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National Insurance Company Limited Head Office:3, Middleton Street,Kolkata-700 071 Website:www.nationalinsuranceindia.

com Private Car Package Policy CERTIFICATE CUM POLICY SCHEDULE Certificate cum Policy No: 25331031116100034146

Policy Issuing Office Code Broker Code Broker Telephone No Period of Insurance Insured Name Insured Address
Hypothecated With Registration Number NEW Vehicle's ExShowroom Price IDV 168110 Trailer Registration Number NA

Tata Pcbu,Department Of Motor Tie-Up Business,Royal Insurance Building , 2nd Floor,14, J. Tata Road,Churchgate Mumbai Mumbai Maharashtra-400038 Telephone : 22841119 TATA MOTORS INSURANCE BROKING & ADVISORY SERVICES 913750 Broker Name LTD. 91 Intermediary Code 201084662385 RTO Location MATHURA From 16:11 06/10/2011 To 05/10/2012 Midnight HARPRITI Policy Issued On 06/10/2011 W/O ROOP SINGH R\O ARMY GARDEN KRISHNA NAGAR,MATHURA,MATHURA,UTTAR PRADESH, PIN - 281006 , Mobile - 9410810789 TATA MOTORS FINANCE LTD. AGRA 253310 Policy Issuing Office Address
Make TATA MOTORS Non-Electrical Accessories 0 Model Type of body Built Additional Mfg Seating CC GVW Type GVW Year Capacity NA 624 935 0 2011 4 Chassis Number Trailer Chassis Number NA Engine Number

NANO CX - BS HATCHBACK IV Electrical/Electronic Accessories 0



Trailer 0

CNG/LPG Unit 0

Retrofittings 0

Total Value 168,110.00

A: OD BASIC ADD : Electrical Acccessories IMT 24 Premium For CNG Kit IMT 25 Premium For LPG Kit Premium For Trailer Fibre Glass Tank Reliability Trials And Rallies Break in loading Geographical Extention Imt 1 For Embassy Vehicles IMT 19 ADD : Driving Tution Less : Discount For Anti Theft Device IMT 10 Handicapped Discount IMT 12 Less : Voluntary Excess (IMT-22A) Less : For Auto Association membership IMT 8 Less : Other Discounts Less : Limited To Own Premises IMT 13 Deduct NCB(-%) Gross (A) : Gross OD & TP : 4,492.00 Net Premium : 4,492.00

5,109.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,482.00 0.00 0.00 3,627.00 Service tax : 463.00

B: TP BASIC ADD : Premium For Trailer ADD : Premium For CNG Unit ADD : Premium For LPG Unit PA to Name Persons PA To Unnamed Passengers PA - Owner WC To Employee Geographical Extention For Soldier Accident Paid Driver PA Cover For Paid Drivers, Cleaners And Conductors(IMT-17) Employees Of Insured

740.00 0.00 0.00 0.00 0.00 0.00 100.00 0.00 0.00 0.00 25.00 0.00 0.00

Gross (B) : Stamp Duty : Net Amount payable

865.00 .50 4,955.00

Geographical Area : India Compulsory deductibles : 500.00 Imposed Excess : 0.00 LIMITS OF LIABILITY : (a)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. (b)Under Section II - 1 (ii) of the policy -> Damage to Third Party Property Rs 750,000.00 ; PA Cover for Owner-Driver under section III: CSI Rs 2,00,000.00 ; Voluntary Deductable Rs. 0.00 LIMITATIONS AS TO USE: The policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of goods(other than samples or personal luggage), Organized racing, Pace making, Speed testing, Reliability trials,Any purpose in connection with Motor Trade. DRIVER'S CLAUSES: Any person including the insured : Provided that a person driving holds an 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. Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto : 7,22,28 Under Hire Purchase/Hypothecation/Lease Agreement with : TATA MOTORS FINANCE LTD. Premium Collection Details :- [Collection No / Amount / ReceiptDate] 1000540065 / Rs.4,955.00 / 06/10/2011 Received with thanks from HARPRITI an amount of Rs. 4,955.00 towards Insurance Premium. Consolidated Stamp Duty Paid. WARNING THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE , THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO' For National Insurance Company Limited I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X,XI of M.V.Act 1988 Service Tax Registration No. : AAACN9967EST099 Insurance Company PAN No. : AAACN9967E Service Tax Code Number : Duly Constituted Attorney(s) Category : Stampduty Challan No. : Dealer Name: ASHOK AUTO SALES LTD. (AGRA) . In Witness whereof this Policy has been signed at AGRA this 06day of October of 2011 , 04:15:45 PM. 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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For legal interpretation,English version will hold good Please call Toll Free No. 1800 209 7979 for all Insurance Related Assistance