ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R109066633 / 05-May-2020
Policy No. & Type M10034911 Period of Insurance 18-May-2020 to 17-May-2021
Policy Issued On 05-May-2020 (00:00) Vehicle Identification No. MA3EYD81S00356894
Insured Name Mr. R Sashidharan Nair Geographical Area INDIA
Invoice No M100349110000 Accounting Code of Service 997134
Insured Address A/30, HATHIBHAI NAGAR, DIWALIPURA, OLD PADRAROAD . , Diwalipura Garden,
BARODA-390015, Gujarat
Insured State & Code Gujarat-24 Place of Supply Gujarat GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 73150
Model & Variant Alto Lxi/MARUTI ALTO LXI(A/C + HTR WITH CATALYSER (BHARAT STAGE II) Non Electrical Accessories 0
Registration No GJ06BA3051 Electrical Accessories 2353
Year of Manufacture 2004 CNG/ LPG Kit 0
Engine- Chassis No 3086758 - MA3EYD81S00356894 Total IDV 75503
Cubic Capacity 796
Seating Capacity 4
Type Of Body Saloon
RTO Location GJ06BA3051 / BARODA
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 836 Basic Third Party Liability 2072
Elec. Accessories Third Party Liability for Bi-fuel Kit 0
1. JVC/MUSIC SYSTEM of value Rs. 94 Compulsory PACover Premium [1 Year] 300
Non- Elec. Accessories 0 PACover for 4 Person of Rs (100000) each (IMT- 16 ) 200
Kit (IMT-25) 0 Legal Liability (WC) to Driver (IMT-28) 50
Geographical Area Extn. (IMT-1) NA
Extra Premium towards Inbuilt CNG/LPG NA
Legal Liability to Employees (IMT-29) 0
Basic Premium 930 Legal Liability to Passenger (IMT 46) 0
Geographical Area Extn. (IMT-1) NA Driving Tuition Loading On TP Premium (60%) NA
Lamp, Tyres etc. (IMT 23) 0 Net Liability Premium (B) 2622
Driving Tuition Loading On OD Premium (60%) NA Total Premium (A+B) 3087
Fiber Glass Tank 0 CGST @9% 277.83
SGST @9% 277.83
Sub-Total Additions 0
Gross Premium Paid 3643
Deductibles
Voluntary Deductibles (IMT 22A) 0 MISP - KIRAN MOTORS LIMITED, BARODA
Anti-Theft Device (IMT-10) 0
AAI Membership (IMT-8) 0 Notes :
No Claim Bonus (50%) 465
1. Policy Issuance is the subject to the realisation of cheque.
Discount for vehicles designed for handicapped NA 2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 465 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT 28, 16,
Depreciation Re-imbursement 0 6. UIN : IRDAN108RP0004V01201819
Engine Secure 0
Return To Invoice 0
Net own Damage Premium (A) 465
Nominee Details : Nominee Name LILABEN NAIR Age 68 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Visa Credit Card 109841577562 ELECTRONIC PAYMENT 3643
Financier Type Not Financed Financier Name NA Financier Branch NA
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 TATA AIG

Authorized Signatory
Policy Issuing Office:-Office no.2-A, 2nd Floor, Turquoise, Panchawati Cross Road, C.G.Road, Ahmedabad
GSTIN: 24AABCT3518Q1Z2, CIN No.:U85110MH2000PLC128425
State Name : Gujarat