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Motor Premium Computation Table_(Two Wheeler) - Expiry

Insured Name: - KOMAL PANKAJ SINGH IDV of the Vehicle [ A ] 48402


D/503, NIRMAL EXOTICA,B/H CHANDKHEDA BUS STOP
CHANDKHEDA,
Address AHMEDABAD, GUJARAT, ENGINE NO. JF50EU9025334
INDIA,382424

HONDA HONDA Model ACTIVA CHASSIS NO. U025296

Vehicle Registration Number :- GJ01PW7866 2018


Vehicle's Cubic Capacity 125 Zone A
Own Damage Premium(A) Liability Premium(B) Rupees
Vehicle Basic Rate 1.708%

Basic for vehicle 827 Liability Premium (TP) 720


Discount on OD premium 40.00% 331 Cng/fuel kits 0

Basic OD premium after discount 496 Total basic liability 720

Electric/Electronics accessories 0 0 Geog. Ext. 0

Cng/fuel kits 0 0 PA owner driver 0

Total Basic premium Input sum 496 PA Benefits for Unnamed Per Pass. 1 Lac 0
insured
Geographical ext. N 0 Pa benefits for named persons Ents_15 0

Anti-theft Discount N 0 PA benefits Paid Driver Endt_17 375

Discount for handicapped N 0 LL to paid driver Endt. 28 0

Voluntary discount 0 0 LL to employees other than paid driver 0


Automobile associate membership
N 0 SUBTOTAL Additions 375
discount
Discount_for_Restriction_of_Liability_for_TPPD_to_Rs.60
Basic own damage premium 496 00/- 0

Loading on OD premium 0.00% 0 Loading on TP premium 0

Total own damage premium 496 Total Liability Premium 1095

No Claim Bonus _(NCB) 20% 99

0.74% 358

Net own damage premium 755

Total Premium before Service Tax (n+x) 1850

G S T @ 18% 333

Final Premium 2183 reliance gic

RM -MADHAV RAJPUT FOS:DIRECT FOS AHMEDABAD

Ops/MotorCS/Ver1.1/13th Jan 2007


INSURED NAME SOURCE FRESH FOS MTR

GST NUMBER PAN NO. AADHAR NO.

ADDRESS BARODA INS.EXPIRY

MAKE / MODEL HONDA WRV REGISTRATION NO GJ06JM1586


YEAR OF MFG SEATING CAPACITY 5
ENGINE NO. CHASSIS NO.
CUBIC CAPACITY 1497 HYPOTHECATION
IDV 55000 ZONE B
ELECTRICAL NON ELECTRICAL

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


3.343% Liability Premium (TP) 3221

Basic for vehicle 1839 Cng/fuel Kits 0

Non Electrical Accessories 0 0 3221


Discount on OD premium 50.00% 920 PA for Owner Driver 315
Basic amount after OD. Discount for 919 0
the vehicle ----
Electric/Electronics accessories 0 0 PA benefits for unnamed pass., Endt_16 0

Cng/fuel kits ADDITIONAL 0 0 PA For Owner Driver 0

Total Basic premium 919 PA benefits Paid Driver Endt_17 250


Anti-theft Discount N 0 LL to paid driver _(Endt. -28) 50

Discount for handicapped N 0 LL to employees other than paid driver 0

Basic own damage premium 919 SUBTOTAL Additions 0

Discount_for_Restriction_of_Liability_for_TPPD_to
Loading on OD premium 0.0% 0 _Rs.6000/- 0

Total own damage premium 919 Loading on TP premium 0

No Claim Bonus _(NCB) 25% 230


ADD ON 0.95% 523

GOLD PLAN 0
Nil Depreciation+ Consumables+ Egine + RSA
TOTAL OWN DAMAGE PREMIUM 1212 TOTAL LIABILITY PREMIUM 3836

Total Premium before Service Tax 5048


(n+x)

G S T @ 18% 909

Final Payable Premium 5957 BHARTI AXA GENERAL INSURANCE CO LTD


NOMINEE
RELATION AGE

imam.m@policyboss.com

Private Car
Motor Premium Computation Table_(4 Whl. GCV. PUBLIC)
SADDAMHUSEN KADARBHAI BAJARIYA
Insured Name / KALAL JHAPA DAHAOD TA-DAHOD DI-DAHOD,DAHOD H.O

Address :-
DAHOD H.O,
DOHAD, DAHOD, GUJARAT,
IDV of the Vehicle [ A ] 983,605
INDIA,389151

ENGINE / CHASSIS NO. 265324/12653 Value of Non-Elect acc [ B ]

Vehicle Make : - Tata Model Lpt Value of Electrical acc [ C ]

Vehicle Registration Number:- GJ20V5040 Year of Manufacture 2013


Cubic Capacity/Gross Vehicle Weight 1550 Zone C

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


Vehicle Basic Rate 1.770%

Basic for vehicle 17410 Liability Premium (TP) 39849

Additional premium 0 0

Basic premium 17410 Total basic liability 39849

Discount on OD premium 64.70% 11264 Geog. Ext. N 0


Input sum insured
Electric/Electronics accessories 0 0 PA owner driver 0

Cng/fuel kits 0 0 PA owner driver 750

Total Basic premium 6146 Pa benefits for named persons Ents_15 0

Geographical ext. N 0 PA benefits Paid Driver Endt_17 0

IMT 23 Y 922 LL to paid driver Endt. 28 150

Geographical ext.(If flat in OD) 0 LL to employees other than paid driver 0

Voluntary discount 0 SUBTOTAL Additions 900


Automobile associate membership Discount_for_Restriction_of_Liability_for_TP
N 0 PD_to_Rs.6000/-
0
discount
Basic own damage premium 7068 Loading on TP premium 0

Loading on OD premium 0% 0

Total own damage premium 7068

No Claim Bonus _(NCB) 35% 2474

ADD ON 0.00% 0

Net own damage premium 4594 Total Liability Premium 40749

Total Premium before Service Tax


45343
(n+x)
G S T @ 18% 8162

Final Premium 53505 RELIANCE GENERAL INSURANCE CO LTD

EXE -ritesh agrwal FOS -LAXMI DHALANI

Ops/MotorCS/Ver1.1/13th Jan 2007


Motor Premium Computation Table_(4 Whl. GCV. PRIVATE)
Insured M/S OPTIVAL HEALTH SOLUTIONS (P) LTD IDV of the Vehicle [ A ] 355,000
ENGINE / CHASSIS NO. 16286P / L96200 Value of Non-Elect acc [ B ]

Vehicle Make : - Ashok Leyland Model DOST HYPOTHECATION

Vehicle Registration Number:- GJ01DX8481 Year of Manufacture 2015


Cubic Capacity/Gross Vehicle Weight 2500 Zone C

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


Vehicle Basic Rate 1.208%

Basic for vehicle 4288 Liability Premium (TP) 7144


Input sum insured
Additional premium 0 Cng/fuel kits 0
Input sum insured

Basic premium 4288 Total basic liability 7144

Discount on OD premium 50.00% 2144 Geog. Ext. N 0

Electric/Electronics accessories 0 0 PA owner driver 0


PA benefits for unnamed pass.,
Cng/fuel kits 0 0
Endt_16
Total Basic premium 2144 Pa benefits for named persons Ents_15 0

Geographical ext. N 0 PA benefits Paid Driver Endt_17 0

IMT. 23 Y 322 LL to paid driver Endt. 28 50

Geographical ext.(If flat in OD) N 0 LL to employees other than paid driver 50

Voluntary discount 0 SUBTOTAL Additions 100


Automobile associate membership Discount_for_Restriction_of_Liability_f
N 0 0
discount or_TPPD_to_Rs.6000/-
Basic own damage premium 2466 Loading on TP premium 0

Loading on OD premium 0% 0

Total own damage premium 2466

No Claim Bonus _(NCB) 35% 863

ADD ON 0.00% 0

Net own damage premium 1603 Total Liability Premium 7244


Total Premium before Service
8847
Tax (n+x)
G S T @ 18% 1592

Final Premium 10439 RELIANCE GENERAL INSURANCE CO LTD

EXE - MADHAV RAJPUT POSP - VILASBA R WAGHELA 9824956123

Ops/MotorCS/Ver1.1/13th Jan 2007


Motor Premium Computation Table_3 Whl. (UPTO 6- PASS.)
Insured Name:- KETAN VIPINCHANDRA SHAH IDV of the Vehicle [ A ] 111300
Cover Note / Proposal No.:- 347280/997790 Value of Non-Elect acc [ B ]
Vehicle Make & Model : - Piaggio AUTO RKSHW. Value of Electrical acc [ C ]

Vehicle Registration Number : - GJ06AV2828 Year of Manufacture 2014


Seating Capacity : - 3 C.C. - 145 Zone C

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


Vehicle Basic Rate 1.260%

Basic for vehicle 1402 Liability Premium (TP) 4544


Discount on OD premium 60.70 851 Cng/fuel kits 0
551 Total basic liability 4544
Input sum insured
Electric/Electronics accessories 0 0 Geog. Ext. 0
Input sum insured
Cng/fuel kits - If Inbuild Y 0 0 PA owner driver

Total Basic premium 551 PA owner driver 750

Geographical ext. N 0 Pa benefits for named persons Ents_15 0


IMT 23 Y 82 PA benefits Paid Driver Endt_17 0
Anti-theft Discount N 0 LL to paid driver Endt. 28 50
Discount for handicapped N 0 LL to employees other than paid driver 0

Voluntary discount 0 0 SUBTOTAL Additions 800


Automobile associate membership Discount_for_Restriction_of_Liability_for_TPPD_t
N 0 o_Rs.6000/- 0
discount
Basic own damage premium 633 Loading on TP premium 0

Loading on OD premium 0% 0

Total own damage premium 633

No Claim Bonus _(NCB) 20% 127

Net own damage premium 506 Total Liability Premium 5344

Total Premium before Service Tax (n+x) 5850

G S T @ 18% 1053

Final Premium 6903

Ops/MotorCS/Ver1.1/13th Jan 2007


YEAR
2018

3_PCV C B A
0 1.260% 1.272% 1.278%

5 1.292% 1.304% 1.310%

>7 1.323% 1.336% 1.342%

TP PREMIUM 2426+1161*P/PASS.

1733+829*P/PASS.

0 0
2500 110
5000 138

7500 165

Ops/MotorCS/Ver1.1/13th Jan 2007


15000 193

Ops/MotorCS/Ver1.1/13th Jan 2007


Motor Premium Computation Table 3 Wheeler_ GCV. PUBLIC

Insured Name : - RUPCHAND SHIVKARAN PERAVA IDV of the Vehicle [ A ] 144,761


Cover Note / Proposal No. : - Value of Non-Elect acc [ B ]
Vehicle Make & Model : - TATA ACE Value of Electrical acc [ C ]

Vehicle Registration Number : - GJ06XX1976 Year of Manufacture 2016


Seating Capacity : - 3 C.C. - 702 Zone C

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


Vehicle Basic Rate PUBLIC 1.640%

Basic for vehicle 2374 Liability Premium (TP) 7144


Discount on OD premium 38% 902 Cng/fuel kits 0

Basic OD premium after discount 1472 Total basic liability 7144


Input sum insured
Electric/Electronics accessories 0 0 Geog. Ext. 0
Input sum insured
Cng/fuel kits - If Inbuild N 0 0 PA owner driver 100

Total Basic premium 1472 PA benefits for unnamed pass., Endt_16 0


Geographical ext. N 0 Pa benefits for named persons Ents_15 0
IMT 23 Y 221 PA benefits Paid Driver Endt_17 0
Anti-theft Discount N 0 LL to paid driver Endt. 28 150
Discount for handicapped N 0 LL to employees other than paid driver 0

Voluntary discount 0 0 SUBTOTAL Additions 250


Automobile associate membership Discount_for_Restriction_of_Liability_for_TPPD_to_Rs
N 0 .6000/- 0
discount
Basic own damage premium 1693 Loading on TP premium

Loading on OD premium 0% 0 Total Liability Premium 7394

Total own damage premium 1693

No Claim Bonus _(NCB) 35% 593

Net own damage premium 1100

Total Premium before Service Tax


(n+x)
8494

G S T @ 18% 1529

Final Premium 10023 RELIANCE GENERAL INSURANCE CO. LTD.

QT - 7544013
FOS NAME: LAXMI DHALANI
RM NAME: AJESH PILLAI

Ops/MotorCS/Ver1.1/13th Jan 2007


DILIPSINH BHATI
INSURED NAME
Policy Expiry 2/26/2016
GANDHINAGAR
ADDRESS Date:
MAKE / MODEL TATA INDICA REGISTRATION NO GJ18AV1502
user:
YEAR OF MFG 2016 SEATING CAPACITY 6 EXCLUDING DR

ENGINE NO CHASIS NO
CUBIC CAPACITY 2145 HYPO
IDV 670000 ZONE A
ELECTRICAL 0 NON ELECTRICAL 0

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


Vehicle Basic Rate 3.612% Liability Premium (TP) 15508
Basic for vehicle 24200 Cng/fuel kits 0
Non Electrical Accessories 0 Total basic liability 15508
Basic premium 24200 PA owner driver 100
Discount on OD premium 20.00 4840 PA benefits for unnamed pass., Endt_16 0
Cng/fuel kits - If Inbuild N 0 0 Pa Input
benefits for named persons Ents_15
sum insured 0
Total Basic premium 19360 PA benefits Paid Driver Endt_17 0
Geographical ext. N 0 LL to paid driver Endt. 28 50
Anti-theft Discount N 0 LL to employees other than paid driver 0
Discount for handicapped N 0 SUBTOTAL Additions 15658
Automobile associate membership Discount_for_Restriction_of_Liability_for_TPPD_to_
N 0 Rs.6000/- 0
discount
Basic own damage premium 19360 Loading on TP premium 0
Loading on OD premium 0.00% 3350
Total own damage premium 22710
No Claim Bonus _(NCB) 20% 4542
Net own damage premium 18168 Total Liability Premium 15658

Total Premium before Service Tax


33826
(n+x)
G S T @ 18% 6089

Final Premium 39915 RELIANCE GENERAL INS CO LTD.


NOMINEE NAME

RELATION AGE

GAURANG SUTARIYA
INSURED NAME SURESHBHAI BHAGWATIPRASAD UPADHYAY
DARSHARAT FALIYA,NR WATER TANK AT AND
PO KARACHIYA VILLAGE,VADODARA Ins. Expiry Date
ADDRESS
MAKE / MODEL Swaraj Mazda/Samrat & Standard REGISTRATION NO GJ06AV3397
user:
YEAR OF MFG 2015 SEATING CAPACITY 28 EXCLUDING DRIVER

ENGINE NO A016860 CHASIS NO A308197


CUBIC CAPACITY 3455 HYPO
IDV 900000 ZONE C
ELECTRICAL 0 NON ELECTRICAL 0
Own Damage Premium(A) Rupees Liability Premium(B) Rupees
Vehicle Basic Rate 450 1.656% Liability Premium (TP) 35716

Basic for vehicle 15354 Cng/fuel kits 0


Electric/Electronics accessories 4.000% 0 Total basic liability 35716

15354 Geographical ext. 0


OD discount 60.00% 9212 PA owner driver 100
Input sum insured
Cng/fuel kits - If Inbuild n 0 0 PA benefits for unnamed pass., Endt_16 0
Total Basic premium 6142 Pa benefits for named persons Ents_15 0

Geographical ext. N 0 PA benefits Paid Driver Endt_17 0

IMT 23 Y 921 LL to paid driver Endt. 28 100

Anti-theft Discount N 0 LL to employees other than paid driver 0

Discount for handicapped N 0 SUBTOTAL Additions 200


Automobile associate membership Discount_for_Restriction_of_Liability_for_TPPD_to_
N 0 Rs.6000/- 0
discount
Basic own damage premium 7063 Loading on TP premium 0

Loading on OD premium 0.00% 0

Own Damage Premium(A) 7063

No Claim Bonus _(NCB) 0% 0

Total own damage premium 7063 Total Liability Premium 35916

Total Premium before Service


42979
Tax (n+x)

G S T @ 18% 7736

Final Premium 50715 RELIANCE GENERAL INSURANCE CO LTD

EXECUTIVE AJESH PILLAI


FOS - LAXMI DHALANI

Ops/MotorCS/Ver1.1/13th Jan 2007


Motor Premium Computation Table_( MISC.-D )
Insured Name: - AASTHA CHARITABLE TRUST FOR WELFARE IDV of the Vehicle [ A ] 400,000
REG. NO GJ01ET0928 Value of Non-Elect acc [ B ]

Vehicle Make Maruti Model Ambulance Value of Electrical acc [ C ]

ENGINE/CHESSIS 459039 / 482547 Year of Manufacture 2017


Cubic Capacity/Gross Vehicle Weight 1196 Zone C

Own Damage Premium(A) Rupees Liability Premium(B) Rupees


Input sum insured
Vehicle Basic Rate 1.190%
Input sum insured

Basic for vehicle 4760 Liability Premium (TP) 5712

Discount on OD premium 30.00% 1428 Cng/fuel kits 0

k 3332 Total basic liability 5712

Electric/Electronics accessories 0 0 Geog. Ext. 0

Cng/fuel kits 0 0 PA owner driver 0


PA benefits for unnamed pass.,
Total Basic premium 3332
Endt_16
Used within Premises (Confined sites) (Endt IMT
- 47)
N 0 Pa benefits for named persons Ents_15 0

Geographical ext. N 0 PA benefits Paid Driver Endt_17 0

IMT 23 Y 500 LL to paid driver Endt. 28 100

Add Overturning 0.5% on IDV (Endt IMT. - 47) N 0 LL to employees other than paid driver 0

Voluntary discount 0 SUBTOTAL Additions 100

Automobile associate membership discount N 0 Discount_for_Restriction_of_Liability_for_TPPD 0


_to_Rs6000

Basic own damage premium 3832 Loading on TP premium 0

Loading on OD premium 0% 0

Total own damage premium 3832

No Claim Bonus _(NCB) 0% 0

Net own damage premium 3832 Total Liability Premium 5812

Total Premium before Service Tax (n+x) 9644

G S T @ 18% 1736

Final Premium 11380 RELIANCE GENERAL INSURANCE CO. LTD.

RM-MADHAV RAJPUT FOS- DIMPLE DESAI

Ops/MotorCS/Ver1.1/13th Jan 2007


Tractor

Motor Premium Computation Table_(4 Whl. GCV. PUBLIC)


Insured Name:- IDV of the Vehicle [ A ] 180,000
Cover Note / Proposal No. :- Value of Non-Elect acc [ B ]
Vehicle Make : - Model Value of Electrical acc [ C ]
Vehicle Registration Number:- Year of Manufacture 2009
Cubic Capacity/Gross Vehicle Weight 1248 Zone C
Own Damage Premium(A) Rupees Liability Premium(B)
Vehicle Basic Rate 1.770%
Basic for vehicle 3186 Liability Premium (TP)
Trolly 0 0
Basic premium 3186 Total basic liability
Discount on OD premium Input sum insured
0.00% 0 Geog. Ext. N
Electric/Electronics accessories 0 PA owner driver
PA benefits for unnamed pass.,
Cng/fuel kits 0
Endt_16
Total Basic premium 3186 Pa benefits for named persons Ents_
Geographical ext. N 0 PA benefits Paid Driver Endt_17
IMT 23 n 0 LL to paid driver Endt. 28
LL to employees other than paid
Geographical ext.(If flat in OD) N 0
driver
Voluntary discount 0 SUBTOTAL Additions
Automobile associate membership Discount_for_Restriction_of_Liability_for
N 0 _TPPD_to_Rs.6000/-
discount
Basic own damage premium 3186 Tractor TP
Loading on OD premium 0% 0 Total Liability Premium

Total own damage premium 3186


No Claim Bonus _(NCB) 0% 0
Net own damage premium 3186

Total Premium before Service


14375 18001
Tax (n+x)
Service Tax @ 15.0%
6326 2700

Final Premium 20701

SHORT PERIOD SCALE_NET_PREMIUM


*** SM Signature
for approval of OD EXCEEDING 8_MONTHS 100%
Discount > 10%
FINAL SHORT PERIOD SCALE_PREMIUM

Page 12
Tractor

YEAR
2018

PUBLIC) YEARS' C B A
180,000 5 YS 1.726 1.743 1.751
5-7 YS 1.770 1.787 1.795
>7 YS 1.812 1.830 1.839
2009
C
Rupees
GVW TP
14390 Upto - 7500 14390 14390 14390
0 7500 - 12000 21511 15365 15365
14390 12000 - 20000 31608 22577 19632
0 20000 - 40000 34591 24708 19766
100 Above - 40000 36120 25800 19846

275 Tractor
0 Trolly 1.05 1830
50
0
425

0
14815

12165

12165

13669

Page 13