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CertificateOfInsuranceandPolicyScheduleForm51oftheCenterMotorVehicleRules,1989
AgentName:KARTHICK.
AgentLicenseCode:9083725AgentContactNo:9840851086
Certificate&Policy
No.:
EndorsementNo.:
015511706000
PeriodofInsuranceFrom:
TN20AU5923
IDVofVehicle
()
14,607.00
Midnighton28/01/2016
To
EffectiveFrom:
InsuredName&Address:
MRPHINEHASG
NO36,
ANBAZHANSTREET
MANALI
CHENNAI600068
CHENNAI
TAMILNADU
Phone:
RegistrationNo.
09:39Hrson29/01/2015
Occupation:
GeographicalArea:
RegistrationAuthority:
HPA/Hyp/Leaseto:
SELFEMPLOYED
India
Tiruvallur
N/A
LoanNo.:
Make&Model
HERO
HONDASPLENDOR
PLUS
IDVofSideCar
()
0.00
EngineNo.
ChassisNo.
CC
Mfg.Year
BodyType
Seating
Capacity
16457
19954
97
2006
MOTORCYCLE
BiFuel/CNG/LPG
Kit( )
0.00
IDVofnonbuiltinAccessories( )
Electrical
NonElectrical
0.00
0.00
TotalInsuredDeclared
Values(IDV)( )
14,607.00
SCHEDULEOFPREMIUM
A.OWNDAMAGE
PremiumonVehicleandnonelectricalaccessories
A.TOTALOWNDAMAGEPREMIUM
C.TOTALADDONPREMIUM
B.LIABILITY
231.37 Basic
231.37 Add:CompulsoryPACoverforOwnerDriver 1,00,000
0.00 Less:IncreaseinPropertyDamageAmountUnlimited 6,000(IMT20)
464.00
50.00
50.00
B.TOTALLIABILITYPREMIUM(Roundoff)
464.00
COMPREHENSIVEPREMIUM(A+B+C)
695.37
NETPREMIUM
695.00
Add:12.36%ServiceTax
TOTALPREMIUM
86.00
781.00
DriversClause:Personsorclassesofpersonsentitledtodrive:Anypersonincludingtheinsured.Providedthatapersondrivingholdsaneffectivedrivinglicenseat
thetimeoftheaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.ProvidedalsothatthepersonholdinganeffectiveLearner'sLicensemayalso
drivethevehicleandthatsuchapersonsatisfiestherequirementsofRule3oftheCentralMotorVehiclesRules,1989.
LimitationsastoUse:ThePolicycoversuseofthevehicleforanypurposeotherthan:a)HireorRewardb)Carriageofgoods(otherthansamplesorpersonal
luggage)c)Organizedracingd)PaceMakinge)Speedtestingf)ReliabilityTrialsg)AnypurposeinconnectionwithMotorTrade
LimitsofLiability:UnderSectionII1(i)ofpolicy(Deathoforbodilyinjury):Suchamountasis I/weherebycertifythatthePolicytowhichthisCertificate
necessarytomeettherequirementsoftheMotorVehiclesAct,1988.
relatesaswellasthisCertificateofInsuranceareissuedin
UnderSectionII1(ii)ofpolicy(ThirdPartyPropertyDamage): 6,000.00
accordancewithprovisionsofChapterXandXIofMotor
VehiclesAct,1988.
UnderSectionIII:PAtoOwnerDriverCSI: 1,00,000.00
InwitnesswhereofthisPolicyhasbeensignedatTAMBARAMon
Nominee:NAAge:33Relationship:OTHERS
29/01/2015
UnderSectionI:(Deductibles)CompulsoryDeductible: 100.00,VoluntaryDeductible:
ReceiptNo.(s):103011000221439Dated:29/01/2015
0.00,
ForTataAIGGeneralInsuranceCompanyLTD.
ImposedExcess: 0.00
Subjectto:A)IMTEndorsementNo.:20,22
ServiceTaxRegistrationNo:AABCT3518QST004
StampDuty 0.50paidvideChallanNo:MH001053052201415Edated05/06/2014
AtriChakraborty
NationalHeadOperations&Systems
TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisSchedule.AnypaymentmadebytheCompanybyreasonofwiderterms
appearingintheCertificateinordertocomplywiththeMotorVehiclesAct,1988isrecoverablefromtheInsured.Seetheclauseheaded"AVOIDANCEOFCERTAINTERMS
ANDRIGHTOFRECOVERY".
Note:ThisSchedule,theattachedPolicyandEndorsementsmentionedhereinaboveshallreadtogetherandwordorexpressiontowhichaspecificmeaninghasbeen
attachedinanypartofthisPolicyoroftheScheduleshallbearthesamemeaningwhereveritmayappear.Anyamendments/modifications/alterationsmadeonthissystem
generatedpolicydocumentisnotvalidandCompanyshallnotbeliableforanyliabilitywhatsoeverarisingfromsuchchanges.Anychangesrequiredtobemadeinthepolicy
onceissued,wouldbevalidandeffective,onlyafterwrittenrequestismadetotheCompanyandCompanyacceptstherequestedamendments/modifications/alterationsand
recordsthesamethroughseparateendorsementtobeissuedbytheCompany.
Insuranceisthesubjectmatterofthesolicitation.Formoredetailsonriskfactors,termsandconditions,pleasereadsalesbrochurecarefullybeforeconcludingasale.
TATAAIGGeneralInsuranceCompanyLtd.Regd.Office:15thfloor,TowerA,PeninsulaBusinessPark,GanpatraoKadamMarg,OffSenapatiBapatMarg,LowerParel,Mumbai400013.
IRDARegistrationNo.108,CINNo:U85110MH2000PLC128425
Website:www.tataaiginsurance.in24X7TollfreeHelpline18002667780Email:customersupport@tataaig.com
2ndFloor,SamsonTowers,403L,PantheonRoad,Egmore,Chennai600008
Tel:04466220222,Fax: