Tata AIG General Insurance Company Ltd.

Date: 22/06/2013

Policy No. : 0151348711 02

Mr. SANDEEP KUMAR
House No-197 Gali No-4
Aggarsain Colony Distt-sirsa
SIRSA, 125053
HARYANA
Phone : 9999791918

Renewal Endorsement for Policy No. 0151348711

Dear Mr. SANDEEP KUMAR,
We thank you for reposing your faith in us once again. As per your instructions in the Renewal Response Form, your
above mentioned policy has been renewed w.e.f. 18/06/2013. The insurance coverage, terms and conditions extended are
the same as opted by you in the previous policy and incorporates changes (if any) requested by you. The premium
computation of the policy is given below and your Certificate Of Insurance is attached. The details of your coverages and
the other guidelines regarding your policy can be had from the policy document sent to you at the inception of the policy
(and attached endorsements, if any).
Looking forward to a beneficial and long term association.
Sincerely Yours

Atri Chakraborty
National Head - Operations & Systems
Service Tax Registration No : AABCT3518QST004
The stamp duty of Rs.0.25/- paid in cash or demand draft or by pay order,vide Receipt/Challan no: MH000046647201314E
the 22/04/2013

dated

TOLLFREE HELP LINE: 1 800 119966

Regd.Office:15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013

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Tata AIG General Insurance Company Ltd.

ENDORSEMENT
Endorsement No:

Effective Date: 18/06/2013

Attached to and forming part of Policy No.

Expiry Date: 17/06/2014

0151348711 02

TA01 -Depreciation Re-imbursement

This coverage is applicable if it is shown on Your schedule.
We will pay You the amount of depreciation deducted on the value of parts replaced for own damage claim
lodged under section 1 of the policy, provided -Vehicle is not more than 3 years old from the date of purchase or date of registration,
whichever is earlier at the start of period of insurance.
-There are not more than 2 claims during the period of insurance
-Vehicle is repaired at any of our Authorised Garage.

TA08 - Repair of Glass, Fiber, Plastic & Rubber Parts

A claim for only Glass / plastic / rubber / fiber part where You opt for repairs rather than replacement, at Our
authorized workshop, will not affect Your No Claim Bonus eligibility at the time of renewal with Us if there
is no other claims for damage to the vehicle during the currency of the policy.

TA09 - Loss of personal belongings

This coverage is applicable if it is shown on Your schedule.
We will pay for the loss or damage to Your and Your Family member's personal belongings caused by perils
mentioned under section 1 of the policy while they are in the vehicle at the time of loss or damage to the
vehicle.
Personal belongings for the purpose of this section means items such as clothes and other articles of personal
nature likely to be worn, used or carried and includes audio/video tapes, CDs but excludes money, securities,
cheques, bank drafts, credit or debit cards, jewellery, lens, glasses, travel tickets, watches, valuables,
manuscripts, paintings and items of similar nature. Any goods or samples carried in connection with any
trade or business is not covered.
A police report must be filed for claims due to burglary, house-breaking or theft.
The maximum amount payable under this section is Rs 10000* during the period of insurance. Any claim
under this section will be admissible only when there is a valid and admissible claim in respect of the vehicle
arising out of the same Accident.
The insured will bear first Rs.250 of each and every claim under this section.

TOLLFREE HELP LINE: 1 800 119966

(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)

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Tata AIG General Insurance Company Ltd.

ENDORSEMENT
Endorsement No:

Effective Date: 18/06/2013

Attached to and forming part of Policy No.

Expiry Date: 17/06/2014

0151348711 02

TA10 - Emergency transport and hotel expenses

This coverage is applicable if it is shown on Your schedule.
We will pay towards the cost of overnight stay, if absolutely necessary and taxi charges for returning back to
Your place of residence or the nearest city You are traveling to if Your motor vehicle has met with an
accident by any of the peril mentioned under section 1 of the policy and can not be driven. We will pay
maximum Rs 5000* for any one accident and Rs 10000* during the period of insurance. Documentary
proof of expenditure must be submitted for any claim under this section.
Any claim under this section will be admissible only when there is a valid and admissible claim in respect of
the vehicle arising out of the same accident.

TOLLFREE HELP LINE: 1 800 119966

(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)

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Tata AIG General Insurance Company Ltd.

ENDORSEMENT
Endorsement No:

Effective Date: 18/06/2013

Attached to and forming part of Policy No.

Expiry Date: 17/06/2014

0151348711 02

TA15. Key Replacement

I.

What We Cover

1. Key Replacement - We will reimburse You for the cost of replacing Your vehicle keys which are Lost or
Stolen. The covered cost is limited to the money You paid to a locksmith to produce a new key.
2. Break-in Protection - We will reimburse You for the cost of replacing Your locks and keys if Your
vehicle is broken into. The covered costs include the labor cost for replacing the lock.
3. Lock Out Reimbursement - We will reimburse You for the cost of obtaining a locksmith if You are
locked out of Your vehicle due to the loss or theft of Your keys.
I.

Coverage Exclusions

We will not pay for:

1.
2.

costs other than those listed in the "What We Cover" section;

The cost to replace keys to vehicles that You do not own for personal use;

II. Coverage Conditions

For Break-in protection claims, You must provide an official police report that indicates the incident
happened within the covered time frame in order for Us to pay the claim unless You are legally incapable of
doing so.
III. Duties After An Accident or Loss
In the event of a covered loss:
1. You shall call Us at 1800119966 or provide written intimation within 24 hrs. of discovering the loss to
make a claim and obtain the proper forms and instructions;
2. You shall file a police report within 24 hours of discovering a covered incident.
3. You shall fill out and return any claims forms and accompanying documents including police reports
(where necessary), receipts for replacing locks and/or keys, and any other documents We may ask You to
provide;
4. The claims form and accompanying documents must be returned to Us within 3 days of making the
original claim.

TOLLFREE HELP LINE: 1 800 119966

(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)

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Tata AIG General Insurance Company Ltd.

ENDORSEMENT
Endorsement No:

Effective Date: 18/06/2013

Attached to and forming part of Policy No.

Expiry Date: 17/06/2014

0151348711 02

Definitions:
1.

We, Us, Our, Ourselves means the Tata AIG General Insurance Co. Ltd.

2. You, Your, Yourself - Means or refers to the person or persons described in the Schedule as the
insured.
3. Constructive Total Loss - A vehicle will be considered to be a Constructive Total Loss (CTL), where
the aggregate cost of retrieval and / or repair of the vehicle subject to terms and conditions of the policy
exceed 75% of the Sum Insured.
4. Hospital / Nursing Home - Any institution established for indoor care and treatment of sickness and
injuries and registered with local authorities and is under the supervision of a licensed and qualified medical
practioner.
5. Ambulance - A self-propelled motor vehicle specifically designed to transport critically sick or injured
people to a medical facility.
6.

Medical Practioner - A person licensed to practice medicine.

7.

Courtesy/Hire car - A vehicle provided to the insured by the hire car company.

8. Hire car Company - Company which is engaged in car hiring business and has provided vehicle to the
insured as per their terms and conditions.
9.

Authorized garage - A motor vehicle repair garage authorised by us.

10. Daily Allowance - Fixed amount to be paid for the purpose of meeting the cost of hired transport.
11. Family - You, Your spouse, Your children, Your parents and any other person residing with you
without paying a commercial rent.

TOLLFREE HELP LINE: 1 800 119966

(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)

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Tata AIG General Insurance Company Ltd.

Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Agent/Broker Name - Sharad Mehra

Agent/Broker License Code - 1798194 :
or landline)

Agent/Broker:Contact No - 09711331101 (mobile

Certificate & Policy No.

0151348711 0151348711 00
Effective time and date of commencement of Insurance

Policy Type

Date of Expiry

Premium (incl.S.Tax)

Midnight on 17/06/2014

Place of Registration

AutoSecure Package Policy

From 00:01 Hours on 18/06/2013

Rs. 6770.00
Insured's Business/Profession SERVICE
Geographical Area
INDIA

SIRSA
Name and address of the Insured

Under Hire Purchase/Hypothecation/Lease with

SANDEEP KUMAR
Name:
Address : House No-197 Gali No-4
Aggarsain Colony Distt-sirsa

N/A

SIRSA 125053
HARYANA

Registration No.

Make & Model

Body Type

Mfg. Year

CC

HR24M7173

HYUNDAI SANTRO
GLS

SALOON

2010

1086

IDV of vehicle(Rs.) IDV of Side Car(Rs.) Bi-Fuel/CNG/LPG

Kit(Rs.)
2,18,100

Seating Capacity

Engine No.

034897

IDV of non-built-in Accessories(Rs.)

Electrical
Non-Electrial
0

Chassis No.
547281

Total Insured Declared

Value (Rs.)

2,18,100

SCHEDULE OF PREMIUM
Premium on Vehicle and non electrical accessories

Rs.

4,523.72

Basic

Rs.

1,110.00

Less : 35.00% for NCB

Rs.

1,583.30

Add:PA benefits as per Endt.IMT 16 No. of Passengers Rs.

: 5 Capital benefits Rs. 100000.00

250.00

A. TOTAL OWN DAMAGE PREMIUM (rounded off) Rs.

2,940.00

Add:Legal Liability to paid driver as per Endt. IMT 28

Rs.

50.00

Add:Depreciation reimbursement (TA01)

Rs.

1,090.50

Add: Compulsory PA Cover for Owner-Driver

Rs.2,00,000

Rs.

100.00

Add:Loss of personal belonging (TA09)

Rs.

110.00

B. TOTAL LIABILITY PREMIUM

Rs.

1,510.00

Add:Emergency transport and hotel expenses (TA10)

Rs.

110.00

COMPREHENSIVE PREMIUM(A+B+C)

Rs.

6,026.00

Add:Key Replacement (Sum Insured (SI) Rs. 25000.00 Rs.

per occurrence limit 50% of SI) (TA15)

265.00

NET PREMIUM

Rs.

6,026.00

Rs.

1,576.00

Add : 12.36% Service Tax

Rs.

745.00

TOTAL PREMIUM

Rs.

6,770.00

C. TOTAL ADD ON PREMIUM

TOLLFREE HELP LINE: 1 800 119966

(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)
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Drivers Clause : Persons or classes of persons entitled to drive :

Limitations as to use:

Any person including the insured: Provided that a person driving holds an effective driving licence
at the time of the accident and is not disqualified from holding or obtaining such a licence. Provided
also that the person holding an effective Learner's Licence may also drive the vehicle and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

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) Organised racing d) Pace
Making e) Speed testing f) Reliability Trials g) Any purpose in connection with Motor Trade.

Limits of Liability:

Subject to

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. 7,50,000/P.A. Cover for Owner - Driver under Section III: CSI
: Rs. 2,00,000/Deductible under Section - I
: Rs. 1,000/Compulsory Deductible
: Rs. 1,000/Voluntary Deductible
: Rs. /Imposed Excess
: Rs. /-

A. Indian Motor Tariff Endorsement No. (IMT)

16,22,28

b.TATA AIG Auto Secure endorsement No.TA01, 08 , 09 , 10 , 15

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 of Motor Vehicles Act, 1988.

For Tata AIG General Insurance Company Ltd.

In witness whereof this Policy has been signed at Mumbai on 22/06/2013.

Receipt(s): CD00016233000
The stamp duty of Rs.0.25/- paid in cash or demand draft or by pay order,vide Receipt/Challan no:
MH000046647201314E
dated the 22/04/2013

Atri Chakraborty
National Head - Operations & Systems

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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".
Note: This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been attached in any part of this Policy or of the Schedule
shall bear the same meaning wherever it may appear.
Any amendments/modifications/ alterations made on this system generated policy document is not valid and Company shall not be liable for any liability whatsoever
arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is made to the Company
and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company.

TOLLFREE HELP LINE: 1 800 119966

(Regd.Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg,Lower Parel, Mumbai- 400 013)
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