HDFC ERGO General Insurance Company Limited

Certificate of Insurance cum Policy Schedule 2302205104882301000

PRIVATE CAR COMPREHENSIVE POLICY

2302205104882301000

Vehicle Details Policy Details

MR AJAY PRAKASH RAJ GOPAL Make JEEP Policy No. 2302 2051 0488 2301 000
PARTHU HALLMARK NA FLAT VINAYAKA NAGAR HAGADUR Model COMPASS-5TH ANNIVERSARY Period of From 11 Dec, 2023 00:01 hrs
MAIN RD BENGALURU BENGALURU BENGALURU EDITION 1.4 DCT PETROL Insurance
KARNATAKA - 560066 Tel. 99XXXXXXX2 Registration No KA-03-ND-8843 To 10 Dec, 2024 23:59
RTO BENGALURU Issuance Date 09/12/2023
Chassis No. MCANJPCH6KFA43916BJ Invoice No. 205104882301000
Cubic Capacity /Watts 1368 Seats 5 Customer Id 101256888591
Year of Manufacture 2018 Body Type SUV
Engine No. 0357877 EIA No. Not provided
Odometer reading:
Payment Details : PMR1673983391346 , Bank Name:BIZDIRECT
Email ID : ajxxxxxxxxx27@gxxxx.com
Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Year 1 From 11/12/2023 To 10/12/2024 1845000 0 0 0 0 1845000
Own Damage Policy Period Liability Policy Period
From Date & Time 11/12/2023 00:01 hrs To Date & Time 10/12/2024 Midnight From Date & Time 11/12/2023 00:01 hrs To Date & Time 10/12/2024 Midnight
Premium Details (`)
Own Damage Premium(a) (`) Liability Premium(b) (`)
Basic Own Damage 19373 Basic Third Party Liability 3416
Total Basic Premium 19373 Net Liability Premium (b) 3416
Add on Coverages Total Package Premium (a+b) 37139
Zero Depreciation (IRDAN125A0021V01201415) 8303 Integrated Tax 18% 6685
Emergency Assistance (IRDAN125A0016V01201314) 350
Engine and Gear box Protection (IRDAN125A0004V01201213) 2399
Cost of Consumables (IRDAN125A0003V01201213) 2399
Emergency Assistance Wider (IRDAN125A0016V01201314) 700
Loss of Personal Belonging - IRDAN125RP0001V02201415/A0023V01202122 199
Total - Add on 14350
Net Own Damage Premium (a) 33723 Total Premium 43824
Geographical Area India Compulsory Deductible (IMT-22) 1,000 Voluntary Deductible 0
Compulsory PA cover for owner driver has not been provided to the insured basis his/her declaration of not holding an effective driving license Or having Alternate PA / Stand alone CPA policy with minimum sum
insured of Rs 15 Lakhs.
Leased Agreement (IMT-6)/Hypothecated (IMT-7) with
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. Persons or Class of Persons entitled to drive: 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 1. Under Section II-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. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 750000 3. P. A. Cover under Section III for Owner - Driver(CSI): `
NA Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request and the same is also available at our website.

I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988.The stamp duty of Rs. 0.50
paid b y Demand Draft, vide Receipt/Challan no. LOA/CSD/547/2022/5450/22 dated 22/12/2022 as prescribed in Government of Maharashtra Order No. Mudrank No. 2017/CR.97/M-1, dated the 09th January 2018. I
/ We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare
an invoice in terms of the provisions of the said sub-rule. IMPORTANT NOTICE: The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment made
b y the Company b y 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". Disclaimer: The Policy shall be void from inception if the premium in full i s not realised by the company. In the event of misrepresentation, fraud or non-disclosure of
material fact, the Company reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared accordingly. The existing damages to the vehicle as mentioned
in the report shall not be paid by the Company. The policy is issued basis the information provided by you, which is available with the company. In case of discrepancy or non recording of relevant information in the
policy, the insured is requested to bring the same to the notice of the company within 15 days. GST for this invoice is not payable under reverse charge basis.

Branch :ff, 808(1), boman lodge dr. amberdkar road, dadar ( east)-400014,mumbai ,maharashtra mumbai

For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
Goods & Services Tax Registration No: 27AABCL5045N1Z8 HSN Code 997134
Broker Name : HERO INSURANCE BROKING INDIA PRIVATE LIMITED For HDFC ERGO General Insurance Company Ltd
Broker Code : 200365194759 Tel No. : 91-8126742969

Duly Constituted Attorney

Scan the code for Instant Policy Info, Register/Track Claim, Renewal and Modifications in policy.
"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings."

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN :IRDAN125RP0001V02201415. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2302205104882301000

Motor Insurance - Proposal Form cum Transcript Letter For Private Car Package

Vehicle Details Proposal Details

Make JEEP Proposal No. 202312090005612
Model COMPASS-5TH ANNIVERSARY Period of From 11 Dec, 2023 00:01 hrs
EDITION 1.4 DCT PETROL Insurance
Registration No KA-03-ND-8843 To 10 Dec, 2024 23:59
2302205104882301000 RTO BENGALURU Issuance Date 09 Dec 2023
MR AJAY PRAKASH RAJ GOPAL Chassis No. MCANJPCH6KFA43916BJ Invoice No. 205104882301000
PARTHU HALLMARK NA FLAT VINAYAKA NAGAR HAGADUR MAIN Cubic Capacity Customer Id 101256888591
1368 Seats 5
RD BENGALURU BENGALURU BENGALURU - 560066
KARNATAKA - Tel. 99XXXXXXX2 Year of Manufacture 2018 Body Type SUV
Engine No. 0357877
Odometer reading:
Payment Details : PMR1673983391346 , Bank Name:BIZDIRECT
Email ID : ajxxxxxxxxx27@gxxxx.com
Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Year 1 From 11/12/2023 To 10/12/2024 1845000 0 0 0 0 1845000
Own Damage Policy Period Liability Policy Period
From Date & Time 11/12/2023 00:01 hrs To Date & Time 10/12/2024 Midnight From Date & Time 11/12/2023 00:01 hrs To Date & Time 10/12/2024 Midnight
Premium Details (`)
Own Damage Premium(a) (`) Liability Premium(b) (`)
Basic Own Damage 19373 Basic Third Party Liability 3416
Total Basic Premium 19373 Net Liability Premium (b) 3416
Add on Coverages Total Package Premium (a+b) 37139
Zero Depreciation (IRDAN125A0021V01201415) 8303 Integrated Tax 18% 6685
Emergency Assistance (IRDAN125A0016V01201314) 350
Engine and Gear box Protection (IRDAN125A0004V01201213) 2399
Cost of Consumables (IRDAN125A0003V01201213) 2399
Emergency Assistance Wider (IRDAN125A0016V01201314) 700
Loss of Personal Belonging - IRDAN125RP0001V02201415/A0023V01202122 199
Total - Add on 14350
Net Own Damage Premium (a) 33723 Total Premium 43824
Geographical Area India Compulsory Deductible (IMT-22) 1,000 Voluntary Deductible (IMT-22A) 0
Compulsory PA cover for owner driver has not been provided to the insured basis his/her declaration of not holding an effective driving license Or having Alternate PA / Stand alone CPA policy with minimum sum
insured of Rs 15 Lakhs.
Leased
Broker Agreement
Name : HERO (IMT-6)/Hypothecated
INSURANCE BROKING (IMT-7)INDIA
with PRIVATE LIMITED Broker Code : 200365194759 Tel No. : 91-8126742969

Anti rebate clause

Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended) : 1. No person shall allow o r offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or
continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any
person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an
insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if
at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees..

Terms and Conditions

I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C:
1 ) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract between me/us and
HDFC ERGO General Insurance Company Limited.
2) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately.
3) I/We also shall endeavor to procure the renewal notice and pass on the same to HDFC ERGO General Insurance immediately upon the receipt of such renewal notice.
4 ) Any person who, knowingly and with intent to defraud the Insurance Company o r other persons, files a proposal for insurance containing any false information, o r conceals for the purpose of misleading,
information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a denial of insurance benefits.
GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details provided during policy
issuance. For any subsequent changes or addition (i.e. if GSTIN not entered at the time of policy issuance ) on policy schedule, changes shall be carried out through fresh policy issuance with prospective effect.
5) I understand the Proposal No. 202312090005612 is issued to me basis on above information.
6) It has been declared by you that you are not a Politically Exposed Person and the source of funds to purchase this policy are from salary/business income.
Transcript Declaration : In case disagreement or objection or any other changes with respect to information and contents mentioned herein above,please contact our toll free number and register your objections /
changes / disagreement to the conte nt of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days from date of your receipt of this transcript along.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN :IRDAN125RP0001V02201415. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com