Signedby:Kishor

eMukulDate:201
3.08.04

Reliance Private Car Vehicle Certificate cum Policy Schedule

Policy/ Certificate No. : 9202732311004278
Proposal/Covernote No: 040813701642 Business/Occupation: NA
Name of Insured: MR. BALDEV SINGH Periodof Insurance: From00:00 Hrs on06/08/2024 to 05/08/2025 on23:59
VILL NAGAL GURU PO. BUNDALA
Address :
AMRITSAR
Contact details: 9877450981
Email ID: [email protected] Zone A Geographical Area India
Particulars of vehicle Insured :
RegistrationNumberand Make / Model Engine / Chassis No.Vehicle Cubic Capacity Year of MFG Seating Capacity Net Premium Rs. IDV(Insured'sDeclared
Place ofsidecar(ifany) Value) Rs
including driver
PB02DC4776 MARUTI/ALTO K10 K10BN2022353 998 2017 5 2093.5
MA3EZDE1S00324928

Limitations As To Use
ThePolicycoversuseforanypurposeotherthan:a.HireorReward,b.Carriageofgoods(otherthansamplesorpersonalluggage),c.Organizedracing,d.Pacemaking,e.Speedtesting,f.Reliabilitytrials,g.Any purpose in connection
with Motor Trade
Persons/Classesof Persons entitled to drive:
AnypersonincludingtheInsuredprovidedthatapersondrivingholdsaneffectivedrivinglicenseatthetimeoftheaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.Providedalsothatthe 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:
a.UnderSectionII-1(i)ofthePolicy-DeathoforbodilyinjurytoanypersonsofarasitisnecessarytomeettherequirementsoftheMotorVehicleAct,1988.b.UnderSectionII(1)(ii)ofthePolicy-Damageto property other than property
belonging to the insured or held in trust or in the custody of control ofthe insured up to the limits specified Rs.7.5 lakhs .
Deductible under Section-
(i)CompulsorydeductibleRs.1000/-(ii)AdditionalcompulsorydeductibleRs.0/-(iii)VoluntarydeductibleRs.0/-(iv)PACoverforowner-driverundersectionIIICSIRs.200000/- Nominee Details:
PA Owner Driver: Nominee Name :MONMI BHARALI TALUKDAR Nominee Age:30 Relationship with Owner Driver:SPOUSE
SpecialConditions: NA
Itis hereby declared and agreed that all pre-existing damages to the vehicle having occurred prior to the commencement of cover are excluded from the scope of thepolicy.
The policy wording with detailed terms, conditions and exclusions are available on our website www.reliancegeneral.co.in
Consolidated stamp duty paid vides Receipt No.MH000023890201314Edated10/04/2013Not applicable for the State of Jammu and Kashmir.
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 M.V. Act, 1988. Note: In the event
ofdishonorofcheque,thispolicydocumentautomaticallystandscancelledfrominceptionirrespectiveofwhetheraseparatecommunicationissentornot.NoClaimBonuswillonlybeallowed,providedthepolicyis renewed within
90 days of the expiry of the previous policy.
Insured's Declared Value

For the Vehicle(Rs) For Trailers (Rs) NonElec.Accessories Elec./ElectronicAccessories (Rs) ValueofCNG/LPGKit (Rs) TotalCoverSI (Rs) Total IDV (Rs)
(Rs)
0.00 0.00 0.00 0.00 0.00 0.00 0.00

Premium Schedule
Own Damage Liability
Basic OD Basic Liability 1045.00
Basic Own Damage Premium Basic Liability Premium 1048.50
Deduct45%for NCB PA Benifits
TOTAL OWN DAMAGE PREMIUM CompulsoryPA cover to Owner Driver of CSI200000(IMT-15)
Total PA Premium
Legal Liability
Total Liability Premium

Package Premium
Add:Service Tax(12%of Net Premium) 368.00
Add:Education Cess(2%of Service Tax) 9.00
Add:Secondary& Higher Education Cess(1%of Service Tax) 5.00
FINAL PREMIUM 2475.50

Subjectto I.M.T. Endt.Nos. &Memorandum printed/herein/attached hereto.IMT22,15 ServiceTax Reg.No. AABCR6747BST001

Category-General Insurance Business Service 00440005
Thepolicyhasbeenissuedbasedontheinformationprovidedbyyouandthepolicyisnotvalidifanyoftheinformationprovidedisincorrect.Subjectotherwisetheterms,conditionsandexclusionsoftheReliance Private Car Package
Policy. In Witness whereof this Policy has been signed at Mumbai on04/08/2013in lieu of Cover Note No.040813701642dated04/08/2013
In the unfortunate event of a claim, Please call along with your Policy No.on 1800 103 1999 (toll free) or 022 41112600 (Standard STD Rates Apply) and register your claimimmediately
within7daysfromthedateofloss.ForCustomerservice,PleasecallalongwithyourPolicyNo.on180030028282(tollfree)or39898282(localchargesapply)|www.reliancegeneral.co.in
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 appealing in the Certificate in order to comply with the Motor Vehicle Act, 1988is ForReliance General Insurance Co. Ltd.
recoverable from the Insured.See the clause headed 'AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY'. For legal
interpretation,Englishversionwillholdgood.NOTE:Kindlyacknowledgereceiptofthispolicy.Incaseyoufindanyvariationsagainstyour proposal or
anydiscrepancy in the policy,kindly contact us immediately

RelianceGeneral Insurance Co. Ltd. DulyConstituted Attorney(s)

Registered Office: Reliance Centre,19, Walchand Hirachand Marg, Ballard Estate, Mumbai- 400 001
Policy Issuing Office : 570,Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai - 400 031

Policyservicingoffice:RelianceGeneralInsuranceCoLtd570-RectifierHouse,NaigaumCrossRoad.Wadala(W).,Mumbai,MAHARASHTRA,India-400031 Intermediary
Code/Name : DIRECT / DIRECT Intermediary Contact No:

Registered Office:
RelianceCentre,19, Walchand Hirachand Marg,Ballard Estate ,Mumbai- 400 001
Some Important Insurance Terms for your understanding of the Motor Insurance Cover

Own Damage Cover:

Own Damage or OD means Loss/Damage to your motor vehicle and/or accessories due to specified PERILS(risks/hazards)
Fire*SelfIgnition*Explosion*Lightning*Theft*Burglary*Housebreaking*Riot*Strike*Earthquake*Floodandalliedperils*Accidentalexternalmeans*Maliciousacts*Terrorist activity
*Transit *Landslide / rockslide
OwnDamagecoverisavailableinPackagePolicyoraComprehensivePolicybutwouldnotbeavailableunderActonlyorThirdPartyPolicy. It is
recommended to essentially go in for Package cover as it is a Comprehensive cover for your vehicle

Third Party Liability Cover:

Meansprotectionagainstanylegalliabilitytowardsthirdpartyincaseyourvehicleaccidentallycauseseither*Deathoforbodilyinjurytoany“ThirdParty”or“damagetoproperty belonging to “Third
Party” as per the provisions of Motor Vehicle Act.
Third Party Property Damage is available up to a limit of Rs 7, 50, 000/-
ThirdPartyLiabilitycoverisamandatorypartofanyMotorVehiclePolicy,eitherPackageorComprehensivePolicyorThirdPartyPolicy. We are
pleased to inform you that Comprehensive Policy can also provide the following against additional premium:
• CompulsoryPersonal Accident cover to owner driver (Individual Insured)up to a value of Rs200000.
• Legal liability towards the paid driver.
• PAcover for Un-named passengers

Major Exclusions:
EveryInsurancepolicyhascertainareaswhichareexcluded.Majorexclusionunderthispolicyare:Consequentialloss,depreciation,normalwearandtear,mechanicalorelectrical breakdown failures
or breakages. Vehicles insured under Private Car category is not covered if used for commercial purposes or if driven by an unauthorized driver.
Note:The above exclusions are indicative.For complete details, pleaserefer to the policy wordings on our website www.reliancegeneral.co.in.
InsurancebeingacontractofUtmostGoodFaithrequiresthecustomertodiscloseallinformationcorrectly.Ifyoufeelanyinformationisnotcapturedcorrectlyorisincomplete,we request you to
approach us.

Other suitable Products of Reliance General Insurance Company Limited

• Reliance Health Wise Policy –Excellent Health Insurance Solution for your entire family
• RelianceCritical Illness Policy–Get Cushioned against financial adversity as a result of critical illness.
• Reliance Personal Accident Policy –Financial Compensationagainst accidents
• Reliance Householders Insurance policy–Package cover for entire Household items including building
• Reliance Overseas Travel Care–Covers Medical Expenses, accident & others during overseas travel

…….Lot more visit http://www.reliancegeneral.co.in

Registered Office:
RelianceCentre,19, Walchand Hirachand Marg,Ballard Estate ,Mumbai- 400 001
 Dear Mr. Arunav Talukdar
WethankyouforplacingyourtrustwithRelianceGeneralInsuranceCompanyLimited We are

pleased to enclose Private Car Package Policy as Proposed by you

ThisPolicyhasbeenissuedonthebasisoftheinformationprovidedbyyouduringthetransaction.Theinformationhasbeencapturedbythesystemas ONLINE PROPOSAL

FORM for future reference. Given here below is an extract of the same for your records and reference.

(I)Details of Registered Owner/Insured

Name of the Insured :Mr.Arunav Talukdar City :NORTH WEST

Address :OLD DOUBLE STOREY State :DELHI

(Policy will be sent there) LAJPAT NAGAR-IV Landline number :9899725745
DELHI-110024 Mobilenumber :9899725745
E-mailID :[email protected]
(II)Policy Details
Total Insured Declared Value (IDV) :Rs237485 TotalPremium amount :Rs4382(Incl ST)
Policy Start date :06/08/2013 PolicyEnd date :05/08/2014
Hypothecation Type :Hypothecated Name of Financial Inst :HDFCBANKLTD
Address of Financial Institution :HDFC Bank Ltd, Churchgate, Mumbai, 400020 Renewal/Rollover/Fresh : Rollover
(III)Vehicle Details
Make :CHEVROLET Manufacturing Month/Year :JUN/2010

Model :SPARK LT Date of Purchase/Registration :14/08/2010

Variant :LT RTOLocation :DELHI WEST JANAK PURI

Engine Number :B10S1521830KC2 Registrationnumber :DL04CAD8812

Chassis Number :MA6MF481EAH048922 SeatingCapacity Including Driver :5

Vehicle IDV :Rs237485 Value of Non Electrical Accessories :Rs0

Valuie of CNG/LPG KIT :Rs0 Valueof Electrical Accessories :Rs0

(IV)AdditonalCover/s Opted
Electrical Accessories :NO LegalLiability to Paid Driver :NO
Non Electrical Accessories :NO Personal Accident Cover for unnamed Passengers :NO
CNG/LPG Kit Attached :NO
(V)Addon Cover/s Opted
Nil Depreciation Cover :NO Total Cover :NO NCBRetention :NO

(VI)Discounts Claimed
Anti Theft Device Discount :Rs0 Automobile Association Discount :Rs0
* Voluntary Deductible Discount :Rs0 Automobile Association Membership number: N/A

* Against this discount you have accepted an additional voluntary deductible of Rs0against each claim
(VIl)PA to Owner Driver -Nominee Details
Nominee Name :MONMI BHARALI TALUKDAR Nominee Relationship with Owner Driver:SPOUSE
Nominee Age :30 Nominee Address :4/19,GroundFloorOldDoubleStoreyLajpat
Nagar-IV DELHI North West Delhi 110024
(VlIl)Payment Details
Payment Mode :Online BankName :

Premium Amount :Rs 4382 Amount in Words :RupeesFourThousandThreeHundredEightyTwoOnly

Payment Date :8/4/2013 7:30:28 PM

Registered Office:
RelianceCentre,19, Walchand Hirachand Marg,Ballard Estate ,Mumbai- 400 001
 Declaration
I agree that the insurance benefit available to me shall become voidable in the event of any untrue or incorrect statement, misrepresentation,
non-description or non-disclosure in any particulars in the application form / personal statement, declaration and connected documents or any material
information has been withheld by me or anyone acting on my behalf to obtain insurance benefit. I hereby declare that I am not aware of any neglect and
omission or error or existence of any circumstances likely to give rise to a claim thereof. I hereby declare, incase of false declaration the Insurance
Company shall have the right to cancel the policy. The insurance company shall have the right to change the premium and conditions agreed to subject to
such terms and conditions as has been communicated to me. I hereby agree that my enrollment for insurance would be at the sole discretion of the
insurance company. I declare and warrant that the information I have given in this online form will be considered as the proposal form in relation to myself
(orotherpersonorcategoriesofpersonstobeinsured)andanydocumentationofinformationaccompanyingitorarisingoutoftheanswersIhavegivenis complete
and accurate in all respects. I understand and agree that this online form and other information and documentation I have given or will give, relating to
myself or any other person to be insured, will be the basis of any insurance that you may issue, and I also understand the consequences of any default. I
further understand that the coverage offered is subject to realization of premium payment.
Online Transaction Facility-Terms and Conditions:
IhavereadandunderstoodthetermsandconditionsgoverningtheOnlineTransactionFacilityofRelianceGeneralInsuranceCompanyLtd.Ihavealso read and
understood the salient, features, terms and conditions of the policy as stated in the brochure.

Insured Name :Mr. Arunav Talukdar Date :04/08/2013

• The information that you give to Reliance General Insurance on this online form will be treated as the proposal form and details in any
supplementalinformationformordocumentationsuppliedbyyouoronyourbehalfwillinfluenceourdecisiontoofferinsuranceandtheterms upon
which to offer it. Further, any policy we issue will be based on what you have told us. It is therefore important that your answers are complete
and accurate in all respect.
• The questions in this online form are indicative rather than exhaustive. You must provide us with all information relevant to the risk to be insured,
even if it is not the subject of a question in this online form. If you are in any doubt as to what information should be given, please email us at
services.rgicl@rcap.co.in.Anyfailuretoprovideuswithfullandaccuratematerialinformationmaymeanthatyourpolicycanbedeclaredasvoid.
• Noinsurance cover will be in force until we have approved it and the premium has been paid.
Statutory Warning-PROHIBITION OF REBATES(Under Section41of Insurance Act1938)
• Nopersonshallalloworoffertoallow,eitherdirectlyorindirectlyasaninducementtoanypersontotakeoutorreneworcontinueaninsurancein 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
premiumshownonthepolicy,norshallanypersontakingoutorrenewingorcontinuingapolicyacceptanyrebate,exceptsuchrebateasmaybe allowed in
accordance with the published prospectuses or tables of the Insurer.
• Anypersonmakingdefaultincomplyingwiththeprovisionsofthissectionshallbepunishablewithfine,whichmayextendtofivehundred rupees.

We hope the information shown above is found by you as correct

Fordetailed terms & condition (Policy Wordings)governing this policy, kindly refer our website.
Incaseofanyqueryyoumaycontactourcustomercareservicenumbersgivenonthefaceofthepolicy.Welookforwardtohavingalongterm&fruitful relationship

Yours truly

Authorized Signatory
For Reliance General Insurance Co ltd

Registered Office:
RelianceCentre,19, Walchand Hirachand Marg,Ballard Estate ,Mumbai- 400 001