ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R128271511 / 05-Mar-2021
Policy No. & Type 12467862 Period of Insurance 15-Mar-2021 to 14-Mar-2022
Policy Issued On 05-Mar-2021 (00:00) Vehicle Identification No. MA3EJKD1S00A84574
Insured Name Mr Narayana Geographical Area INDIA
Invoice No R128271511 Accounting Code of Service 997134
Insured Address #51/1 SADAR STREET BEHIND VENKATARAMANASWAMY TEMPLE ATTIBELE,, ,
BANGALORE-562107, Karnataka
Insured State & Code Karnataka-29 Place of Supply Karnataka GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 306670
Model & Variant D' Zire New VXI/MARUTI SWIFT DZIRE VXI BS IV Non Electrical Accessories 0
Registration No KA51MK4382 Electrical Accessories 0
Year of Manufacture 2017 CNG/ LPG Kit 0
Engine- Chassis No 1944489 - MA3EJKD1S00A84574 Total IDV 306670
Cubic Capacity 1197
Seating Capacity 5
Type Of Body Saloon
RTO Location KA51MK4382 / BANGALORE
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 3726 Basic Third Party Liability 3221
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [1 Year] 325
PACover for 0 Person of Rs (0) each (IMT- 16 )
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
Basic Premium 3726 Legal Liability to Employees (IMT-29) 0
Geographical Area Extn. (IMT-1) NA Legal Liability to Passenger (IMT 46) 0
Lamp, Tyres etc. (IMT 23) 0 Driving Tuition Loading On TP Premium (60%) NA
Net Liability Premium (B) 3596
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 10602
Fiber Glass Tank 0 CGST @9% 954.18
Sub-Total Additions 0 SGST @9% 954.18
Deductibles Gross Premium Paid 12510
Voluntary Deductibles (IMT 22A) 0 MISP - R N S MOTORS, BANGALORE
Anti-Theft Device (IMT-10) 93
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus 0 0
Discount for vehicles designed for handicapped NA 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 93 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT 10, 28,
DEPRECIATION WAIVER 3373
Engine And Gear Box Protection Cover 0
New Vehicle Replacement 0
Net own Damage Premium (A) 7006
Nominee Details : Nominee Name HANUMANTHRAJU Age 40 Relation Son-in-Law
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Electronic Payment 110099990607 ELECTRONIC PAYMENT 12510
Financier Type Not Financed Financier Name NA Financier Branch NA
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)
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 : [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 IFFCO TOKIO GENERAL INSURANCE COMPANY LIMITED

Authorized Signatory
Policy Issuing Office:-KSCMF Building 3rd Floor, 3rd Block No. 8, Cunningham Road Bangalore Karnataka 560052
GSTIN: 29AAACI7573H1Z8, CIN No.:U74899DL2000PLC107621
State Name : Karnataka