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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 N92200277 / 29-Nov-2018
OD- 29-Nov-2018 to midnight on 28-Nov-2019
Policy No. & Type MAX/S6194207 Period of Insurance
TP- 29-Nov-2018 to midnight on 28-Nov-2023
Policy Issued On 29-Nov-2018 (00:00) Vehicle Identification No. MB8DY11AK8127901
Insured Name Mr. Rakesh Puri Geographical Area INDIA
Invoice No S6194207 Accounting Code of Service 997134
H NO 15-5-333 OSMAN SHAHI AFZAL GUNJ,
Insured Address
HYDERABAD-500012, Telangana
Insured State & Code Telangana-36 Place of Supply Telangana GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Suzuki Vehicle 98334
Model & Variant GL150 (INTRUDER)/ Non Electrical Accessories 0
Registration No Electrical Accessories 0
Year of Manufacture 2018 CNG/ LPG Kit 0
Engine- Chassis No BGA1-582106 - MB8DY11AK8127901 Total IDV 98334
Cubic Capacity 155
Seating Capacity 2
Type Of Body Solo With Pillion
RTO Location HYDERABAD
Schedule Of Premium (Amount in Rs.)
Part A (1 Year) & Part B (5Years) LIABILITY SECTION (B)
Vehicle 1410 Basic Third Party Liability 5453
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PA Cover Premium [1 Year] 750
Kit (IMT-25) 0 PA Cover for 0 Person of Rs (0) each (IMT- 16 )
Extra Premium towards Inbuilt CNG/LPG NA Legal Liability (WC) to Driver (IMT-28) 0
Basic Premium 1410 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
Driving Tuition Loading On OD Premium (60%) NA Net Liability Premium (B) 6203
Fiber Glass Tank 0 Total Premium (A+B) 8006
Sub-Total Additions 0 CGST @9% 721
Deductibles SGST @9% 721
Voluntary Deductibles (IMT 22A) 0 Gross Premium Paid 9448
Anti-Theft Device (IMT-10) 0 Note :
AAI Membership (IMT-8) 0
No Claim Bonus 0 0 1. Policy Issuance is the subject to the realisation of cheque.
Discount for vehicles designed for handicapped NA 2. Consolidate stamp duty paid to State Exchequer
3. The Policy is subject to a compulsory Deductible of Rs 100 (IMT -22)
Sub - Total Deductibles 0
4. Voluntary excess Rs (0)
Add - On Coverages 5. Subject to Endorsements IMT
NIL Depreciation 393
Engine Protect 0
Return to Invoice 0
Net own Damage Premium (A) 1803
Nominee Details : Nominee Name MAHAVIR Age 24 Relation Brother
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Cheque 001857 HDFC BANK LIMITED. 9448
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: (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 , 1988.Under Section II - 1(ii) of the
policy -Damage to Third Party Property - Rs .100000 lakh. 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"
For information on ombudsman you may visit website http://www.gbic.co.in/ombudsman.html
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 co.ltd

Authorized Signatory

Policy Issuing Office:-3rd, Floor, 6-3-666/B/6, Gokul Towers, Punjagutta, Hyderabad Telangana
GSTIN: 36AADCB2008D1ZD, CIN No.:U66030KA2007PLC043362

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State Name : Telangana

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