Service Branch Address: No.4B, 4th Floor, "" A"" Block, Mena Kampala Arcade,Sir Theyagaraya Road, T.Nagar.

MAR 26, 2019

Mr. Saroj Wo Shiv Narayan

PLOT NO-1098, WARD-34, VIJAY N Intermediary Code: OA505227
AGAR, MAIN JHAJJAR ROAD CHUNGI, NEAR FITS
FACTORY AND MRF SHOWROOM,
Intermediary Name: Policybazaar Insurance Web
FARIDABAD, HARYANA Aggregator Private Limi
124001
Telephone : Contact: 1800 208 8787
Mobile : 999999997

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Two Wheeler Package Policy

Certificate of Insurance & Policy No. Policy Period: Period Of Insurance

VMPB058537000100 From 00:00:00 hours on 29/03/2021 To 23:59:59 hours on 28/03/2022

INSURED DETAILS
Name of Insured Insured Date of Birth Geographical Area Business/Profession Registration Authority Registration Date

Mr. Saroj Wo Shiv Narayan 18/11/1965 INDIA FARIDABAD 01/09/2013

INSURED'S DECLARED VALUE (IDV) (in Rs.)
Year For the Vehicle For Side-car Non Electrical Accessories Electrical/ Electronic Total IDV
Accessories

1st Year 29,170.00 0.00 0.00 0.00 29,170.00

The Vehicle: any of the following (Two-wheeler shall be deemed to include a sidecar attached to it)
VEHICLE DETAILS
Registration Number HR51AV0170 Type of Body SOLO
Engine Number JF50E80097489 Cubic Capacity 109
Chassis Number ME4JF501BD8098223 Year of Manufacturer 2013
Make of the Vehicle HONDA MOTORS LTD. Seating Capacity 2
Model Description ACTIVA -2 SEATER Total Premium (in Rs.) 1,122.00

LIMITATIONS AS TO USE: DRIVER:

The Policy covers use of the vehicle for any purpose other than: Any person including the Insured
a) Hire or Reward • Provided that a person driving holds a valid Driving Licence at the time of the
b) Tution accident and is not disqualified from holding or obtaining such a Licence.
c) Carriage of goods (other than samples or personal luggage) • Provided also that the person holding an effective Learner’s Licence may also
d) Organized racing drive the vehicle and that such a person satisfies the requirements of Rule 3 of
e) Pace making The Central Motor Vehicles Rules, 1989.
f) Speed testing
g) Reliability Trials
h) Any purpose in connection with Motor Trade

LIMITS OF LIABILITY:
Under Section I-1(i) of the Policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act,1988.
Under Section I-1 (ii) of the Policy - Damage to Third Party Property - Rs.100,000/-
Personal Accident cover for Owner - Driver under section III: CSI Rs. 15,00,000.00