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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
2311100002787104000
0 5050
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
nsurances@safdarj
ang.com
E M ail i
Phone
08/02/2013 Mi
dni
ght
To Date & Ti
me
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
Electrical Acc.
CNG/LPG Kit
Total IDV
35,525
188,618
35,525
Appointee
Premium Details ( )
T o tal B as ic Premium
L ess: N o C laim Bo nu s (5 0% )
T o tal - L es s
2168
2168
1 005
3172
327
2167
G eo grap h ic al A rea
2 3 1 1 1 00002 7 8 7 1 04 000
2 00000
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
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
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.
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.
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)
2. For addition of electrical and non electrical accessories/CNG & LPG K it:
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)
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
:
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* 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.