Policy Number : P0021000100/4101/718940
DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016
(www.magma-hdi.co.in)
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800 266 3202
Date : 29/09/2020
To,
MR. JAGJIVAN PURUSHOTTAM PATIL
AT POST MHASAWAD, TALUKA SHAHADA DISTRICT NANDURBAR
NANDURBAR
MAHARASHTRA - 425432
Mobile No: 8055565757
Agent/ Intermediary Name and Code: POLICYBAZAAR INSURANCE WEB AGGREGATOR PRIVATE LIMITED WAG0000001
Sub: Risk Assumption Letter
Dear Sir /Madam,
Thank you for choosing Magma-HDI General Insurance Company Limited as your preferred General Insurance Company. Please find
enclosed Policy No. . P 0 0 2 1 0 0 0 1 0 0 / 4 1 0 1 / 7 1 8 9 4 0 , w h i c h h a s b e e n i s s u e d b a s e d o n t h e d e t a i l s f u r n i s h e d t o u s a s b e l o w :
Insured & Vehicle Details
Name of Insured Mr. JAGJIVAN PURUSHOTTAM PATIL
Period of Insurance 23/09/2020 TO 22/09/2021
Vehicle Make/Model MARUTI/ALTO
RTO Hingoli
Vehicle Registration No. MH-39-D-1198
Vehicle Registration Date 22/01/2009
Engine No. F8DN3593293
Chassis No. 1275873
Previous Policy Details
Previous Policy No. ABC123
Previous Policy Period 14/05/2019 TO 14/05/2020
Previous Insurer Name Cholamandalam
Previous Policy Type Package
The information provided above is based on the information received from you and accordingly, the proposal has been processed.
Coverage of risk is subject to realisation of the full premium post which, insurance coverage under the policy would commence. In case the
premium is not received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at
[email protected] or calling our toll free helpline on 1800-3002-3202. Absence of any communication from you in this regard
within a period of 20 days of date of this letter, would mean that the issued policy is in order and as per your proposal.The Risk Assumption
Letter is to be read in conjunction with the policy and shall be considered as null and void without the same.
Thanking You,
Regards
For Magma HDI General Insurance Co Ltd.
Authorised Signatory
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Policy Number : P0021000100/4101/718940
DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016
In case of any query, assistance or claims, please contact us at 1800-3002-3202
PRIVATE CAR PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office : Khodal Chambers,2nd Floor, Unit 203 & 204, R B Mehta Marg, Ghatkopar E, Mumbai, 400077
Policy No P0021000100/4101/718940 Period Of 00:01 Hrs of 23/09/2020
Insured MR. JAGJIVAN PURUSHOTTAM PATIL Insurance To Midnight of 22/09/2021
Address AT POST MHASAWAD, TALUKA SHAHADA DISTRICT Agent No. : WAG0000001
NANDURBAR Agent Contact : 1800-258-5970
NANDURBAR Covernote No. :
MAHARASHTRA
425432
Contact Number 8055565757
Email Address
[email protected]GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No. & Year of
Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
RTA Location Manufacture
MH-39-D-1198 /
2009 F8DN3593293 1275873 MARUTI ALTO /LXI 796 5
MH39
IDV (INSURED'S DECLARED VALUE)
IDV of Vehicle ₹ Non Electrical Accessories ₹ Electrical/electronic Accessories ₹ Bi-Fuel kit(LPG/CNG) ₹ Other accessories ₹ Total Value ₹
78,703.00 0 0 0.00 0 78,703.00
OWN DAMAGE(A) ₹ LIABILITY(B) ₹
Basic - OD 593.23 Basic - TP 2,072.00
Sub Total 593.23
Sub Total 2,072.00
Less
Total Liability Premium(B) 2,072.00
Sub-Total Deductions 0
Total Own Damage Premium(A) 593.23
Premium Computation
Total Package Premium(A+B) 2,665.23
IGST @ 18% 480.00
Total 3,145.00
Disclaimer:The Exclusions in this policy are as specified in the pre inspection report ID :I/2017/10029846768
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)Use in connection with Motor Trade
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
Driver
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
Clause :
Rule 3 of the Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY
Damage to Third Party
Excess in respect of each and every Property Rs. 750000/-
Under Under In respect of any one Under Under
claim under Sec I of motor policy in respect of any one PA Owner – Driver as per
Section Section accident -- As per Motor Section Section
Compulsory : Rs. 1000/- Voluntary : Rs. claim or series of claims premium computation table
I II-I (i) Vehicle Act II-I (ii) III:
0/- Imposed : Rs. 0/- Total : Rs. 1000/- arising out of one
event.
Subject to I.M.T Endorsement Nos. IMT 7,IMT 15,IMT 16,IMT 22,IMT 28
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Policy Number : P0021000100/4101/718940
NOMINATION DETAILS
Name Of the Nominee Age of Nominee Relationship With Insured Percentage
ABDUL JABBAR SHAIKH AZAD 34 Brother 100
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.
Premium Collection Details :- [Collection No - ReceiptDate - Amount] : PB21928829- 29-Sep-2020 , ₹ 3145
Premium Amount in Word's ( ₹ ) :- Three Thousand One Hundred Fourty Five only
In case of Claims, please contact us at 1800 - 3002 - 3202 For Magma HDI General Insurance Co. Ltd.
Date of Issue :29-Sep-2020
Place : Kolkata
Authorised Signatory
Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 928-F.T, dated
01/06/2017
GST Number of MHDI - 27AAGCM1685C1ZJ
GST Invoice Number - POL2709210005934
Accounting Code for Service - 997134, Motor vehicle insurance services
Place of Supply:MAHARASHTRA ( 27 )
Whether Tax is payable on Reverse Charge - No
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 be good.
For Complete details of coverage , terms, conditions & exclusion please refer the standard policy wording attached with this schedule
IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
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