Date: 06-Jan-2024

To,
Mr MR PRASHANT ASHOKBHAI NIMBARK
A 203, Pramukh Elysium, Sargasan Ahmedabad Gujarat(24) 382421
Contact Details: 9898678783
Policy number: PBW/000000300059

Subject: Risk assumption for Kotak Car Secure (Liability Only Policy)

Dear Mr NIMBARK ,

We welcome you to Kotak Mahindra General Insurance Company Limited and thank you for choosing us as your preferred service provider.

This is with reference to your above mentioned Policy issued under Kotak Car Secure(Liability Only Policy).

Enclosed please find the Policy Schedule and Policy Wordings. We wish to inform you that the proposal is underwritten and policy is issued based on
the information submitted to us as well as acceptance of the terms and conditions

We request you to carefully go through the same once again and in case of any disagreement, discrepancy or clarifications, please call us on our toll
free number 1800 266 4545 or write to us at [email protected] within 15 days from the date of this letter. Alternatively, you can also write to us at 8th
Floor, Zone IV, Kotak Infiniti, Bldg. 21, Infinity IT Park, Off WEH, Gen. AK Vaidya Marg, Dindoshi, Malad (E), Mumbai – 400097

Please note that the information provided by you will be verified at the time of claim and the captioned Policy shall be treated as void if we discover
any untrue or incorrect statement, misrepresentation, non-description or non-disclosure in any form whatsoever made by you or by your agent, on
your behalf, at any stage.

As a valued customer, we would like to provide regular updates on your policy through email and SMS. We therefore request you to keep us updated
of any change in your contact details.

Assuring you of our best services at all times.

Thanking you,

Yours sincerely,

For Kotak Mahindra General Insurance Company Limited

Authorised Signatory

Kotak Mahindra General Insurance Company Limited

CIN: U66000MH2014PLC260291, Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra East, Mumbai ​ 400051. Maharashtra, India.
Corporate Office: 8th Floor, Zone IV, Kotak Infinity, Building No.21, Infinity IT Park, Off Western Express Highway, General AK Vaidya Marg, Dindoshi, Malad(E), Mumbai ​ 400097. India.
Toll Free: 1800 266 4545 Email:[email protected] Website: www.kotakgeneral.com IRDAI Reg. No. 152
 Kotak Mahindra General Insurance Company Limited
CIN: U66000MH2014PLC260291, Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra East, Mumbai ​ 400051. Maharashtra, India.
Corporate Office: 8th Floor, Zone IV, Kotak Infinity, Building No.21, Infinity IT Park, Off Western Express Highway, General AK Vaidya Marg, Dindoshi, Malad(E), Mumbai ​ 400097. India.
Toll Free: 1800 266 4545 Email:[email protected] Website: www.kotakgeneral.com IRDAI Reg. No. 152
 Kotak Car Secure
Liability Only Policy
Certificate cum Policy Schedule
Policy / Certificate No: PBW/000000300059
For any assistance please call 1800 266 4545 or visit www.kotakgeneral.com
INSURED DETAILS POLICY DETAILS
Name: Mr MR PRASHANT ASHOKBHAI NIMBARK Policy Issuing Office: Kotak Mahindra General Insurance Company Limited
Address: A 203, Pramukh Elysium, Sargasan Ahmedabad Gujarat(24) 382421 201-204, 301, 2nd & 3rd Floor, Chintamani Classique, Vishweshwar Nagar, off
Aarey road, Near, Udipi Vihar Hotel,
Goregaon ((E), Mumbai 400063
Phone: NA
Period of Insurance:
Mobile: 9898678783
For Third Party: From: 08-01-2024 00:00 to: 07-01-2025 Midnight
Email: [email protected]
Policy issued on: 06-01-2024 Cover Note No: NA
GSTIN:
Hypothecated to:

VEHICLE DETAILS

Registration Manufacturer Model Variant Year of RTO Location Engine Vehicle Chassis/ Cubic Seating
Number Manufacture Number Trailer Chassis No. Capacity Capacity

GJ01RL5844 HONDA AMAZE 1.5 S (O) MT 2015 AHMEDABAD N15A13013373 MAKDF25GGFN108689 1498 5

Insured Declared Value Non - Electrical Electrical & Electronic Trailer CNG / LPG Kit Total Value of the Vehicle
(IDV) of the Vehicle Accessories fitted to the Accessories fitted to the (in ₹) (in ₹) (in ₹)
(in ₹) Vehicle (in ₹) Vehicle (in ₹)

0.00 0 0 0 0.00 0.00

PREMIUM COMPUTATION TABLE (IN ₹)

Section I Section II
Own Damage Liability
Basic TP Including TPPD Premium 3,416.00
PA Cover for Owner Driver of ₹ 0.00
Unnamed PA Cover for Passenger ₹ 0/Per Person 0.00
Legal Liability to Paid Driver 0.00

Total Liability Premium (B) 3,416.00

Total Own Damage Premium (A) 0.0
Taxable value of Services(A+B) 3,416.00
IGST @ 18% 615
Total Premium (in ₹ ) 4,031.00

Geographical Area INDIA Additional Excess ₹ 0 Compulsory Deductibles ₹ 0

INTERMEDIARY DETAILS

Intermediary Code 3 3 1 6 1 3 0 0 0 0 Intermediary Name Policybazaar Insurance Brokers Private Limited.

Intermediary's Mobile No. Intermediary's Landline No. 1 8 0 0 2 0 8 8 7 8 7

DISCLAIMER
For complete details on terms and conditions governing the coverage and NCB please read the Policy Wordings. This document is to be read with the Policy Wordings (which are
also available on the Company website i.e. www.kotakgeneral.com Please refer to the claim form for necessary documents to be submitted for processing the claim.

Kotak Car Secure UIN: KMG-MO-P16-47-V01-15-16 ; Depreciation Cover UIN: KMG-MO-A00-00-24-V01-15-16 ; Consumables Cover UIN: KMG-MO-A00-00-25-V01-15-16;
Kotak Mahindra General Insurance Company Limited
CIN: U66000MH2014PLC260291, Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra East, Mumbai ​ 400051. Maharashtra, India.
Corporate Office: 8th Floor, Zone IV, Kotak Infinity, Building No.21, Infinity IT Park, Off Western Express Highway, General AK Vaidya Marg, Dindoshi, Malad(E), Mumbai ​ 400097. India.
Toll Free: 1800 266 4545 Email:[email protected] Website: www.kotakgeneral.com IRDAI Reg. No. 152
LIMITS OF LIABILITY
Under Section II - 1(i) of the policy -> Death of or bodily injury: Such amounts is necessary to meet their requirements of Motor Vehicles Act, 1988.
Under Section II - 1(ii) of the policy -> Damage to Third Party Property ₹ 750000.00; PA Cover under Section III: for Owner Driver CSI ₹

DRIVER'S CLAUSES
Any person including the insured: Provided that a person driving hold an effective Driving License at the time of accident and is not disqualified from holding or obtaining such a
license. Provided also that the person holding an effective Learners License may also drive the Vehicle and that such a person satisfies the requirements of Rule 3 of the Central
Motor vehicles Rules 1989.

SPECIAL CONDITIONS
Partial Theft of battery not covered.

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 Policy 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.

Subject to I.M.T. Endt.Nos. & Memorandum IMT 27, Printed/herein/attached hereto Under Hire Purchase Agreement with NA

TAX DETAILS
Service Tax/GST Registration
2 7 A A F C K 7 0 1 6 C 1 Z T Category : General Insurance Services
No.
SAC Code 997134 Description Motor vehicle insurance services

DECLARATION
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.

In Witness whereof this Policy has been signed for and behalf of Kotak Mahindra General Insurance Company Limited,201-204, 301, 2nd & 3rd Floor, Chintamani Classique,
Vishweshwar Nagar, off Aarey road, Near, Udipi Vihar Hotel,Goregaon ((E), Mumbai 400063 at Mumbai this 06 day of January of 2024

₹ 0.50 for this policy paid as part of consolidated stamp duty payment.

For Kotak Mahindra General Insurance Company Limited

Authorised Signatory

This document is digitally signed, hence counter signature / stamp is not required.

Kotak Car Secure (Liability Only Policy) UIN: KMG-MT-P16-52-V01-15-16;

Kotak Mahindra General Insurance Company Limited
CIN: U66000MH2014PLC260291, Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra East, Mumbai ​ 400051. Maharashtra, India.
Corporate Office: 8th Floor, Zone IV, Kotak Infinity, Building No.21, Infinity IT Park, Off Western Express Highway, General AK Vaidya Marg, Dindoshi, Malad(E), Mumbai ​ 400097. India.
Toll Free: 1800 266 4545 Email:[email protected] Website: www.kotakgeneral.com IRDAI Reg. No. 152