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IFFCO-TOKIO

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Servicing Office
FFCO TOKIO GEN INS CO LTD No. 28 (Old No. 195)
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North Usman Road T Nagar
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CHENNAI TAMILNADU
IFFCO-TOKIO GENERAL INSURANCE CO.LTD NDIA 600017
Royd Office IFFCO Sedan C1 DM. Centre, Saket New Delhi 110017 . 3
hone #: 04428144693
SCHEDULE
Corporate IdentlficaUon Number (CIN) Agent Name: -
91 DIRECT-1
4 U74899DL2000PLC 107621, IRDA Reg. No. 106 Agent #: 91001043
Agent Mobile #: NA
Insured s Name: K SURENDHAR Policy #: 1-DJJUXHF P400 Policy #: 30106481
Address: o 39b n n27b ambedkar street kodungaiyur Date of Issuance 14/03/201718:28:39
CHENNAI TAMILNADU Pin Code 600118 Period of Insurance From; 14/03/201
INDIA :28:32
To: Midnight On 13/03/2018 23:59:59
Phone #: Cover Note # Geographical Area: Within India Only

.—
Insured Motor Vehicle Details & Premium Calculation
j -
Type of Body l
Engine No , . I Seating
Registration Mark
No.
1
Year of Manuf.
r*
J
I
CC f Coverage IDV in Rs. I Non Elect Acc.
A17649 lI^ asRCper
Capacity

TN05Y 2229 2008


Make of Vehicle
h BAJAJ DISCOVER 135 1
135 Liability Only
1
1.00
| Non Electrical Accessories are not
covered as its value is 0
| Chassis No.
A99374
III I
Roglstratlon Authority
Vehicle StdeCar Accessories Elf. /Elect. Acc. -
Bi Fuel Kit Total Value Net Premium Rs.
1.00 0.00 0.00 0.00 000 1.00 769.35
A. Own Damage Premlum(Rs ) B. Third Party PremlumfRs.)
Basic Premium 0.00 Basic Premium
Side Car Premium 619.00
0.00 |Bi Fuel Kit (IMT 25) 0.00
Electrical Accessories (IMT 24 ) “
1
Accessories (IMT 33)
Fuel Kil (IMT 25)
0.00
0.00 "
A OwnerDriver CSI Rs 100000 50.00

*
Add:
0.00
Add:
Rallies (IMT 31) 0.00 Legal Liability to Drive (IMT 28) o.oo
Foreign Vehicle Loading (IMT 19) 0.00 *
Legal Liability to Employee (IMT 29) 0.00
Geographical Area Extension (IMT 1) 0.00 PA to Passenger (IMT 16)
Driving/Tuitions 0.00
0.00 Rallies (IMT 31) 0.00
Fiber Glass Fuel Tank
_ i. 0.00 jQeojyajJbical Area Extension (IMT 1)
. 0.00


.. .

•Additional Loading,,, f JBflL


. ess:
! Less:
> X V«r/:v^ V HNN( WNtMW0Mm
* »

Voluntary Excess Less 0% (IMT 22A)


Anti Theft Device (IMT 10)
Automobile Association (IMT 8)
I 0.00 Third Party Property Damage (IMT 20)
0.00 Limit of Liability Under Section ll l (ii)
0.00
- I 0.00

Handicap Discount (IMT 12) 0.00 I6


Vehicle Use (IMT 13) 0.00
No Claim Bonus Discount
im 0.00
Jo Claim Compensation Discount
' s
Any OShar Issding/Discount 0.0 % ) 0.00 __ Anf Other Loading Discount »
WC S
^* « W W'

-
:>ow

'tot (A) 1 0.00 Net (B) 669.00


Co-Insurance Details
, Agent No./Share |Total Premium (A + B) Rs. 669.00
-
Co Insurer 1 No Co-Insurer IService Tax/GST Rs. 100.35
Co-Insurer 2 |
1(93.66) +Swachh Bharat Cess(3.34) +Krishi Kalyan Cess(3.34)
-
No Co Insurer Premium Paid Rs. Rs. 769.35
Under Hire Purchase /Hypothecated/Lease Agreement with NA | Nominees: (DUMMY),
Subject to IMT Endorsement Nos.
. Printed here in / attached here to
Limitation To Use: Use only for social domestic and pleasure purpose arid for the insured's business or profession. The^

.
policy does not cover use for hire or reward, tution, racing, pace making reliability trails, speed testing, carriage of goods(other
than samples or personal luggage) in connection with any trade or business or use for any purpose in connection with Motors Trade . -
» Driver Clause: Any person including insured: provided that the person driving holds and 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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules,1989
The preceding year 20 % j Preceding two consecutive year 25% j Preceding three consecutive yea 35% - Preceding four consecutive year 45%
* Preceding five consecutive year 50%

No claim bonus will only be allowed, provided the policy is renewed within 90 days of the expiry date of the previous policy
Ptoaive noto that the atxive premium is likely to be changed with effect from 1.4.2016 in respect of Third Party section of the policy
as per IRDA guidelines as well as Sen/ice Tax. In case the premium rates and Service Tax are revised you are
requested to give the revised increased premium in order to avail the continuity of benefits under your Motor Insurance Policy.
Limit of Liability i Imposed Excess:
Under Section IM(I) tiudi amount trn is necessary to meet the requirements of the Motor Vehicles Act, 1988 Partial Loss:
-
Under Section ll lfil) As per premium ixxnputalion table Total Loss: 1
Under Section III PA Owner - Driver as per premium computation table : Voluntary Excess:
Compulsory Excess Compulsory Excess (IMT 22) Rs 100 :
Inspection Status
Inspection Date: Inspection Ref No:. Inspecting Agency :
The benefit under the policy will not be payable unless the policy is endorsed with proper registration No. of the vehicle within a maximum period of 7 days from the dale and
lime of the Registration of the vehicle.
Previous Policy No. Previous Insurer Name and Address
Expiry Previous Date
II
.
1’1/ we hereby certify that the policy to which the certificate related as well as the certificate of insurance are issued in accordance with provisions of Chapter X XI of
.
.
2."Warranted that in case of Dishonor of premium cheque This document stands automatically cancelled "AB-INITKr
3,’lmportant Notice: This insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this
MV act 1988"

schedule. Any payment made by the company by reason of wider terms appearing in the certificate in order to comply with
motor vehicle act 1988 is recoverable from the insured. See the clause headed 'avoidance of certain terms and right of recovery*
Receipt Particulars:
Pay Method Receipt Amount Instrument S Instrument Date
S.Tax.No AAAC17 S73HST001 .
CashPG Bank
760 00 IIC 25190070406 03/15/2017
Amount Received 768.00
For IFFCO-TOKIO General Insurance Co Ltd .

Authorised Signatory

Policy Wording for Two Wheelers -


Whereas the insured by a proposal and declaration dated as slated in the Schedule which shall be the basis of this contract and is deemed io be incorporated herein has applied to the Company for the insurance
hereinafter contained and has paid the premium mentioned
in the schedule as consideration for such insurance in respect of accidental toss or damage occurring during the period of insurance.

1) "Policy Issuing Office: Delhi", 2) "Consolidated Stamp Duty deposited as per the order of Government of National Capital Territory of Delhi
Page 1 of 3
Validity unknow FOR CLAIMS CALL 1800 103 5499(To!l Free),0124-4285499 or SMS"CLAIM" to 56161
"

Digitally signed by SUBRAT/


Date: 2017.03.15 10:34:21 IJ
Reason: Valid Policy Copy
Location: IFFCO Tokio Gene mmiurance Company Ltd India
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