Auto Secure Private Car Package Policy

RENEWPOLICY-TRACKON-1-31822390
Date : 11/07/2024

Name : MR AMMU KUMARA SARMA Your Policy Details

Policy Number : 0160036325 05 00
Address : FLAT NO. FF3 CHAKRAVARTI GRAND JN ROAD,
Own Damage Policy Period : From 06/08/2024 to. Midnight of
RAJAHMUNDRY
05/08/2025
EAST GODAVARI
ANDHRA PRADESH
533103 Liability Policy Period : From 06/08/2024 to. Midnight of
05/08/2025

PA Cover to Owner Driver Policy Period : From 06/08/2024 to.

Midnight of 05/08/2025

Phone : 9390676221 Premium Paid : `5,172.00

Dear MR AMMU KUMARA SARMA ,

We thank you for reposing your faith in us by renewing your vehicle

insurance policy. Your policy has been renewed as per youradvice
and incorporates changes (if any) requested by you.

We are enclosing policy schedule cum certificate of insurance of

your vehicle. You can access policy wordings, on our website
www.tataaig.com. You may also reach us at our 24*7 helpline1800
266 7780 in case you desire to have a printed copy of policy
wording.

As our valued customer, you will continue to enjoy a host of value

added benefits and give the extra protection that your vehicle needs.

We assure you of our best services at all times. Happy driving!

Sincerely ,
For TATA AIG General Insurance Company Limited

Authorized Signature

Tata AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001 Page 1 of 6
 Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989
Agent Name : DIRECT
Agent License Code : NA Agent Contact No : 24*7 Tollfree Helpline
1800-266-7780
Policy Type: Auto Secure Private Car Package Policy
Policy No: 0160036325 05 00
Cover Note No: Cover Note Issuance Date:
Policy Code : 00/05/3184/02 Period of Insurance
Name & Address of Insured
(Section - I Own Damage) From 00:01
Name : MR AMMU KUMARA SARMA Hours on 06/08/2024 To Midnight of 05/08/2025 .
Address : FLAT NO. FF3 CHAKRAVARTI GRAND JN ROAD,,,,
,RAJAHMUNDRY,EAST GODAVARI (Section - II Liability) From 00:01
ANDHRA PRADESH 533103 Hours on 06/08/2024 To Midnight of 05/08/2025 .
Contact Number : 9390676221
Customer Id : 6049588173 (Section - III CPA Cover For Owner Driver) From 06/08/2024 To
GSTIN : Midnight of 05/08/2025
Place of Supply : ANDHRA PRADESH
Supply Code : 37 ZONE : B

Hire Purchase / Hypothecation / Lease With : GAIL INDIA LTD

RTO LOCATION : KAKINADA AMALAPURAM RAJAHMUNDRY
Geographical Area : India Lessor GSTIN :

Contract/Loan/Reference No:

Licensed
Registration Make / Model / Body Trailer Registration No. carrying
Engine Number Chassis Number Mfg. Year CC/KW
Number Type / Chassis No. Capacity
including driver
AP 05 CW HONDA/AMAZE 1.2 MAKDF152FE400
L12B31607222 2014 1198 5
3286 SX I-VTEC/SEDAN 0080
Insured Declared Value (IDV) `
Electrical / Elec
Non Electrical Bifuel / CNG /
Year IDV Of Vehicle tronic Accesso Trailer Side car Total IDV
Accessories LPG Kit
ries
1 176604 0 0 0 0 176604
SCHEDULE OF PREMIUM
Section - I OWN DAMAGE (A) Section - II LIABILITY (B)

Own Damage Premium on Vehicle & Third Party Premium

Accessories Basic TP premium ` 3,416.00

Basic OD Premium ` 1,183.60 PA Benefits

Add: Repair Glass Fiber plastic ` 0.00 1 Year(s) Compulsory PA cover for Owner Driver ` 375.00

Discount Under Own Damage Section TOTAL LIABILITY PREMIUM (B) ` 3,791.00
Less: No claim bonus (50) ` 591.80 COMPREHENSIVE PREMIUM (A+B+C) ) ` 4,383.00

TOTAL OWN DAMAGE PREMIUM (A) ` 592.00 NET PREMIUM ` 4,383.00

IGST @18% ` 789.00
TOTAL ADD ON PREMIUM (C) ` 0.00
TOTAL POLICY PREMIUM ` 5,172.00
Drivers Clause: Persons or classes 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.

Limitations as to Use: The Policy covers use of the vehicle for any purpose other than : a) Hire or Reward other than for the purpose of driving tuitions 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

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 2 of 6
LIMITS OF LIABILITY
Under Such amount as Under ` 7,50,000.00 Number of claims
Under Section III
Section II - 1 is necessary to Section II - ` 15,00,000.00 covered under
:1
(i) of policy meet the 1 Depreciation
Year(s)
(Death of or requirements of (ii) of policy Reimbursement Cover:
Compulsory PA
bodily injury) the Motor (Third Party N/A
Cover for
Property Basis of claim settlement
Vehicles Act, OwnerDriver
Damage) for Tyre Secure cover :
1988.

Deductible
Under Section UIN Numbers: , IRDAN108RP0002V01200001/A0005V01200910(TA 08)
I

Compulsory Deductible : ` 1,000.00

Voluntary Deductible : ` 0.00
Imposed Excess: ` 0.00
Franchisee: ` 0.00

Subject to: A) IMT Endorsement Number : 22 , 07

B) TATA AIG Auto Secure Endorsement Number (TA): 08

NOMINATION DETAILS
Name of the Nominee Relationship with insured Name of Appointee (If nominee is minor) Relationship with Nominee
MRS VISHALAKSHMI Wife NA NA
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 TATA AIG General Insurance Company LTD.
In witness whereof this Policy has been signed at MUMBAI on 11/07/2024

Receipt No.(s): 102001077573183 11/07/2024

Stamp Duty of Rs.0.25/ - is paid as provided under Article 47-B of Indian Stamp Act, 1899
and included in Consolidated Stamp Duty Paid to the Government of MaharashtraTreasury
vide Order of Addl. Controller Of Stamps, Mumbai at General Stamp Office, Fort, Mumbai - Authorized Signatory
400001., vide this Order No. LOA/ENF1/CSD/13/2024/2289 Validity Period Dt.30/05/2024To
Dt.09/05/2027/2289 Date:10/05/2024
GSTIN :27AABCT3518Q1ZW MAHARASHTRAService Account Code: 997134

Policy Servicing Office : 2ND FLOOR, CITI TOWER, 61, DR. S.S.RAO ROAD,, NEXT TO M.G.M HOSPITAL, PAREL(E), MUMBAI - 400012 ,MUMBAI - 400012,
MUMBAI, MAHARASHTRA, 400012

Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness
certificate, as applicable, on the date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or
fitness Certificate, as applicable, during the subsistence of the Policy. Further, the Company reserves the right to take appropriate action in case
of any discrepancy in the PUC or fitness certificate.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 3 of 6
 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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed 'AVOIDANCE OF
CERTAIN TERMS AND RIGHT OF RECOVERY'. This policy does not cover pre existing damages as per Inspection photographs and Report

Note :This Schedule, Policy terms and conditions available on company website and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been
attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any amendments/modifications/alterations made on this system generated policy document is not
valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is
made to the Company and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company. You are advised to go
through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim Bonus or any other material
information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. You may visit company
website at www.tataaig.com for detailed benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of
policy wording. Our grievance redressal procedure and details about ombudsman is also available in our policy wording. Please note that any misrepresentation, non disclosure or withholding of material facts will
lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any. We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we
receive confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own damage section of the policy.

For Policy wordings, please scan the below QR code :

Disclaimer:
INSURANCE ACT 1938 Section 41 Prohibition of Rebates:
1. No person shall allow or 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 prospectus or tables of the Insurer.
2. ANY PERSON MAKING DEFAULT IN COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHED WITH A FINE WHICH MAY EXTEND TO TEN LAKHS RUPEES

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 4 of 6
 RECEIPT

Receipt No. 102001077573183 Receipt Date: 11/07/2024

Policy No: 0160036325

Received with thanks from MR AMMU KUMARA SARMA a sum of 5172 ( Rupees Five Thousand One Hundred Seventy-Two And Paise Z
ero Only ) vide Credit / Debit Card No 9999XXXXXXXX9999 dated 11/07/2024 Name as in credit/debit card - drawn on IDBI BANK LTD., NOI
DA branch towards

Sl.No. Policy Number Total Premium ` Utilized from the receipt for policy ` Balance `

1 0160036325 5,172.00 5,172.00 0.00

Note:
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void.
3. Amounts received by cheque shall be subject to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.

GSTIN: 27AABCT3518Q1ZW MAHARASHTRA Service Accounting Code: 997134

Revenue (Consolidated) Stamp Duty paid vide challan No. LOA/ENF1/CSD/25/2023/5069 date 18/12/2023 for applicable cases

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001
Page 5 of 6
 Auto Secure Private Car Package Policy

1 Name (Registered Owner of the Motor Vehicle)* : MR AMMU KUMARA SARMA

2 Address For Communication* : FLAT NO. FF3 CHAKRAVARTI GRAND JN ROAD,,,,,RAJAHMUNDRY,

EAST GODAVARI,ANDHRA PRADESH,533103.

3 Vehicle Details : Please refer policy schedule cum certificate

4 Fuel Type : PETROL
5 Insured’s Declared Value - Please refer policy schedule cum certificate.
6 Previous Insurance Particulars*:
Policy Number : 0160036325
Date of inception of TP portion : 06/08/2023
Date of Expiry of TP portion : 05/08/2024
Type of Cover : Package
Name of the Insurer : TATAAIG
OD claim in previous year(YES/NO) :
NCB in previous policy : 0
NCB claimed : 50
7 Own Damage period of insurance desired from* : 06/08/2024 to midnight of 05/08/2025
8 Liability period of insurance desired from* : 06/08/2024 to midnight of 05/08/2025
9 Compulsory PA cover forowner driver period of insurance desired from : 06/08/2024 to midnight of 05/08/2025
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Unnamed Persons Personal Accident Cover for seating capacity, including driver CSI :

Wider Legal Liability to Paid Driver (As per Workmen’s Compensation Act, Fatal Accident Act & Common Law) :

Compulsory PA Cover for Owner Driver : ` 15,00,000.00 Term : 1 Years

Name of the Nominee : MRS VISHALAKSHMI Age : 18 RelationShip : Wife

Name of Appointee (if Nominee is Minor) :NA Relationship to the Nominee : NA
Battery No :
Charger No :

12 Restriction of Cover/Discounts/Concessions/Extended Covers

Automobile association membership opted : No Third Party Property Damage Cover restricted to 6,000/ only : No
Is Voluntary Deductible opted : No Amount of Deductible opted : 0
Vehicle is fitted with Anti Theft Device approved by ARAI : N/A

13 Add on covers : N/A.

14 Bank Details (Required for Refund / Claims)

Name of the Account Holder : Name of Bank & Branch :

Account Number : IFSC Code of Bank :

15 Declaration for No Claim Bonus : N/A .

16 I hereby give my consent toreceive one page insurance policy.

17 AML Guidelines:
1. I/we hereby confirm that all premiums paid / payable in future will be from bonafide sources and not paid out of proceeds of crime and
that such premiums are not disproportionate to my/our income. I / we understand that the Company has the right to call for documents to
establish sources of funds and to cancel the insurance policy in case I / we are found guilty by any competent court of law under any of
the statutes, directly or indirectly governing the prevention of money laundering law in India.
2. I / we are not Politically Exposed Persons * nor are their close relatives. I / we shall keep the company informed if we subsequently
become a Politically Exposed Person.
“Politically Exposed Persons” shall have the meaning assigned to it under sub clause (xii) of 3(b) of Chapter I of Master Direction – Know
Your Customer (KYC) Direction, 2016 issued by Reserve Bank of India (RBI), as amended from time to time
18 We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

Insurance is the subject matter of the solicitation.For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
Tata AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com Page 6 of 6
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01200001