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ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE B

(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R173498158 / 13-Mar-2023
Policy No. & Type 98000031220112925565 Period of Insurance 13-Mar-2023 to 12-Mar-2024
Policy Issued On 13-Mar-2023 (00:00) Vehicle Identification No. MA3EUA61S00160383
Insured Name Mr. Y Arun Kumar Singha Geographical Area INDIA
Invoice No 11221536663 Accounting Code of Service 997134
S/O - LT Y MONI SINGHA, VILL - NAYAGRAM, P.O - FULERTAL.MOB-9401134625,
Insured Address
SILCHAR-788106, Assam
Insured State & Code Assam-18 Place of Supply Assam GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 82327
Model & Variant Alto800 Lxi/ Non Electrical Accessories 0
Registration No AS11G2799 Electrical Accessories 0
Year of Manufacture 2012 CNG/ LPG Kit 0
Engine- Chassis No F8DN 4948657 - MA3EUA61S00160383 Total IDV 82327
Cubic Capacity 796
Seating Capacity 5
Type Of Body Saloon
RTO Location AS11G2799 / SILCHAR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 538 Basic Third Party Liability 2094
Third Party Liability for Bi-fuel Kit 0
Elec. Accessories 0
Compulsory PA Cover Premium to Owner-Driver (1 Year) 275
Non- Elec. Accessories 0 PA Cover for 5 Person of Rs (100000) each (IMT- 16 ) 250
Kit (IMT-25) 0 Legal Liability (WC) to Driver (IMT-28) 50
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Legal Liability to Employees (IMT-29) 0
Basic Premium 538
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) 2669
Total Premium (A+B) 2931
Driving Tuition Loading On OD Premium (60%) NA
IGST @18% 527.58
Fiber Glass Tank 0 Gross Premium Paid 3459
Sub-Total Additions 0
MISP - JAIN UDYOG, SILCHAR
Deductibles
Voluntary Deductibles (IMT 22A) 0
Notes :
Anti-Theft Device (IMT-10) 13
AAI Membership (IMT-8) 0 1. Policy Issuance is the subject to the realisation of cheque.
No Claim Bonus (50%) 263 2. Consolidate stamp duty paid to State Exchequer
3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Discount for vehicles designed for handicapped NA 4. Voluntary excess Rs (0)
Sub - Total Deductibles 276 5. Subject to Endorsements IMT ,7 10, 28, 16,
6. UIN : IRDAN190RP0042V01100001
Add - On Coverages 7. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from
NCB to Non-NCB, the recoverable amount may be more than the NCB amount.
Nil Depreciation 0
Engine Protect 0
Return To Invoice 0
Net own Damage Premium (A) 262
Nominee Details : Nominee Name MRS Y NIVA RANI DEVI Age 55 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Credit Card 75379707078 ICICI BANK LIMITED 3459
Financier Type Financed Financier Name CENTRAL BANK OF INDIA Financier Branch FULERTAL BRANCH

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)

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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 THE NEW INDIA ASSURANCE CO. LTD

Authorized Signatory
Policy Issuing Office:-1215, NAURANG HOUSE 21, K G MARG, NEW DELHI - 110001
GSTIN: 07AAACN4165C1ZT, CIN No.:L66000MH1919GOI000526
State Name : Delhi

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