HDFC ERGO General Insurance Company Limited

Certificate of Insurance cum Policy Schedule

Motor Insurance - Goods Carrying Comprehensive Policy

Vehicle Details Policy Details

Registration No. WB-78-4808 Policy No. 2320101323767600000
RTO KALIMPONG Period of From 03 Jan, 2023 19:22 hrs
LCC 2 Insurance To 02 Jan, 2024 Midnight
GVW 25000 Issuance Date 03/01/2023
Body Type OPEN Invoice No. 2040436439000055
Mfg Year 2012 Customer Id 1001714512756
LAXMI BOSE
CHANGRABANDHA 154 NAGAR CHANGRABANDHA COOCH Private/Public Carrier PUBLIC
BEHAR COOCH BEHAR WEST BENGAL 735301 Tel EIA No. Not provided
: 8116552981
Payment Details : Fund Transfer
Email ID : [email protected]
Make Model - Variant Engine No Chassis No

TATA MOTORS LTD TATA TRUCKS - LPT 2515 EX B591803221G63276163 MAT448033C2G17069

Insured's Declared Value (IDV) (`)
Vehicle Chassis Vehicle Body Electrical Accessories Non Electrical Accessories CNG/LPG Kit Trailer Total IDV
665,000 210000 0 0 0 0 875,000
Trailer Chassis No
Premium Details (`)
Own Damage Premium(a) Liability Premium(b)
Basic Own Damage 11619 Basic Third Party Liability 43037
Total Basic Premium 11619 PA Cover for Owner Driver of 1500000 325
Add : Cover for Lamps, Tyres, Mudguards, Bumpers (IMT-23) 1743 LL to Paid Driver/Conductor/Cleaner (IMT-28) 150
Add : Geographical Area Extension (IMT-1) 400 Third Party Liability for Geo-extension 100
Total - Add 2143 Net Liability Premium (b) 43612
Less: Others 8366 Total Package Premium (a+b) 49008
Total - Less 8366 GST 18% : Central Tax 9% ( `537.5) + State Tax 9% ( `537.5) on Other Premium 1075
GST 12% : Central Tax 6% (`2582) + State Tax 6% ( `2582) on Basic Third Party Liability 5164
Premium
Total Tax 6239
Net Own Damage Premium (a) 5396 Total Premium 55247
Geographical Area India , Bangladesh-Bhutan-Nepal Compulsory Deductible (IMT-21) 1,500
Nominee for Owner driver N/A Appointee
Hypothecated(IMT-7) with:HDB FINANCIAL SERVICES LTD,Siliguri

LIMITATIONS AS TO USE:The Policy covers use of the vehicle only under a permit within the meaning of the Motor Vehicle Act 1988 or such a carriage falling under Sub-Section (3) of Section 66 of the Motor
Vehicle’s Act 1988. The Policy does not cover use of the vehicle for a) Organized racing b) Speed Testing. 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 when not used for the transport of goods at the time of the accident 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) : ` 1500000 Terms, Conditions and Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of
cost on request & the same is also available at our website. A personal copy of the same is available free of cost on request & the same is also available at our website.

Insured is carrying on or engaged in the business or occupation of and no other for the purposes of this insurance
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 ` 0.50
paid by Demand Draft, vide Receipt/Challan no. CSD/362/2020/1302 dated 03/01/2023 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018". .
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'. Disclaimer: The Policy
shall be void from inception if the premium cheque is not realized. 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.

Goods & Services Tax Registration No: 19AABCL5045N1Z5 SAC 997134

Code
Branch :1st floor, sona complex, 3rd mile sevoke road, siliguri siliguri

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.

Agent Name : HDB FINANCIAL SERVICES LIMITED For HDFC ERGO General Insurance Company Ltd
Agent Code : 202047016703 Tel No. : 91-44-42984541

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 : IRDAN125P0005V01200203. 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

Motor Insurance - Proposal Form cum Transcript Letter For Goods carrying Comprehensive

Vehicle Details Proposal details

Registration No. WB-78-4808 Proposal No. 202102250114775
RTO KALIMPONG Period of From 03 Jan, 2023 19:22 hrs
LCC 2 Insurance To 02 Jan, 2024 Midnight

GVW 25000 Issuance Date 03/01/2023

Body Type OPEN Invoice No. 2040436439000055
LAXMI BOSE Mfg Year 2012 Customer Id 100171451276
CHANGRABANDHA 154 NAGAR CHANGRABANDHA COOCH
BEHAR COOCH BEHAR WEST BENGAL 735301 Tel Private/Public Carrier PUBLIC
: 8116552981
Payment Details : Fund Transfer
Email ID : [email protected]
Make Model - Variant Engine No Chassis No
TATA MOTORS LTD TATA TRUCKS - LPT 2515 B591803221G63276163 MAT448033C2G17069
Insured's Declared Value (IDV) (`)
Vehicle Chassis Vehicle Body Electrical Accessories Non Electrical Accessories CNG/LPG Kit Trailer Total IDV
665,000 210000 0 0 0 0 875,000
Trailer Chassis No
Premium Details (`)
Own Damage Premium(a) Liability Premium(b)
Basic Own Damage 11619 Basic Third Party Liability 43037
Total Basic Premium 11619 PA Cover for Owner Driver of 1500000 325
Add : Cover for Lamps, Tyres, Mudguards, Bumpers (IMT-23) 1743 LL to Paid Driver/Conductor/Cleaner (IMT-28) 150
Add : Geographical Area Extension (IMT-1) 400 Third Party Liability for Geo-extension 100
Total - Add 2143 Net Liability Premium (b) 43612
Less: Others 8366 Total Package Premium (a+b) 49008
Total - Less 8366 GST 18% : Central Tax 9% ( `537.5) + State Tax 9% ( `537.5) on Other Premium 1075
GST 12% : Central Tax 6% (`2582) + State Tax 6% ( `2582) on Basic Third Party Liability 5164
Premium
Total Tax 6239
Net Own Damage Premium (a) 5396 Total Premium 55247

Geographical Area India , Bangladesh-Bhutan-Nepal Compulsory Deductible (IMT-21) 1,500

Nominee for Owner driver N/A Appointee
Hypothecated(IMT-7) with:HDB FINANCIAL SERVICES LTD,Siliguri
Agent Name : HDB FINANCIAL SERVICES LIMITED Agent Code : 202047016703 Tel No. : 91-44-42984541

Anti rebate clause

Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended) : 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 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 understand that: My premium is derived on the basis of information filled by me, which includes my previous year policy details and No claim Bonus Discount %, if any.
HDFC ERGO General Insurance Company (Company) may verify my previous year policy details and may hold claim settlement process till the time confirmation is received from previous insurer
The Company shall have no liability under this insurance contract if it is found that any of my / our statement on particulars or declaration (other than NCB discount) in this proposal form
or other documents are incorrect and / or untrue / false.
If any discrepancy found in the information provided for arriving at NCB discount %, Company shall communicated to me via e-mail &/ or letter for payment of the balance premium amount within 20 days from the
date of communication. If the balance amount is not paid by me within 20 days from the date of communication then Claim will be paid proportionately.
4) 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.
5) Any person who, knowingly and with intent to defraud the Insurance Company or other persons, files a proposal for insurance containing any false information, or 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.
6) I / we declare and confirm having a valid PUC and vehicle fitness certificate.
7) I understand the Proposal No. 202102250114776 is issued to me basis on above information.
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 content 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 : IRDAN125P0005V01200203. 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

Frequently Asked Question’s (FAQ’s) - Motor Insurance

WHAT ARE THE MAJOR COVERS UNDER THE POLICY? HOW DO I FILE A CLAIM?
Loss or Damage to the Insured Vehicle caused due to: For Accidental Damage to Insured Vehicle (Own Damage Claims):
a. Fire, explosion, self ignition or lightning. ◾ Mobile App: Simply download HDFC ERGO Mobile App - Insurance Portfolio Organizer
b Burglary, housebreaking or theft from Play Store. Link your policy by providing few simple details and register a claim.
c All act of God perils like earthquake, flood, cyclone etc ◾ Call Toll Free 1800 2700 700 (Accessible from India only) and provide your policy
d Accidental external means, terrorism, riot and strike number for reference and register a claim
Liability to Third Parties:
Provides cover for any legal liability arising out of the use of the vehicle for Please keep the following details handy while intimating a claim
a Accidental death / injury to any third party a. Policy Number
b Any damage to property owned by third party b. Registration Details / RC Copy
Personal Accident Cover: c. Drivers details at the time of accident including driving License Number
The policy provides for a mandatory Personal Accident cover for owner driver and optional d. FIR on a case to case basis
cover for passengers covering accidental death and permanent total disability e. Repair estimate

WHAT ARE THE MAJOR EXCLUSIONS OF THE POLICY? WHAT IS THE CLAIM PROCESS?
a. General aging, wear & tear, mechanical or electrical breakdown, failure, depreciation, 1. If your vehicle can be driven, take it to the nearest dealer / garage.
any consequential loss 2. Get a repair estimate, fill up the claim form and attach a copy of the registration
b. Damage by a person driving without a valid license certificate and driving license of the person driving at the time of the accident.
c. Damage by a person driving under the influence of liquor or drugs 3. If the garage is within our network, you could avail of cashless claim facility. Pay for non
d. Loss/damage attributable to war, mutiny, nuclear risks accident related repairs, depreciation and deductible. We would settle the rest.
e. Damage to tyres and tubes, unless damaged during an accident 4. If the garage is outside our network, you would have to get the claim reimbursed
f. Usage on hire & reward (applicable for all classes except public commercial vehicles) subsequently.
g. Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes,
headlights, paint work (applicable for all commercial vehicles; unless opted CLAIMS DOCUMENTS -
additionally)
h. Loss or damage resulting from overturning arising out of operation as a tool (applicable a. Duly filled and signed claim form & satisfaction voucher
for mobile cranes, drilling rigs, mobile plants, navvies, shovels, grabs, rippers unless b. Registration Certificate (RC)
opted for additionally) c. Driving license of the person driving at the time of the accident
i. Loss of or damage to accessories by burglary housebreaking or theft unless the vehicle d. Policy Copy, original repair estimate, repair invoice
is stolen at the same time (applicable to all commercial vehicles & two wheelers) e. Payment receipt for non-cashless claims
f. Original repair invoice for cashless claims
TRANSFER OF INSURANCE (INCASE VEHICLE IS SOLD) g. AML documents for amount more than `1 lakh (PAN card, 2 passport size photo,
To place your request for Transfer of Insurance, visit Customer Support section on our residence proof)
website www.hdfcergo.com. h. Form 35 & original NOC from financer incase of total loss where payment is made to
insured
i. Acopy of police FIR/panchnama is required for TP injury / death / property damage
WHAT CHANGES CAN BE DONE IN MY POLICY ENDORSEMENT
j. Sale deed / Delivery note / Form 29 and 30 / transferred RC Copy in 'Used Car' cases
To place your request for any ''Changes in Policy', visit Customer Support section on our
website www.hdfcergo.com. Additional documents required for commercial vehicles:
a. Spot survey b. Load challan c. Fitness certificate d. Route permit
CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT
WHAT IS NCB?
a. Duly filled and signed claim form & discharge voucher ( after loss settlement )
NO CLAIM BONUS (NCB):
b. Original Registration Certificate (RC)
c. Original Policy Copy NCB is provided for every claim free year basis the slab as provided by Tariff.
How can I get No Claim Bonus Reserving Letter?
d. Copy of FIR lodged at the nearest police station
e. All original keys & vehicle invoice copy NCB Reserving letter can be provided only on Sale of vehicle evidenced by transferred RC
f. No trace report confirming that the stolen vehicle is not traceable copy OR Sale Deed and Form 29 & 30. The OD section of the policy needs to be transferred
g. Original NOC from financer incase of hypothecation / HPA to the new owner or cancelled.
h. Intimation to RTO for theft of vehicle HOW DO I RENEW MY POLICY?
i. Duly signed RTO transfer papers (Form 26, 28,29,30,35)
a. Visit www.hdfcergo.com to renew c. Visit our nearest branch / your agent
j. RC extract with stolen remark from the concerned RTO after the loss
k. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence instantly online
proof) d. Send a copy of the renewal notice along
b. SMS "RENEW <POLICY NO> " to 9999 with premium cheque to our branch
l. Deed of subrogation cum indemnity on judicial stamp paper
700700 office /Corporate office
Disclaimer: Where it is brought to the notice of the Company, that vehicle insured
HOW TO CONTACT US?
which is not a new vehicle but shown as a new vehicle with a malafide intention,
claims for total loss of such vehicle would not be admissible, if there is a gap of more Visit Customer Support section on our website www.hdfcergo.com and avail host of
than 10 days from date of invoice of vehicle and the proposal date. services online which is easy, instant & convenient

Convenience at your fingertips

On the Customer Support section of our website, you can:
Ver.Feb18

Get Policy Copy/ Make Changes Track Claim Update Contact

80D Tax Certificate on Policy Status Details
This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.