11221568300 Accounting Code of Service 997134
W/O-PRITOM DAS,VILL-DIGER FULERTAL PT-I,PO-FULERTAL,PS-LAKHIPUR,DIST-CACHAR,ASSAM - -,
Insured Address
SILCHAR-788106, Assam
Insured State & Code Assam-18 Place of Supply Assam GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 650358
Model & Variant SWIFT ZXI+ BS VI/MARUTI SWIFT ZXI+ 1.2L ISS 5MT Non Electrical Accessories 0
Registration No AS11W7483 Electrical Accessories 0
Year of Manufacture 2022 CNG/ LPG Kit 0
Engine- Chassis No K12NP 1203663 - MBHCZCB3SNC977402 Total IDV 650358
Cubic Capacity 1197
Seating Capacity 5
Type Of Body Saloon
RTO Location AS11W7483 / SILCHAR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) Pre-Existing Third Party Policy Details.
Vehicle 5190 Insurance Company Name THE NEW INDIA ASSURANCE CO. LTD
Elec. Accessories 0 Policy No. 98000031210911364909
Risk Inception Date 25-Mar-2022
Non- Elec. Accessories 0
Risk Expiry Date 24-Mar-2025
Kit (IMT-25) 0
Extra Premium towards Inbuilt CNG/LPG NA MISP - JAIN UDYOG, SILCHAR
Basic Premium 5190
Geographical Area Extn. (IMT-1) NA Notes : ( For Stand-alone OD Policy )
Lamp, Tyres etc. (IMT 23) 0
Driving Tuition Loading On OD Premium (60%) NA 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Fiber Glass Tank 0 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Sub-Total Additions 0 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10,
Deductibles 6. UIN : IRDAN190RP0001V01201920
Voluntary Deductibles (IMT 22A) 0 7. The Coverage under this policy is only for Own Damage and no other liability in
connection with the vehicle.
Anti-Theft Device (IMT-10) 130
8. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from
AAI Membership (IMT-8) 0 NCB to Non-NCB, the recoverable amount may be more than the NCB amount.
No Claim Bonus (20%) 1012
Discount for vehicles designed for handicapped NA
Sub - Total Deductibles 1142
Add - On Coverages
Nil Depreciation 3902
Engine Protect 1171
Return To Invoice 1301
Net own Damage Premium (A) 10422
IGST@18% 1875.96
Total OD Premium 12298
Nominee Details : Nominee Name PRITOM DAS Age 38 Relation Husband
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Credit Card 75420687074 ICICI BANK LIMITED 12298
Financier Type Financed Financier Name HDFC BANK LIMITED. Financier Branch SILCHAR BRANCH

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 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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Deductibles: Deductible under section-I : Rs 1000(Compulsory Deductible Rs 1000 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if no claim is made or pending during the preceding year (s), as per the following: The
preceding year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will
only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.

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