The Certificate of Insurance Page 1 of 3
ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.
TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Bundled Motor Policy- 5 Yr TP + 1 Yr OD ( Private Vehicle ) Proposal No. & Date N98049557 / 28-Jun-2021
Policy No. & Type MPX/SL167711 Period of Insurance Own Damage- 28-Jun-2021 to 27-Jun-2022
Third Party- 28-Jun-2021 to 27-Jun-2026
Policy Issued On 28-Jun-2021 (00:00) Vehicle Identification No. MB8DP12DFM8726413
Insured Name Mr. Nalband Salma Geographical Area INDIA
Invoice No SL167711 Accounting Code of Service 997134
D/O SYED AHMED,19-2-590-1,RAJAMMA NAGAR,OLDTOWN,ANANTHAPUR ANANTHAPUR,
Insured Address
ANANTAPUR-515001, Andhra Pradesh
Insured State & Code Andhra Pradesh-37 Place of Supply Andhra Pradesh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Suzuki Vehicle 77900
Model & Variant ACCESS DISC CBS SPL ED 2021 BS6 UZNEYM1/ACCESS-Z Non Electrical Accessories 0
Registration No Electrical Accessories 0
Year of Manufacture 2021 CNG/ LPG Kit 0
Engine- Chassis No AF216693308 - MB8DP12DFM8726413 Total IDV 77900
Cubic Capacity 124
Seating Capacity 2
Type Of Body Solo With Pillion
RTO Location ANANTAPUR
Schedule Of Premium (Amount in Rs.)
Part A (1 Year) & Part B (5Years) LIABILITY SECTION (B)
Vehicle 653 Basic Third Party Liability 3285
Third Party Liability for Bi-fuel Kit 0
Elec. Accessories 0
Compulsory PA Cover Premium to Owner-Driver (1 Year) 285
Non- Elec. Accessories 0 PA Cover for 2 Person of Rs (100000) each (IMT- 16 ) 700
Kit (IMT-25) 0 Legal Liability (WC) to Driver (IMT-28) 0
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Legal Liability to Employees (IMT-29) 0
Basic Premium 653
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) 4270
Total Premium (A+B) 5235
Driving Tuition Loading On OD Premium (60%) NA
CGST @9% 471.15
Fiber Glass Tank 0 SGST @9% 471.15
Sub-Total Additions 0 Gross Premium Paid 6177
Deductibles
MISP - Amruth Automotives Pvt Ltd, ANANTAPUR
Voluntary Deductibles (IMT 22A) 0
Anti-Theft Device (IMT-10) 0
Notes :
AAI Membership (IMT-8) 0
No Claim Bonus 0 0 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Discount for vehicles designed for handicapped NA
3. The Policy is subject to a compulsory Deductible of Rs 100 (IMT -22)
Sub - Total Deductibles 0 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 16,
Add - On Coverages 6. UIN : IRDAN139RP0040V01201819
Depreciation Cover 312
Engine & Gear Box Protection Cover 0
Invoice Price Cover 0
Net own Damage Premium (A) 965
Nominee Details : Nominee Name S MUJAHID Age 31 Relation Husband
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 43627372 HSBC BANK LTD 6177
Financier Type Financed Financier Name HDFC BANK LIMITED. Financier Branch ANANTHAPUR
LIMITATIONS AS TO USE : The Policy covers use of the vehicle for any purpose other than: (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage (3) Organized racing
(4) Pace making (5) Speed testing (6) Reliability Trials (7) Any purpose in connection with Motor Trade.
DRIVER : Any person including 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 the requirements of the Motor Vehicles Act , [Link] Section II -1(ii) of the
Policy - Damage to Third Party Property - Rs. 100000 - (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
Lakh
Deductible under section -I : Rs 100 (Compulsory Deductible Rs 100 Imposed Deductible Rs 0 and Voluntary Deductible Rs, 0)
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: The preceding
year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50% of NCB on OD Premium. 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"
[Link] 08/05/2024
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For information on ombudsman you may visit website [Link]
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 Bharti AXA General Insurance [Link]
Authorized Signatory
Policy Issuing Office:-D No. 40-26--24/3 4th Floor, JM -3 , Mohiuddin Estate, Beside M & M Show Room M.G. Road, Vijayawada Andhra Pradesh
GSTIN: 37AADCB2008D1ZB, CIN No.:U66030MH2007PLC351131
State Name : Andhra Pradesh
[Link] 08/05/2024
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[Link] 08/05/2024
