LIBERTY VIDEOCON GENERAL INSURANCE COMPANY LIMITED Awarded for 'Best Contact Center 2015' across BFSI sector in Customer Experience Summit An Initiative by Kamikaze PRIVATE CAR PACKAGE POLICY CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE IMPORTANT 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization of the premium cheque. 2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy. Policy Issuing Office 10th Floor, Tower A Peninsula Business Park, Ganpath Rao Kadam Marg Lower Parel MUMBAI MAHARASHTRA 400013 Phone: +91 22 6700 1313 Fax: +91 22 6700 1606 Policy Servicing Office 63885/7, 3RD Floor, Sapphire Square, Rajiv Gandhi Circle,Somajiguda, HYDERABAD TELANGANA 500082 PH: +91 40 48460000 FAX: +91 0 0 Policy No 201150010117101089302000 Geographical Area India Insured SHAH MOTILAL FOODS LTD Address REP BY:RAJESH GANDHI 18229/10, PLOT NO:144 I FLOOR, SINDHI COLONY, P G ROAD, SECUNDERABAD HYDERABAD TELANGANA 500003 Contact Number (M) +919347039377 Customer ID 1101819932 GSTIN No/State Name NA/TELANGANA Period Of Insurance From 00:00 Hrs of 09/02/2018 To Midnight of 08/02/2019 Policy Issued On 09/02/2018 Covernote No/Ecovernote No Covernote Date RTO Location HYDERABAD Zone ZoneA UIN CODES LVGMOP1323V011213 Agent Name KAMAL KISHORE PENDAM Agent Code IMD1009384 Agent Contact No 9347039377 INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION Licensed Carrying Registration Year of Trailer Registration Trailer Chassis Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW capacity including Trailer IDV Mark & No. Manufacture No. No. Driver TS 10 EB TOYOTA/INNOVA 2.5 V 7 2014 2KDU620513 MBJ11JV40074853250914 2651 STR/Muv 2494 7 IDV (INSURED'S DECLARED VALUE) IDV of Vehicle Trailers Side Car Non Electrical Accessories Electrical/electronic Accessories BiFuel kit (CNG / LPG) Total Value 1019771 0 0 0 0 0 / 0 1,019,771.00 AOWN DAMAGE BLIABILITY Own Damage Premium on vehicle and accessories Basic Cover Basic OD 15,786.05 Basic TP 7,890.00 DISCOUNTS UNDER OWN DAMAGE SECTION No claim bonus 25% 3,946.51 Personal Accident CoverUnnamed( No. Of Persons=7,SI=200000 ) 700.00 TOTAL OWNDAMAGE PREMIUM (A) 11,839.54 Legal Liability CADD ON COVERS Third Party Premium Basic Cover PA Benefits LL to Paid Driver IMT 28 50.00 Passenger Assist 525.00 TOTAL LIABILITY PREMIUM (B) 8,640.00 Depreciation Cover 7,138.40 Net Premium(A+B+C) Taxable Value 28,143.00 TOTAL ADDON COVER PREMIUM (C) 7,663.40 CGST(9% TELANGANA) 2,532.87 SGST(9% TELANGANA) 2,532.87 TOTAL POLICY PREMIUM 33,209.00 Hire Purchase/ Lease /Hypothecated with HDFC BANK LTD. LIMITATION AS TO USE : The Policy covers use of vehicle for any purpose other than: a) Hire or Reward b)Carriage of goods(other than sample of personal luggage) c) Organized racing d)Pace Making e)Speed Testing f)Reliability Trial g)Use in connection with motor trade. DRIVERS CLAUSE Persons or Classes of Person entitled to drive: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 Vehicle Rules, 1989. LIMITS OF LIABILITY Deductible Compulsory Deductible: Rs 2000/, Under Section III (i) of such amount necessary to 0.00 under Voluntary Deductible: Rs 0/, the policy (Death of or meet the requirements of section I Imposed Excess : Rs 0/. bodily injury): motor vechile Act,1988 Under Section III (ii) of the policy (Damage to third party property) 750,000.00 P.A. cover for owner Driver under section III : CSI Subject to I.M.T Endorsement Nos. AD01,AD04,IMT 16,IMT 22,IMT 28,IMT 7 Passenger assist cover details:Hospital Cash: Rs 1500 per day for 30 days (per Pax.), Medical Expenses: Rs 10,000 (per Pax.), Ambulance Charges: Rs. 5000 NOMINATION DETAILS Name of the Nominee Relationship with Insured Name of Appointee (if nominee is minor) Relationship with the Nominee 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. In witness whereof this Policy has been signed at Mumbai on 09/02/2018 Receipt No: 10250010117100283100 In case of Claims, Please contact us at : Toll Free No 18002665844, email id email@example.com Date of Issue : 09/02/2018 Place : Mumbai Stamp duty for the said policy is paid vide GRASS DEFACE no. dated as prescribed in Government Notification Revenue & Forest Department no. Mudrank GRASS DEFACE no. 000 , Dt 15/11/2017. For Liberty Videocon General Insurance Company Limited Invoice No. 1142101089302000 Branch GSTIN No : 36AABCL9950A1ZM QRCode_LOGO SAC Code : 997134; Description of Service : General Insurance Service; Place of Supply : TELANGANA/36 IRDA Regn. No. 150 Authorised Signatory CIN No. U66000MH2010PLC209656 Tax is not payable under reverse charge by the recipient 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 be good.