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TATA MOTORS & LPK 2518 HD. 2018 3 5883 OPEN 25000
Insured's Declared Value(IDV)(Rs.) for Vehicle and Accessories (Acc. not included in Manufacturer's listed selling price) Licensed Carrying Capacity
(Passenger Carrier)
Vehicle Side Car Electrical Acc. CNG/LPG Non-Electrical Acc.
2730000 0 NA NA NA NA
Registration Number Place Of Registration Chassis Number Engine Number PUC Number PUC Center
HR 66 B 8181 HARYANA 22649 10149
Chassis Number
Registration Number (For Trailer) Trailer Type (Agriculture/Forestry) Number of Trailers Trailer IDV (Rs.)
(For Trailer)
NA NA NA NA NA
Depreciation Waiver NA Daily Cash Allowance NA Key Replacement
Return to Invoice Accidental Hosp. Road Side Assistance
Add on Covers
Driving Train Protect Hydrostic lock cover Cost of consumables Secure Towing
Road Side Assistance Freedom Engine Protector NCB Protector
Additional risk, if any: Premium Details Amount(Rs.)
Financier's Name: CITI BANK Basic Own Damage(OD) Premium 36488.00
Financier's Address: . Add: IMT23 5473.00
State if the vehicle is under: Hire Purchase Lease Agreement Hypothecation Total Basic Own Damage 41961.00
Form "52"(India), Rule 142(I) of Motor Vehicle Rules, 1989 Less: De Tariff Discount 20183.00
Insured's Name: SHIKOPUR STONE CRUSHER COMPANY Basic OD after Discount 21778.00
Address Line 1: VPO- SHIKOPUR Less: No claim Bonus(20%) 4356.00
Sum: Total OD(A) 17422.00
Address Line 2: .
Liability Premium 17476.00
City/ District: GURGAON Mobile Number 9811111111
Legal Liability to
Area/ Village: GURGAON Phone Number - Add: 100.00
Cleaner/Conductor/Coolies
State: HARYANA Email Address NA
Add: LL-Paid Driver 50.00
Pin Code: 122001 GST Number NA
Sum: Total Cover Liability(C) 150.00
Nominee Name:
Sum: Total Liability(B) 17626.00
Relationship With Proposer:
Policy Duration: 1 Year Premium(A+C) 17572.00 Basic TP 17476.00
From: 08/08/2019 Time: 00:01 AM IGST(18%) 3162.96 IGST(12%) 2097.12
Period of
Insurance: CGST(9%) 0.00 CGST(6%) 0.00
To Midnight of: 07/08/2020
SGST(9%) 0.00 SGST(6%) 0.00
Payment Mode Instrument Date of Name of Bank drawn
Amount(Rs.) TOTAL
(DD/ Cheque/ EFT, Others) Number Issuance on TOTAL OD(E) 20734.96 19573.12
ORIENTAL BANK OF TP(F)
CHEQUE 45625 03/08/2019 40308.00 Premium Payable (E + F) 40308.00
COMMERCE
SpecialCondition:
NA
Warranty:
Warranted that the Assured named herein/owner of the vehicle insured holds a valid Pollution Under Control (PUC) Certificate on the date of
commencement of the Policy and renews and maintains valid and effective PUC Certificate during the duration of the Policy period. If the PUC is
not found valid on the date of loss, the company shall repudiate the OD claim made under the Policy.
Driver Clause:
Any Person including 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 when not used for the transport of passengers/goods at the time of the accident and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules,1989
Limitations As To Use(Package Policy)
1.Goods Carrying Vehicles/Miscellaneous&Special type of Vehicles/Passenger Carrying Vehicles:
The Policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or such a carriage falling under Sub-
section(3)of Section 66 of Motor Vehicles Act,1988. The Policy does not cover use for;a)Organised racing,b)Pace
making,c)Reliability trials,d)Speed testing,e)Use whilst drawing a trailer except the towing(other than for reward)of any one
disabled Mechanically propelled vehicle.
2.Private Cars/Two Wheelers:
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)Organized racing,d)Pace making,e)Speed testing,f)Reliability trials,g)Any purpose in connection with
Motor Trade.