HDFC ERGO General Insurance Company Limited

2311201320986601000

Policy No. 2311 2013 2098 6601 000 Certificate of Insurance cum Policy Schedule

Private Car Package Policy

Insured Name DR RATANSING SHAMSHAHA JUGNE RTO NAGPUR

Correspondence S. M. JUGNE PLOT NO.9, SADGURU CHS, ADARSH Registration PLOT NO -9 AADARSH COLONY SADGURU CHS PIPLA PHATA
Address COLONY PIPLA NAGPUR Address NAGPUR, MAHARASHTRA, 440034
NAGPUR, MAHARASHTRA, 440034
Mobile 9422583879 Phone 9422-583879 E Mail m.s.jugne@gmail.com Registration No. MH-40-AR-5294

Period of Insurance From Date & Time 28/03/2017 06:13hrs To Date & Time 27/03/2018 Midnight Policy Issuance Date 28/03/2017

Make Model - Variant Engine No Chassis No Mfg Yr Seats Body Type CC

HYUNDAI I20 - Active 1.4 SX G4LAFM878333 MALBM51BLFM192464 2015 5 HATCHBACK 1396

Insured's Declared The Vehicle (`) For Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Value (IDV) 702,202 0 0 0 0 702,202

Named Persons & Nominee (IMT-15)

Nominee for Owner driver MRS SHILA S JUGNE , MOTHER Appointee
Hypothecated(IMT-7) with: HDFC BANK LTD
Premium Details (`)
Own Damage Premium (a) Liability Premium (b)
Basic Own Damage: 12324 Basic Third Party Liability: 2237
LL to Paid Driver (IMT-28) 50
PA Cover for Owner Driver of ` 200000 100
Total Basic Premium 12324
PA Cover for Un-Named Persons of ` 80000 Each (for 5 Persons) (IMT-16) 200

Less: No Claim Bonus (20%) 2465

Total - Less 2465
Add on Coverages Net Liability Premium (b) 2587
Total Package Premium (a+b) 12796
Service Tax 15% (Including Swachh Bharat Cess 0.50%, Krishi Kalyan Cess 0.50% as
Emergency Assistance 350 1919
applicable)
Total - Add on 350
Net Own Damage Premium (a) 10209 Total Premium 14715

Geographical Area India , Compulsory Deductible (IMT-22) ` 1000.00 Voluntary Deductible (IMT-22A) ` 0.00
Payment Details: Fund Transfer No. MR1703035343 Dated : 28/03/2017 Drawn on BizDirect

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. Persons or Class of Persons 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 Vehicles Rules, 1989. Limits of Liability 1. Under Section II-1 (i) of the policy - Death of or bodily injury -
Such amount a s i s necessary to meet the requirements of the Motor Vehicles Act, 1988. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 750000 3. P. A. Cover under Section
III for Owner - Driver(CSI): ` 200000 Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request & the same is also available at
our website.

I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988. "The stamp duty of
` 0.50 paid b y Demand Draft,vide Receipt/Challan no. 5063196201617 dated 10/03/2017 as prescribed in Government Notification Revenue and Forest Department No. Mudrank 2004/4125/CR 690/M-1,
dated 31/12/2004". Service Tax Registration No: AABCH0738EST004 . IMPORTANT NOTICE: The Insured i s not indemnified if the vehicle i s used o r driven otherwise than in accordance with this
Schedule. Any payment made b y the Company b y 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". Disclaimer: The Policy shall be void from inception if the premium cheque is not realized. In the event of misrepresentation,
fraud o r non-disclosure of material fact, the Company reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared accordingly. The existing
damages to the vehicle as mentioned in the report shall not be paid by the Company. The policy is issued basis the information provided by you, which is available with the company. In case of discrepancy
or non recording of relevant information in the policy, the insured is requested to bring the same to the notice of the company within 15 days.

Policy Issuing Office : (B) 5TH FLOOR, SHRIRAM TOWER, NEXT TO NIT BUILDING KINGSWAY SADAR,NAGPUR - 440001 NAGPUR, 440001. Phone No : +91-712-3988360

Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.

Agent Name : ADITYA BIRLA INSURANCE BROKERS LTD *1*

Agent Code : 200500288952 Contact No : 43568300

#1# Duly Constituted Attorney

*$*NAGENDRA_SAI#$#

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T . Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | care@hdfcergo.com | www.hdfcergo.com. CIN : U66010MH2002PLC134869. IRDAI
HDFC ERGO General Insurance Company Limited
Frequently Asked Question’s (FAQ’s) - Motor Insurance

WHAT ARE THE MAJOR COVERS UNDER THE POLICY? HOW DO I FILE A CLAIM?
Loss or Damage to the Insured Vehicle caused due to: For Accidental Damage to Insured Vehicle (Own Damage Claims):
a. Fire, explosion, self ignition or lightning. ¡ Call our customer care Toll-free 1800-2-700-700 (Accessible from India only) if the vehicle meets
b Burglary, housebreaking or theft with an accident and provide your policy number for reference and register the claim
c All act of God perils like earthquake, flood, cyclone etc ¡ Alternatively, you can visit and register on IPO (available on website/Download IPO app on your
d Accidental external means, terrorism, riot and strike smart phone) by providing personal details, link your policy and register your claim under "Claims"
Liability to Third Parties: tab
Provides cover for any legal liability arising out of the use of the vehicle for Please keep the following details handy while intimating a claim
a Accidental death / injury to any third party a. Policy No.
b Any damage to property owned by third party b. Registration details/ RC copy
Personal Accident Cover: c. Drivers details at the time of accident including driving license number
The policy provides for a mandatory Personal Accident cover for owner driver and optional cover for d. FIR on a case to case basis
passengers covering accidental death and permanent total disability e. Repair estimate
WHAT ARE THE MAJOR EXCLUSIONS OF THE POLICY? WHAT IS THE CLAIM PROCESS?
a. General aging, wear & tear, mechanical or electrical breakdown, failure, depreciation, any 1. If your vehicle can be driven, take it to the nearest dealer / garage.
consequential loss 2. Get a repair estimate, fill up the claim form and attach a copy of the registration certificate and
b. Damage by a person driving without a valid license driving license of the person driving at the time of the accident.
c. Damage by a person driving under the influence of liquor or drugs 3. If the garage is within our network, you could avail of cashless claim facility. Pay for non accident
d. Loss/damage attributable to war, mutiny, nuclear risks related repairs, depreciation and deductible. We would settle the rest.
e. Damage to tyres and tubes, unless damaged during an accident 4. If the garage is outside our network, you would have to get the claim reimbursed subsequently.
f. Usage on hire & reward (applicable for all classes except public commercial vehicles)
g. Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes, headlights, paint CLAIMS DOCUMENTS -
work (applicable for all commercial vehicles; unless opted additionally) For ACCIDENTAL DAMAGE TO INSURED VEHICLE
h. Loss or damage resulting from overturning arising out of operation as a tool (applicable for mobile a. Duly filled and signed claim form & satisfaction voucher
cranes, drilling rigs, mobile plants, navvies, shovels, grabs, rippers unless opted for additionally) b. Registration Certificate (RC)
i. Loss of or damage to accessories by burglary housebreaking or theft unless the vehicle is stolen at c. Driving license of the person driving at the time of the accident
the same time (applicable to all commercial vehicles & two wheelers) d. Policy copy , original repair estimate, repair invoice
e. Payment receipt for non-cashless claims
TRANSFER OF INSURANCE (INCASE VEHICLE IS SOLD)
f. Original repair invoice for cashless claims
a. No objection letter from the previous insured g. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence proof)
b. Form 29/30, Sale Deed OR transferred RC copy. In case of smart card, RTO transfer fee paid h. Form 35 & original NOC from financer incase of total loss where payment is made to insured
receipt. i. A copy of police FIR/panchnama is required for TP injury / death / property damage
c. Differential Premium if any (NCB recovery, PA to Owner - Driver etc)
d. NOC from Financier, if applicable. Additional documents required for commercial vehicles:
e. Pre-inspection is must if transfer request date is >14 days from the endorsed RC copy date a. Spot survey b. Load challan c. Fitness certificate d. Route permit
f. Break-in loading >45 days ( if applicable)
CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT
Additional Documents a. Duly filled and signed claim form & discharge voucher ( after loss settlement )
a. Incase of death of Insured - a. Death Certificate b. Legal heir certificate b. Original Registration Certificate (RC)
b. Incase of Employer to Employee transfer - a. Letter from Employer c. Original policy copy
d. Copy of FIR lodged at the nearest police station
WHAT CHANGES CAN BE DONE IN MY POLICY ENDORSEMENT e. All original keys & vehicle invoice copy
For Changes related to registration of vehicle or vehicle details like f. No trace report confirming that the stolen vehicle is not traceable
a. Correction in registration number/ location / address g. Original NOC from financer incase of hypothecation / HPA
b. Correction in vehicle make & model/ cubic capacity/ seating capacity/ engine & chassis h. Intimation to RTO for theft of vehicle
number/manufacture year i. Duly signed RTO transfer papers (Form 26, 28,29,30,35)
j. RC extract with stolen remark from the concerned RTO after the loss
To make above changes, you need following documents: k. AML documents for amount more than 1 lac (PAN card, 2 passport size photo, residence proof)
a. Request letter for the change l. Deed of subrogation cum indemnity on judicial stamp paper
b. Policy copy
WHAT IS NCB?
c. Registration Certificate copy /Invoice Copy for change in vehicle details
d. Cheque for additional premium if applicable NO CLAIM BONUS (NCB):
NCB is provided for every claim free year basis the slab as provided by Tariff.
For addition of electrical and non electrical accessories, CNG & LPG Kit: How can I get No Claim Bonus Reserving Letter?
a. Request letter for the change NCB Reserving letter can be provided only on Sale of vehicle evidenced by transferred RC copy OR
b. Policy copy Sale Deed and Form 29 & 30. The OD section of the policy needs to be transferred to the new owner or
c. Invoice copy (mandatory where value of accessory exceeds ` 20,000/-) cancelled.
d. Endorsed Registration Certificate Copy (For CNG/LPG kit)
e. Cheque for additional premium HOW DO I RENEW MY POLICY?
E mail or Call us for additional premium details & send relevant documents copy to our customer service a. Visit www.hdfcergo.com to renew instantly d. Send a copy of the renewal notice along with
office online premium cheque to our branch office
b. SMS "RENEW <POLICY NO> " to 9999 /Corporate office
For Change of financier details (Hypothecation/Lease/Hire-Purchase) 700700 e. Call our toll free number 1800 2 700 700
a. Request letter for the change c. Visit our nearest branch / your agent (Accessible from India only)
b. Policy copy
c. Endorsed Registration Certificate copy HOW TO CONTACT US?
d. NOC from financier (not mandatory for deletion if RC is endorsed) Call Toll-free :1800 2 700 700 (Accessible from India only)
Fax :022 6638 3669
For any endorsments on your policy you can contact us through any of the below mentioned modes: E-Mail :care@hdfcergo.com
E mail us at : care@hdfcergo.com OR Call Toll-free: 1800 2 700 700 (Accessible from India only) Write to us at :HDFC ERGO General Insurance Company Limited
OR Fax your request at: 022 6638 3669 OR Raise a service request on Insurance Portfolio (Customer service office) 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (East),
Organizer (IPO) from www.hdfcergo.com Mumbai - 400 059
IPO :Raise a service request on Insurance Portfolio Organiser (IPO)

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This document is a summary of the benefits offered. The information mentioned above is illustrative and not exhaustive. Information must be read in conjunction with the policy wordings.
In case of any conflict between this document and the policy wordings, the terms and conditions mentioned in the policy wordings shall prevail.