CERTIFICATE CUM POLICY SCHEDULE

GOODS CARRYING MOTORISED THREE WHEELERS AND MOTORISED PEDAL CYCLES-PUBLIC

CARRIERS LIABILITY ONLY POLICY - ZONE C
Issue Office: 421012-NAGAPPA COMPLEX, II ND FLOOR 1076, METTUPALAYAM ROAD NORTH COIMBATORE-COIMBATORE TAMIL NADU
641002 Tel 0422-4366746,3214797
Policy No : 421012/31/11/011314 Prev Policy No - Geographical Area INDIA
Insured's Code/ Name: 1900772 Mr.G SUBRAMANI
Address: 1/146-A, KIZRANDAI STREET,VANDAVAR TK -HOSUR TAMIL NADU Tel
9843816636 Fax RS11041 FUTURE ONE INSURANCE
Executive: NA0000001137 Mr.VIJAYAKUMAR. M Agent :
Period of Insurance : From 10:21 on 21/10/2010 To Midnight of 20/10/2011 Cvr Note No. - Issue date
Gross Premium: 1,405 Service Tax: 145 Total: 1,550 Collection No & Dt CSH 1036011586 - 21/10/2010

Registration Engine No Make - Model Type of Body Cubic Year Of Seating Capacity
Mark & Place Chassis No Capacity G. V. W Manf (Including Driver)
TN 25 W 5386 92239 BAJAJ TEMPO LTD.- OPEN 499 1350 2004 1+1
Thiruvannamalai 105E04 MINIDOR

IDV For the IDV For Non Electrical Electrical CNG KIT SI Total Value
Vehicle Trailers Accessories Accessories

SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY
BASIC TP COVER 1,530.00
ADD :LL TO PAID DRIVER COUNT : 1 25.00
LESS :GR39A-TPPD COVER 150.00
TP TOTAL 1,405.00
TOTAL PREMIUM 1,405.00
ADD :SERVICE TAX 145.00
TOTAL AMOUNT 1,550.00
Deductibles under Section-I :
Subject to IMT Endorsement Printed herein/attached to : IMT-28 , IMT-40 , IMT-20 , IMT-42
Hypothecation Agreement with:
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. 6000
P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 0
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 goods at
the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limitations as to Use
Use only for carriage of goods within the meaning of the Motor Vehicles Act. 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 carrying
passengers in the vehicles; except employees (other than the driver) not exceeding the number permitted in the registration document and coming under the
purview of Workmen's Compensation Act 1923.

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 the policy 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 COIMBATORE on 21-OCT-10
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 isrecoverable 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.
Preinspection Report: Not Applicable
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.

Entered By : VIJAYASARATHI.P For and on behalf of

SHRIRAM GENERAL INSURANCE COMPANY LTD
Examined By : VIJAYASARATHI.P

Place : COIMBATORE Proposal Date : 21/10/2010 Date : 21/10/2010

All the Amounts mentioned in this policy are in Indian Rupees
Authorised Signatory
Service Tax Reg. No. AAKCS2509KST001 Page 1 of 1