CERTIFICATE CUM POLICY SCHEDULE

PCCV-4 (more) wheeled vehicles-capacity > 6 and 3 wheelers-carrying passengers-capacity > 17 PACKAGE POLICY - ZONE C
Issue Office: 417007 - Address:- H.NO.1-7-1105/3, 1ST FLOOR, OPP.HANUMAN TEMPLE NEAR EKASHILA PARK, ADVOCATES COLONY,
HANAMKONDA, WARANGAL-WARANGAL ANDHRA PRADESH 506002 Tel

Policy No : 417007/31/12/000745 Prev Policy No Insured's Code/ Name: 3643787 Mr.MOHAMMAD PASHA SYED

Geographical Area

INDIA

Address: S/O: KHAJAMIYA H.NO: 25-9-36, BAPUJI NAGAR, KAZIPET -WARANGAL ANDHRA PRADESH 506003 Tel 9849334199 Fax Executive: NA0000001822 Agent Details : Contact No: Period of Insurance : From 12:27 on 18/11/2011 To Midnight of 17/11/2012 Cvr Note No. 100001033581 Gross Premium: 12,428 Registration Mark & Place AP 24 W 9398 Nalgonda IDV For the Vehicle 3,00,000 S Tax: 1,280 GST:0 Make - Model
FORCE MOTORS-CRUISER

Issue date 18-NOV-11

Total: 13,708 Type of Body CLASSIC (9)

Collection No & Dt CSH 1080000753 - 18/11/2011 Cubic Capacity 2596 CNG KIT SI 0 Year Of Seating Capacity Manf (Including Driver) 2007 9+1 Total Value 3,00,000

Engine No Chassis No D27020870 T570529381107 IDV For Trailers 0

Non Electrical Accessories

Electrical Accessories

A. OWN DAMAGE BASIC OD COVER LESS :DETARIFF DISCOUNT ON BASIC OD OD TOTAL

SCHEDULE OF PREMIUM
5,318.00 1,755.00 3,563.00

B. LIABILITY 8,740.00 100.00 25.00 8,865.00 12,428.00 1,280.00 13,708.00

ADD :BASIC TP COVER ADD :GR36A-PA FOR OWNER DRIVER ADD :LL TO PAID DRIVER COUNT : 1 TP TOTAL TOTAL PREMIUM ADD :SERVICE TAX TOTAL AMOUNT

* NCB discount - %

Previous Policy : NA

COMPULSORY DEDUCTIBLE Rs.500 Deductibles under Section-I : Subject to IMT Endorsement Printed herein/attached to : IMT-28 , IMT-21 Hypothecation Agreement with: Hire Purchase/Lease Agreement with: Limit of Liability
Under Section II-1(i) in respect of any one accident: as per Motor Vehicles Act, 1988. Under Section II-1(ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000 P.A. Cover under Section III for Owner - Driver (CSI) : Rs. 200000

Driver's Clause
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 when not used for the transport of passengers at the time of accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

Limitations as to Use
The insurance under this policy is subject to conditions, clauses, warranties, endorsements as per forms attached.Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void abinitio (from inception). I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act, 1988. In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at WARANGAL on 18-NOV-11 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 MVAct, 1988 isrecoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY". POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION. Preinspection Report: Not Applicable Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.

Entered By Examined By Place :

: :

G SAHITHYA G SAHITHYA Proposal Date : 18/11/2011 Date : 18/11/2011

For and on behalf of SHRIRAM GENERAL INSURANCE COMPANY LTD

WARANGAL

We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the expiry date of your policy. If you do not want us to contact you, kindly send an e-mail for the same on dnd@shriramgi.com All the Amounts mentioned in this policy are in Indian Rupees Service Tax Reg. No. AAKCS2509KST001 Authorised Signatory Page 1 of 1