ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Bundled Motor Policy- 3 Yr TP + 1 Yr OD ( Private Vehicle ) Proposal No. & Date N97012396 / 25-Dec-2020
Policy No. & Type MPX/SL127814 Period of Insurance Own Damage- 25-Dec-2020 to 24-Dec-2021
Third Party- 25-Dec-2020 to 24-Dec-2023
Policy Issued On 25-Dec-2020 (00:00) Vehicle Identification No. MA3EUA61S00G95290
Insured Name Mr. Dharam Pal Geographical Area INDIA
Invoice No SL127814 Accounting Code of Service 997134
Insured Address S/O BALAK RAM, VILLAGE-KURAHA,P.O.MATERNE KARAHU(324),
SOLAN-173205, Himachal Pradesh
Insured State & Code Himachal Pradesh-02 Place of Supply Himachal Pradesh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 337345
Model & Variant NEWALTO VXI/MARUTI ALTO VXI 0.8L 5MT Non Electrical Accessories 0
Registration No Electrical Accessories 0
Year of Manufacture 2020 CNG/ LPG Kit 0
Engine- Chassis No F8DN 6443788 - MA3EUA61S00G95290 Total IDV 337345
Cubic Capacity 796
Seating Capacity 5
Type Of Body Saloon
RTO Location SOLAN
Schedule Of Premium (Amount in Rs.)
Part A(1 Year) & Part B (3Years) LIABILITY SECTION (B)
Vehicle 7175 Basic Third Party Liability 5286
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [1 Year] 325
PACover for 0 Person of Rs (0) each (IMT- 16 )
Kit (IMT-25) 0
Legal Liability (WC) to Driver (IMT-28) 150
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Basic Premium 7175 Legal Liability to Employees (IMT-29) 0
Geographical Area Extn. (IMT-1) NA Legal Liability to Passenger (IMT 46) 0
Lamp, Tyres etc. (IMT 23) 0 Driving Tuition Loading On TP Premium (60%) NA
Net Liability Premium (B) 5761
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 14444
Fiber Glass Tank 0 IGST @18% 2599.92
Sub-Total Additions 0 Gross Premium Paid 17044
Deductibles
MISP - AUTOPACE NETWORK PRIVATE LIMITED, CHANDIGARH
Voluntary Deductibles (IMT 22A) 0
Anti-Theft Device (IMT-10) 179
Notes :
AAI Membership (IMT-8) 0
No Claim Bonus 0 0 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Discount for vehicles designed for handicapped NA 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Sub - Total Deductibles 179 4. Voluntary excess Rs (0)
Add - On Coverages 5. Subject to Endorsements IMT ,7 10, 28,
6. UIN : IRDAN139RP0039V01201819
Depreciation Cover 1687
Engine & Gear Box Protection Cover 0
Invoice Price Cover 0
Net own Damage Premium (A) 8683
Nominee Details : Nominee Name OM KALA Age 30 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 41243976 HSBC BANK LTD 17044
Financier Type Financed Financier Name HINDUJALEYLAND FINANCE LTD Financier 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.
Limits of Liability: Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is necessary to meet there requirements of the Motor Vehicles Act, 1988. Under Section II -1(ii) of the Policy - Damage to
Third Party Property - Rs.7.5 lakhs - (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Cover for Owner - Driver under section III (CSI) Rs 1500000 - 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.
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 RIGHT OF RECOVERY". For Legal interpretation, English
version will hold good.
For information on ombudsman you may visit website : http://www.gbic.co.in/ombudsman.html
I / We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X and Chapter XI of M.V. Act, 1988.
For Bharti AXA General Insurance co.ltd

Authorized Signatory
Policy Issuing Office:-1st Floor, SCO 350-351-352, Sector 34A, Chandigarh Chandigarh
GSTIN: 04AADCB2008D1ZK, CIN No.:U66030KA2007PLC043362
State Name : Chandigarh