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INSURANCES@

09/
08/
02/
02/
2012
2013
2311
If declaration
Policy
02/12/2011
MrHolder
Dayaram
found
declare
incorrect,
that no
benefits
claim has
under
beeth

HDFC ERGO General Insurance Company Limited

2311100002787104000
0 5050

Certificate ofInsurance cum Policy Schedule

Policy No.2311100002787105000
Private Car Package Policy
Insured Name
Mr
Mr Dayaram
JITENDAR S JHA
O Umra Si
ngh,Vi
l
l
age Hyatpur,
Correspondence S/
B-36
GF
SOUTH
END
FLOOR
Pos
tOf
fi
ceGarhiHar
saru,
Address
Gur
gaon,
gaon Har
yanaGURGAON
121104
SEC
49 Gur
SHONA
ROAD
Mobile 999999999

RTO
GURGAON
Vi
l
l
age Hyatpur
Registration Pos
B-36
GF
tOf
fi
ceSOUTHEND FLOOR SEC 49
Address
Gar
hiHarsROAD
aru Gurgaon
SOHNA
GURGAON
Gur
gaon,Haryana,122001
HARYANA

Registration No. HR26-AJ-2499


HR26-J-9605

nsurances@safdarj
ang.com
E M ail i

Phone

Period ofInsurance From Date & Ti


me 09/02/2012 00:01hrs

08/02/2013 Mi
dni
ght

To Date & Ti
me

Policy Issuance Date 13/02/2012

M ake

Model -Variant

Engine No

Chassis No

Mfg Yr

Seats

Body Type

CC

HYUNDAI

SANTRO SANTRO
XING-XOLE
ERLX -EURO III

057443
098236

043402
048208

2007
1999

HATCHBACK

1086

Insured'
s Declared
Value (IDV)

Vehicle
188,618
35,525

Trailer

Non Electrical Acc.

Electrical Acc.

CNG/LPG Kit

Named Persons & Nominee


Nominee (Owner Driver)

Total IDV
35,525
188,618
35,525

Appointee
Premium Details ( )

Own Damage Premium (a)


Basic Own Damage

L iab ility Premium (b )

T o tal B as ic Premium

4 3 3 5 Basic T h ird P arty L iab ility


L L to P aid Driv er (IM T -2 8 )
P A C o v er fo r Owner Driv er o f
4335

L ess: N o C laim Bo nu s (5 0% )
T o tal - L es s

2168
2168
1 005

T o tal Pac k age Premium (a+ b )


S erv ice T ax (Inclu d ing E d u catio n C ess & H igh er E d u catio n C ess, wh erev er ap p licab le)

3172
327

2167

G eo grap h ic al A rea

C o mp uls o ry Ded uc tib le (IM T -2 2 )

Pay ment Details : C h eq u e N o . 3 5 1 8 6 8


Prev io us Po lic y N o .

2 3 1 1 1 00002 7 8 7 1 04 000

2 00000

N et L iab ility Premium (b )

N et Own Damage Premium (a)

Ind ia

880
25
1 00

3499

T o tal Premium

Dated : 07 /02 /2 01 2
V alid fro m 09 /02 /2 01 1 to 08 /02 /2 01 2 ,

5 00.00

V o luntary Ded uc tib le (IM T -2 2 A )

Drawn o n IN DIA N BA N K
o f H DF C E R G O

N o C laim B o nus

45%

P o licy H o ld er d eclare th at no claim h as b een mad e in th e p rev io u s y ear p o licy . If d eclaratio n fo u nd inco rrect, b enefits u nd er th e p resent p o licy in resp ect o f o wn d amage sectio n will stand fo rfeited .

List OfEndorsements
0

E nd t N o

Des c rip tio n

E ffec tiv e Date

E nd Date

Premium (In )

L IM IT A T ION S A S T O U S E : T h e P o licy co v ers u se o f th e v eh icle fo r any p u rp o se o th er th an: a) H ire o r R eward , b ) C arriage o f go o d s (o th er th an samp les o r p erso nal lu ggage), c) Organiz ed racing, d )
P ace mak ing, e ) S p eed testing, f) R eliab ility T rials, g ) A ny p u rp o se in co nnectio n with M o to r T rad e. Pers o ns o r C las s o f Pers o ns entitled to d riv e: A ny p erso n inclu d ing th e insu red , p ro v id ed th at a
p erso n d riv ing h o ld s an effectiv e d riv ing license at th e time o f th e accid ent and is no t d isq u alified fro m h o ld ing o r o b taining su ch a license. P ro v id ed also th at th e p erso n h o ld ing an effectiv e learner`s license
may also d riv e th e v eh icle and th at su ch a p erso n satisfies th e req u irements o f R u le 3 o f th e C entral M o to r V eh icles R u les, 1 9 8 9 . L imits o f L iab ility 1 . U nd er S ectio n II-1 (i) o f th e p o licy - Death o f o r
aa7 5 0000 3 . P . A . C o v er
b o d ily inju ry - S u ch amo u nt as is necessary to meet th e req u irements o f th e M o to r V eh icles A ct, 1 9 8 8 . 2 . U nd er S ectio n II - 1 (ii) o f th e p o licy -Damage to T h ird P arty P ro p erty u nd er S ectio n III fo r Owner - Driv er(C S I): aa2 00000T erms , C o nd itio ns & E x c lus io ns : A s p er th e Ind ian M o to r T ariff. A p erso nal co p y o f th e same is av ailab le free o f co st o n req u est & th e same is
also av ailab le at o u r web site.
I / W e h ereb y certify th at th e p o licy to wh ich th e certificate relates as well as th e certificate o f insu rance are issu ed in acco rd ance with th e p ro v isio n o f ch ap ter X , X I o f M . V .A ct l9 8 8 .''T h e stamp d u ty
o faa.5 0 p aid b y Demand Draft, v id e R eceip t/C h allan no 4 01 7 8 d ated 02 /1 2 /2 01 1 a s p rescrib ed in G o v ernment N o tificatio n R ev enu e and F o rest Dep artment N o M u d rank 2 004 /4 1 2 5 /C R 6 9 0/M -1 , d ated
3 1 /1 2 /2 004 .'' S erv ice T ax R egistratio n N o .: A A BC H 07 3 8 E S T 004 . IM POR T A N T N OT IC E : T h e Insu red is no t ind emnified if th e v eh icle is u sed o r d riv en o th erwise th an in acco rd ance with th is S ch ed u le. A ny
p ay ment mad e b y th e C o mp any b y reaso n o f wid er terms ap p earing in th e C ertificate in o rd er to co mp ly with th e M o to r V eh icle A ct, 1 9 8 8 i s reco v erab le fro m th e Insu red . S ee th e clau se h ead ed
''A V OIDA N C E OF C E R T A IN T E R M S A N D R IG H T OF R E C OV E R Y .'' Dis c laimer: T h e P o licy sh all b e v o id fro m incep tio n if th e p remiu m ch eq u e is no t realiz ed . In th e ev ent o f misrep resentatio n, frau d o r
no n-d isclo su re o f material fact, th e C o mp any reserv es th e righ t to cancel th e P o licy fro m incep tio n.

Policy Issuing Office:Mumbai

ForHDFC ERGO GeneralInsurance Company Ltd.

Dul
y Consti
tuted Attorney

C o rp o rate Off.: 6 th F lo o r, L eela Bu siness P ark , A nd h eri-K u rla R o ad , A nd h eri(E ), M u mb ai 4 00 05 9 . T o ll-F ree N o .1 8 0 0 -2 -7 0 0 -7 0 0 F ax 9 1 2 2 6 6 3 8 3 6 9 9 c are@ h d fc ergo .c o m www.h d fc ergo .c o m
R egistered Off.: R amo n H o u se, H .T .P arek h M arg, 1 6 9 , Back b ay R eclamatio n, M u mb ai 4 00 02 0, Ind ia.

Frequently Asked Questions (FAQs) - MOTOR INSURANCE


Loss or Damage to the Insured Vehicle caused due to:
a) Fire, explosion, self ignition or lightning.
b) Burglary, housebreaking or theft
c) All act of God perils like earthquake, flood, cyclone etc
d) Accidental external means, terrorism, riot and strike

W HAT ARE THE MAJOR COVERS OF THE POLICY?


Personal Accident Cover:
Liability to Third Parties:
The policy provides for mandatory Personal Accident cover for
Provides cover for any legal liability arising out of
owner driver and optional cover for passengers covering
the use of the vehicle for:
accidental death and permanent total disability.
a) Accidental death / injury to any third party
b) Any damage to property owned by third party

W HAT ARE THE MAJOR EXCLUSIONS IN THE POLICY?


a) General aging, wear & tear, mechanical or electrical breakdown, failure, depreciation,
any consequential loss
b) Damage by a person driving without a valid license
c) Damage by a person driving under the influence of liquor or drugs
d) Loss/damage attributable to war, mutiny, nuclear risks
e) Damage to tyres and tubes, unless damaged during an accident
f) Usage on hire & reward (applicable for all classes expect public commercial vehicles)

g) Loss or damage to bonnet side parts, mudguard, bumpers, lamps, tyres, tubes,
headlights, paint work (applicable for all commercial vehicles; unless opted additionally)
h) Loss or damage resulting from overturning arising out of operation as a tool
(applicable for mobile cranes, drilling rigs, mobile plants, navvies, shovels, grabs,
rippers unless opted for additionally)
i) Loss of or damage to accessories by burglary housebreaking or theft unless the
vehicle is stolen at the same time (applicable to all commercial vehicles & two wheelers)

W HAT DO I DO IN CASE OF A CLAIM?


1. DETAILS TO K EEP HANDY W HILE REGISTERING A CLAIM
a) Policy No.
b) Registration details / RC copy
c) Drivers details at the time of accident including driving license number
d) FIR on a case to case basis
e) Repair estimate
2. HOW DO I FILE A CLAIM?
For Accidental Damage to Insured Vehicle (Own Damage Claims):
a) Call our customer care Toll-free 1800-2-700-700 if the vehicle meets with an accident
b) Provide your policy number for reference and register the claim
c) If your vehicle can be driven, take it to the nearest dealer / garage
d) Get a repair estimate,fill up the claim form and attach a copy of the registration
Certificate driving license ofthe person driving at thetimeof the accident
e) If the garage is within our network, you could avail of cashless claim facility. Pay for non
accident related repairs, depreciation and deductible. We would settle the rest.
f) If the garage is outside our network, you would have to get the claim reimbursed
subsequently.
g) Sign the repairers satisfaction voucher and drive off!
4 . CLAIMS DOCUMENTS: IN CASE OF LOSS DUE TO THEFT
a) Duly filled and signed claim form & discharge voucher ( after loss settlement )
b) Original Registration Certificate (RC)
c) Original policy copy
d) Copy of FIR lodged at the nearest police station
e) All original keys & vehicle invoice copy
f) No trace report confirming that the stolen vehicle is not traceable

3. CLAIMS DOCUMENTS - IN CASE OF ACCIDENTAL DAMAGE TO INSURED


VEHICLE
a) Duly filled and signed claim form & satisfaction voucher
b) Registration Certificate (RC)
c) Driving license of the person driving at the time of the accident
d) Policy copy , original repair estimate, repair invoice
e) Payment receipt for non-cashless claims
f) Original repair invoice for cashless claims
g) AML documents for amount more than 1 lac (PAN card, 2 passport size photo,
residence proof).
h) Form 35 & original NOC from financer incase of total loss where payment is made
to insured.
i) A copy of police FIR/panchnama is required for TP injury/death/property damage
Additional documents req uired for commercial vehicles:
a) Spot survey
b) Load challan
c) Fitness certificate
d) Route permit
g) Original NOC from financer incase of hypothecation / HPA
h) Intimation to RTO for theft of vehicle
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
k) AML documents for amount more than 1 lac (PAN card, 2 passport size photo,
residence proof).
l) Deed of subrogation cum indemnity on judicial stamp paper.

HOW DO I MAKE CHANGES IN MY POLICY (ENDORSEMENTS)?


1. Changes related to registration of vehicle or vehicle details like:

2. For addition of electrical and non electrical accessories/CNG & LPG K it:

a) Correction in registration number/ location / address


b) Correction in vehicle make & model / cubic capacity / seating capacity/ engine & chassis
number / year of manufacture

a) Request letter for the change


b) Policy copy
c) Invoice copy (mandatory where value of accessory exceeds
20,000/-)
d) Endorsed Registration Certificate Copy (For CNG/LPG kit)
e) Cheque for additional premium
Call us for additional premium details & send relevant documents copy to our corporate
office

Documents Required:
a) Request letter for the change b) Policy copy c) Registration Certificate copy
3. Documents req uired to change financier details
(Hypothecation/Lease/Hire-Purchase)

4 .Changes / Correction in Policy Holder's Name / Correspondence Address /


Contact Numbers / E-mail id / any other changes:

a) Request letter for the change


b) Policy copy
c) Endorsed Registration Certificate copy
d) NOC from financier (not mandatory for deletion if RC is endorsed)

E mail us at : care@hdfcergo.com OR
Call Toll-free: 1800 2 700 700 / 1800 226 226 OR
Fax your request at: 022 6638 3669

HOW DO I RENEW MY POLICY?


a) Visit www.hdfcergo.com to renew instantly online.
b) SMS " " RENEW < POLICY NO> " " to 9999 700700
c) Visit our nearest branch / your agent
d) Send a copy of the renewal notice along with premium cheque to our branch office /
Corporate office
e) Call our toll free number 1800 2 700 700 / 1800 226 226.

Manage Your Portfolio


@ hdfcergo.com /
Smartphones*

HOW TO CONTACT US?


Call Toll-free
Fax
E-Mail
Write to us at

View your policy details


Link multiple policies of yourself and your loved ones
Change your personal details on the go

:
:
:
:

1800 2 700 700 / 1800 226 226


022 6638 3669
care@hdfcergo.com
HDFC ERGO General Insurance Company Limited
6th floor, Leela Business Park, Andheri Kurla Road,
Andheri(East), Mumbai - 400 059

Track your claims online whenever the need arises


Raise service req uest / complaints & set renewal reminders
Information about branches, garages and hospitals

* supports smart phones based on Blackberry, iPhone, Android & Symbian platforms
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.

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