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Go Digit General Insurance Ltd.

Schedule/Certificate
Digit Two-Wheeler Policy - Bundled
UIN No.: IRDAN158RP0009V02201819

Name SATYANARAYAN BRIJNANDAN UPADHYAY Vehicle Registration No. NEW

DOLPHIN INSURANCE BROKING
A-11 MADHU PARK MATHURADAS ROAD NEAR Partner Name: SERVICES PRIVATE LIMITED
N Address DHANAMAL HIGH SCHOOL KANDIVALI WE,ST - 1106646
400067,Mumbai-400067
Partner Code:
Mobile xxxxxxxxx7336 Partner Mobile No. 9326717980

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51 Email [email protected] Partner Email [email protected]

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Aadhar No. -- For Claims,contact us at 1800-258-5956

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YOUR POLICY DETAILS

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Policy No. D076133200 / 16092022 Policy Issue Date 16-Sep-2022 Invoice No. IA074325647 Invoice Date 16-Sep-2022

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Period of Policy Own Damage Cover and Add On(s) if Opted Third Party Liability Cover PA Owner Driver

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From 16-Sep-2022 11:38:48 16-Sep-2022 11:38:48 --

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To 15-Sep-2023 23:59:59 15-Sep-2027 23:59:59 --

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Compulsory NCB % (Current Policy) 0%
Deductible 100

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Voluntary
Deductible (`) 0.00 Additional Excess (`) --

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110 Coverages Opted Digit Two-Wheeler Policy - Bundled

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Add On(s) Opted --

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G0 YOUR VEHICLE DETAILS

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Model/Vehicle

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RTO Location Mumbai,MAHARASHTRA Make HONDA

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Variant (Sub- ACTIVA/6G DLX (BSVI)
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Engine No. JF91EW7366450 Chassis No. ME4JF91AJNW366350 7- Type)
Year of
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Regn/Year of
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Body Type Scooter Fuel Type Petrol Mfg. --/2022

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Seating Capacity 2 Cubic Capacity 110 CC Odometer

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FASTag Number Financier Details

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Motor YOUR VEHICLE IDV

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Year Vehicle IDV Non-Electrical Accessories IDV Electrical Accessories IDV CNG/LPG IDV Total IDV PA Owner Driver
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MAK -- -- --
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Year 1 71743 -- 71743

51 Year 2 0 0 0 0 0 --
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Year 3 0 0 0 0 0 --
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Year 4 0 0 0 0 0 --
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Year 5 0 0 0 0 0 --
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OWN DAMAGE PREMIUM [A] (`) LIABILITY PREMIUM [B] (`)

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Own Damage Premium (`) Basic Third-Party Liability

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367.61 (`) 3601.00

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Add-Ons Premium (`) 0.00 PA cover for Owner-Driver (`) --

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NCB Discount Amount Legal Liability to Employees (`)

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(`) -0.00 --
0 Legal Liability to Paid Driver (`)
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--
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367.61 PA cover for 2 unnamed passengers each (`) --

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0 PA cover for Paid Driver (`) --

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Total OD Premium 367.61 Total Act Premium 3601.00

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(`) (`)
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0 Net Premium (`) 3968.61

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CGST @ 9% = (`357.17) + SGST/UTGST @ 9% = (`357.17) 714.34

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0 Final Premium 4682.95

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A000C (`)
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Note:The above total OD premium is inclusive of all applicable loading / discounts viz (automobile association memberships, voluntary excess, anti-theft
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32 handicap person, driver tuition, fiber glass, CNG/ LPG unit, imported vehicle etc., wherever applicable).
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A Imp note: Own Damage cover shall end on completion of first year of this comprehensive bundled policy. The policy will continue as a third party cover
governed by standard wordings of Act only till the end of remaining period of policy
0A367.6 If the “Own Damage Cover” under your policy is cancelled during the policy period, then your policy shall be governed by the standard terms and conditions
0 of “Act only” policy for the Third Party Cover during the remaining period of policy

0 ENDORSEMENT

0 Invoice Number Invoice Date Net Premium Igst Cgst Sgst Utgst Cess Gross Premium

IA074325647 2022-09-16 3968.61 0.00 357.17 357.17 0.00 0.00 4682.95

Policy No: D076133200

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Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095. IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 27AACCO4128Q1Z0 HSN: 997134/General Insurance Services, GSTIN Address: Mumbai MD
Business Centre,13th floor, Godrej Colesium, 628A/2, Kurla Village, Lokmanya Pan Bazar, Sion,Mumbai,Maharashtra,PIN-400022
https
Go Digit General Insurance Ltd.
Schedule/Certificate
Digit Two-Wheeler Policy - Bundled
UIN No.: IRDAN158RP0009V02201819

OTHER DETAILS
Previous Insurer -- Previous Policy No. --

IMT - Endorsements Previous Policy --

IMT-20,IMT-22 Expiry Date
GSTIN/UIN No. Unregistered State Code 27
Receipt No. RA079870536 Receipt Date

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Nominee Details --

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Other Details

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Follow these rules like you follow the rules of the road.
Geographical Area: Any accidental loss, damage and/or liability caused, sustained or incurred within India shall be covered subject to Policy Terms and Conditions, unless specifically

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agreed and endorsed. Limitation as to use The policy covers use of the vehicle for any purpose other than hire or reward, racing, pace making, reliability trial, speed testing and use

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for any purpose in connection with the Motor Trade. Person or Class of persons entitled to drive: Any person including the insured 1) Provided that a person driving holds a valid &

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effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. 2) Provided also that the person holding a valid & effective

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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 and any subsequent amendment as
applicable. Limits of Liability: 1) Under Section I of the policy_ IDV as shown in the schedule. 2) Under Section II - 1 (i)of the policy: Death of or bodily injury _ Such amount as is

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necessary to meet the requirements of the Motor Vehicles Act, 1988 and any subsequent amendment as applicable. 3) Under Section II _ 1 (ii)of the policy: Damage to Third Party

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Property(` 6000) 4) P.A. Cover for Owner Driver under Section III (CSI) (per annum) - (` 0)

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Big Legal words

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NCB Declaration: The premium has been charged and policy has been issued subject to NCB declared by you as an insured. In the event of NCB found wrongly declared at any point

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of time during policy period, all benefits and coverages under the Policy in respect of section I of the Policy will stand forfeited. If there is any disagreement, write to us within 7 days
from the date of issuance of policy or before the start date of period of insurance whichever is earlier. PUC Declaration: The Policy has been issued subject to valid Pollution Under

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Control (PUC) Certificate disclosed by you as an insured on or before the date of commencement of the Policy . Cheque dishonor / Non-receipt of payment: If premium paid through

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Cheque, the policy is void ab-initio in case of dishonor of Cheque or non-receipt of payment. This policy is subject to the standard policy wordings, warranties and conditions
applicable for this product in addition to coverages and exclusions specified in the motor vehicle tariff published by IRDAI. The insured is not indemnified if the vehicle is used or driven

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otherwise than in accordance with this Schedule. Any payment made by the Company by reason of wider terms appearing in Certificate in order to comply with the Motor Vehicle

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Act, 1988 is recoverable from the insured. See the Clause headed “AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY”. Pre-existing Damages: All types of pre-existing
damages or cost of repair of such damage will be excluded at the time of claim settlement.Violation of Motor Vehicle Act: This policy is issued in accordance with the provision of
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Chapter X and Chapter XI of MV act, 1988 and any subsequent amendment as applicable. Any violation will forfeit all benefits and coverages under the Policy. Important Notice: The
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company may cancel the policy by sending 7 days notice in case of fraud, misrepresentation, non disclosure of material fact or non co-operation of the insured. This policy is subject
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to the standard policy wordings, warranties and conditions applicable for this product in addition to Indian Motor Tariff. Break in Insurance: In case of a break-in, the company may
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conduct pre-inspection of the vehicle and in such a case, Own Damage cover (Section -I) of the policy would not commence unless the pre-inspection of the vehicle has been done
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and the acceptance of risk is subject to evaluation of the vehicle inspection report. In case of any adverse findings in the report, the Company, at its discretion, may cancel the Policy
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as per the Motor Tariff.

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Note: The policy is issued in utmost good faith, relying on the information shared by insured at the time of obtaining the policy. The terms and conditions detailed in this policy
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schedule as well as the policy document sent by Digit shall prevail in case of any dispute.
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The Policy has been issued without Compulsory Personal Accident Cover to Owner Driver on the basis of your declaration that you do not hold a valid Driving License on or before the
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date of commencement of this Policy / already have an alternate Personal Accident insurance cover of Rs. 15 Lakhs
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For & On Behalf of Go Digit General Insurance Ltd.

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In case of claim or any other query, please contact our 24-hour Call
Centre at 1800-258-5956 or email us at [email protected]
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or visit our website www.godigit.com.

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Praveen Bhat
Senior Vice President - Customer Experience
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[email protected]
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Authorized Signatory
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Printed, Signed, and Executed at Bengaluru

Consolidated Stamp Duty has been paid as per Letter of
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Authorization No.67-B/04/2017-18 Date: 30th May 2017

issued by Department of Stamps and Registration ,
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Bengaluru- 560009 - KARNATAKA.

Hey, our document is now digitally signed
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Click here to view the certificate.

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For instant resolution, you can ping us “Hi”

on WhatsApp at 702 606 1234
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Policy No: D076133200

Page No: 2 of 2

Go Digit General Insurance Ltd. Address: Atlantis, 95, 4th B Cross Road, Koramangala Industrial Layout, 5th Block, Bengaluru, Karnataka 560095. IRDAI Reg
No. 158 CIN U66010PN2016PLC167410, GST Reg. No.: 27AACCO4128Q1Z0 HSN: 997134/General Insurance Services, GSTIN Address: Mumbai MD
Business Centre,13th floor, Godrej Colesium, 628A/2, Kurla Village, Lokmanya Pan Bazar, Sion,Mumbai,Maharashtra,PIN-400022