Form 51 of the Central Motor Vehicle Rules, 1989

Certificate / Policy No : FCV/S4505741/A2/12/004265 Account Number : A2006142

Policy type : Commercial Vehicle – Goods carriage- COMPREHENSIVE INSURANCE POLICY
Period of Insurance :
Premium Paid (incl. S. Tax) :
Policy holder’s Name :
Address :
Under Hire Purchase/Hypothecation/Lease with : Agent Name : BHARTI AXA DIRECT ACCOUNT SMSN
Geographical Area : INDIA Tel No – Moline No : 08666639100
Agent Details

Regn.No : Place of Regn :

Make / Model :
Year of Manufacture : Body Type : OPEN
Seating Cap. (incl.Driver) : 3 Engine C.C :
Public / private Carrier : Gross Vehicle Weight :
Chassis No. : Engine No. :
IDV of the Vehicle :
Bi-Fuel(CNG/LPG) :
Total Insured declared Value of the Vehicle :
Schedule of Premium
A)Own Damage Premium B) Liability premium
Premium for (Vehicle and non Electrical Basic
Accessories) Restricted TPPO
CNG/LPG KIT (IMT 25) Comp. PA
Geographical Area No. of Passengers :
Fibre Glass Tank Add: legal Liability to paid Driver as per Endt.
IMT – 23 IMT 28
Own Premises B. Total Liability Premium
NCB 0 % Net Annual
Load /Discount Premium (A+B)
A. Total Own Damage Premium ADD : CGST 9 % (Annual)
ADD : CGST 9 % (Annual)

Total Annual Premium :

Driver’s clause: Person or Classes of person entitled to drive
Any person including the insured : Provided that a person driving holds an effective driving license at that 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 when not used for transport of passengers at the
time of accident and that such a person satisfies the requirement of Rule 3 of the central Motor Vehicle Rules , 1989
Limitation As to Use
The Policy covers use only for carriage of passengers in accordance with the permits(contract carriage or stage carriage) issued within the meaning of Motor Vehicle
Act. Policy does not cover:
1)Use for Organised racing ,pace making ,reliability trail or speed testing. 2)Use whilst drawing a trailer,except towing(other than for reward)of any one disabled
mechanically propelled vehicle.
Limit of Liability
Under section II-1 (i) of the policy (Death or bodily injury) : such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988.
Under Section II-1 (ii) of the policy
(Damage to third party property)
P.A. Cover for owner – Driver Under Section
III. CSI
Compulsory Deductible Seating Capability not exceeding 17 Passengers
Seating Capability not exceeding 17 but not 36 Passengers
Seating Capability not exceeding 36 Passengers
Taxis and Three Wheelers rated as Commercial Vehicles
(Cubic Capacity not exceeding 1500 CC)
Taxis and Three Wheelers rated as Commercial Vehicles
(Cubic Capacity exceeding 1500 CC)
Name of Nominee :- Age of Nomine :
Driver Nominee :- Name of Appointee :
Appointee Nominee Relationship :
Subject to Indian Motor Traffic Endorsement (nos)
IMT28-
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 XI
Motor Vehicle Act, 1988.
In witness of this policy has been signed at __________ on__________ in lieu of cover note no. Dated
Receipt No.
Service Tax Registration no. :AADCB2008DST001
BHARATI AXA GENERAL INSURANCE COMPANY LTD

Authorized Signature
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