ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R188556982 / 15-Dec-2023
Policy No. & Type 2302205947700200000 Period of Insurance 19-Dec-2023 to 18-Dec-2024
Policy Issued On 15-Dec-2023 (00:00) Vehicle Identification No. MBHCZC63SLL690920
Insured Name M/S Sunny Enterprises Geographical Area INDIA
Invoice No 2059477002000 Accounting Code of Service 997134
60 MEDICAL COMPLEX TELIPARA, BILASPUR,9893267070,
Insured Address
BILASPUR-495001, Chattisgarh
Insured State & Code Chattisgarh-22 Place of Supply Chattisgarh GSTIN of Customer 22AKXPK2079G1ZW
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 417329
Model & Variant NEW SWIFT ZXI BS-VI/MARUTI SWIFT ZXI Non Electrical Accessories 0
Registration No CG10AZ7661 Electrical Accessories 0
Year of Manufacture 2020 CNG/ LPG Kit 0
Engine- Chassis No 1314873 - MBHCZC63SLL690920 Total IDV 417329
Cubic Capacity 1197
Seating Capacity 5
Type Of Body Saloon
RTO Location CG10AZ7661 / BILASPUR
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 3168 Basic Third Party Liability 3416
Third Party Liability for Bi-fuel Kit 0
Elec. Accessories 0
Compulsory PA Cover Premium to Owner-Driver (1 Year) 0
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 3168
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) 3716
Total Premium (A+B) 9480
Driving Tuition Loading On OD Premium (60%) NA
CGST @9% 853.20
Fiber Glass Tank 0 SGST @9% 853.20
Sub-Total Additions 0 Gross Premium Paid 11186
Deductibles
Point of Sale - SATYA AUTO PRIVATE LIMITED, BILASPUR
Voluntary Deductibles (IMT 22A) 0
Anti-Theft Device (IMT-10) 79
Notes :
AAI Membership (IMT-8) 0
No Claim Bonus (35%) 1081 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 1000 (IMT -22)
Sub - Total Deductibles 1160 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10, 28, 16,
Add - On Coverages 6. UIN : IRDAN125RP0001V02201415
ZERO DEPRECIATION 3756 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.
Engine & Gear Box Protector 0
Return To Invoice 0
Net own Damage Premium (A) 5764
Nominee Details : Nominee Name Age 0 Relation
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Visa Credit Card 113111169842 ELECTRONIC PAYMENT 11186
Financier Type Financed Financier Name KOTAK MAHINDRA BANK LIMITED Financier Branch BILASPUR
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 -
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 : https://www.cioins.co.in/Ombudsman
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 HDFC ERGO General Insurance Company
Limited
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of
the said sub-rule.

Authorized Signatory
Policy Issuing Office:-3rd Floor, Chawla Complex, Devender Nagar Road, Sai Nagar, Raipur (Formerly HDFC General Insurance Limited from September 14, 2016 and L&T General Insurance Company
Limited up to September 13, 2016)
GSTIN: 22AABCL5045N1ZI, CIN No.:U66030MH2007PLC177117
State Name : Chattisgarh