Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.

Service Branch Address:

Old No : 113 & 114 , New No. 18 & 20 ,No.4B, 4th Floor, " A" Block, Mena Kampala Arcade,Sir Theyagaraya Road,[Link],X1-T Nagar
,CHENNAI - 600017.

Apr 04, 2021

Mrs.T AMBIKA
NO 27/1A VELAKANNI FLAT 1ST FLOOR
NEXT RENEWAL
NEW COLONY 1ST MAIN ROAD IS ON
PORUR
CHENNAI - 600116, TAMILNADU 04/04/2022
Telephone :
Mobile : 98xxxxxx21

Certificate of Insurance and Policy No. Policy Period: Period of insurance

VPC1449528000100 From 00:00:00 hours on 05/04/2021 To Midnight of 04/04/2022

Dear Customer,
Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are delighted to have you as our [Link] find enclosed
Private Car Policy No. VPC1449528000100 which has been issued based on the details mentioned below:
Name of the Insured: Mrs.T AMBIKA
Mobile No.: 98xxxxxx21 Email ID: muk*****************@[Link]
Make of the Vehicle: MARUTI UDYOG LTD. Model Description: Ritz ZXI
Engine No.: K12MN1010447 Chassis No.: MA3EDKD1S00132340
Premium Amount (Rs.) 6,480.56 Add-on Covers Opted : No
Previous Policy No. MD582884
Previous Policy Insurance Co. IFFCO
Based On your declaration on No claim being made in expiring policy, we have extended next slab of no claim discount in
your policy (20 %)
Does the vehicle have valid Pollution Under Control (PUC) Certificate: Yes
Pollution Certificate Number (PUC) :
PUC expiry date :
*In line with the Central Motor Vehicle Act, 1989 and as per the directive of Hon'ble Supreme Court of India, it is mandated that insured must
produce a valid "Pollution Under control" Certificate as and when asked by the insurer and it is the responsibility of the insured to renew the
same before expiry of the validity of the PUC certificate. Absence of Valid certificate may lead to cancellation of insurance
CPA Status
Opted – Coverage Sum Insured :1,500,000
The policy is processed based on the information declared by you. While the information regarding the vehicle, insured
(yourselves), detail of covers and terms/conditions could be ascertained from the Certificate of Insurance and Policy
Schedule (Enclosed), some of the very critical ones like No Claim Bonus extended, KYC Details, status of Compulsory
Personal Accident (CPA) Cover and details regarding Vehicle Inspection if any etc. are furnished above.
Coverage of risk is subject to realization of the full premium, post which, insurance coverage under the policy would
commence. In-case the premium is not received by us due to cheque dishonor or any other reason or misrepresentation of
any information, the insurance cover shall be void ab-initio.
Please check all the information printed in these pages for its correctness and should there be a discrepancy, reach us
(Contact details provided below) for suitable rectification. In case there is no response within 15 days of policy inception, it will
be deemed that all information provided are correct and all future transactions would be based on such information only.
The above information is to be read in conjunction with the policy certificate of issuance and policy schedule and shall be
considered null and void without the same.
To read the “policy” & “add on” terms, conditions, exceptions and applicable endorsement, please log on to our
website [Link]. Should you have any queries, please contact our Customer Service helpline number
1860-425-0000,1860-258-0000. You may also write to [Link]@[Link]

Assuring you of our best services at all times.

Yours sincerely,
Signature Not Verified
Digitally signed by TAIKAD
MAHADEVAN SHYAMSUNDER
Date: 2021.04.04 21:04:44 IST
Reason: For RoyalSundaram
Location: Chennai

Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
8165888fae39498fcbe85aadb74e4c29
Note: To download the claim form and to know more about Royal Sundaram products please log on to [Link]
For Motor Claim Intimations Call us first 1800 568 9999 (24/7 Tollfree)
Registered Office: 21, Patullos Road, Chennai - 600002 | IRDAI Reg. No.102 | CIN: U67200TN2000PLC045611
Customer Care 1860 425 0000,1860 258 0000 | Email: [Link]@[Link] | Visit: [Link]
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.

Service Branch Address:

Old No : 113 & 114 , New No. 18 & 20 ,No.4B, 4th Floor, " A" Block, Mena Kampala Arcade,Sir Theyagaraya Road,[Link],X1-T
Nagar ,CHENNAI - 600017.
Apr 04, 2021
Mrs.T AMBIKA
Intermediary Code: POS07857
NO 27/1A VELAKANNI FLAT 1ST FLOOR Intermediary Name: C Saravanan .
NEW COLONY 1ST MAIN ROAD
PORUR Contact: 9941116943
CHENNAI - 600116,TAMILNADU
Telephone:
Mobile: 98xxxxxx21

CERTIFICATE OF INSURANCE & POLICY SCHEDULE

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Package Policy
Certificate of Insurance and Policy No. Policy Period: Period of insurance
VPC1449528000100 From 00:00:00 hours on 05/04/2021 To Midnight of 04/04/2022

INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date

Mrs.T AMBIKA India CHENNAI 20/01/2010

INSURED'S DECLARED VALUE (IDV) (in Rs.)

Non Electrical / Value of For Life
For the For Total Loss Of Invoice
Electrical Electronic CNG/LPG Time Road
Vehicle Trailers IDV Baggage Price
Accessories Accessories Kit Tax
135,000 0 0 0 0 135,000 0 0 0
VEHICLE DETAILS
Registration Number TN22BH7420 Type of Body SALOON
Engine Number K12MN1010447 Cubic Capacity 1,197
Chassis Number MA3EDKD1S00132340 Year of Manufacture 2009
Make of the Vehicle MARUTI UDYOG LTD. Seating Capacity (including Driver) 5
Model Description Ritz ZXI Total Premium (in Rs.) 6,481
Persons or Classes of Persons entitled to Drive:
LIMITATIONS AS TO USE: Any person including the Insured
The Policy does not cover use for • Provided that a person driving holds an effective Driving Licence at
a) Hire or Reward b) Carriage of goods (other than samples or personal the time of the accident and is not disqualified from holding or
obtaining such a License.
luggage) • Provided also that the person holding an effective learner's license
c) Organized racing d) Pace Making e) Speed testing may also drive the vehicle when not used for the transport of goods
f ) Reliability Trials and any purpose in connection with motor trade at the time of the accident and that such a person satisfies the
requirements of Rule 3 of The Central Motor Vehicles Rules, 1989
LIMITS OF LIABILITY:
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.
Under Section II-1 (ii) of the Policy - Damage to Third Party Property - Rs 750,000 (as per IMT 20) - In respect of any one claim or series of claims
arising out of one event.
Personal Accident cover for Owner - Driver under section III: CSI - Rs.1,500,000\-

DEDUCTIBLE: Total deductible Rs. 1,000 in respect of each and every claim. (Compulsory Deductible [Rs.1,000], Voluntary
Deductible [Rs. 0], Imposed Deductible [Rs. 0] and Loss Of Baggage Deductible[Rs. 0] )

Document Code: RAGVSV999999 Certificate of insurance & policy schedule continued in Page 2
8165888fae39498fcbe85aadb74e4c29
Point of Sales Person Name : C Saravanan . Contact No : 9941116943
Aadhaar Card Number : 821111111251 PAN Number : GXSPS6655E

For Motor Claim Intimations Call us first 1800 568 9999 (24/7 Tollfree)
Registered Office: 21, Patullos Road, Chennai - 600002 | IRDAI Reg. No.102 | CIN: U67200TN2000PLC045611
Customer Care 1860 425 0000,1860 258 0000 | Email: [Link]@[Link] | Visit: [Link]
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.

CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Private Car Package Policy
Policy No.VPC1449528000100
Premium in Premium in
A - OWN DAMAGE B - LIABILITY
Rs. Rs.
1. Basic premium on Vehicle and Non-Electrical Accessories 2,382.00 1. Basic premium including premium for TPPD 3,221.00
2. Electrical & Electronic accessories @ 4%(IMT 24) 0.00 2. Less: For restricted TPPD cover for Rs.6000 (IMT 20) 0.00
3. Bi-Fuel kit (CNG/LPG) @ 4% (IMT 25) 0.00 3. Bi-Fuel kit (CNG/LPG) 0.00
4. Trailers (IMT30) 0.00
ADD: ADD:
4. Trailer 0.00 Personal Accident Benefits
5. Geographical Area [Link]-1 0.00 5. Under Section III (Owner Driver), CSI Rs.1,500,000 315.00
6. 30% for Imported vehicles without custom duty (IMT 19) 0.00 6. Geographical Area [Link]-1 0.00
7. Named Passengers, CSI Rs.0.00 each as per list
7. Fibre Glass Tanks 0.00 0.00
attached (IMT 15)
8. 60% on OD Premium for Driving Tution 0.00 8. Unnamed Passengers, CSI Rs.0 each (IMT 16) 0.00
9. Additional Towing Charges. Rs.0 0.00 9. PA Cover to Paid Driver, CSI Rs.0 (IMT 17) 0.00
10. For any Other extra 0.00 10. Enhanced PA cover , Owner Driver, CSI Rs.0 0.00
11. Enhanced PA cover, Named Passengers CSI Rs.
0.00
0.00 Each as per list attached
12. Enhanced PA cover, Unnamed Passengers, CSI Rs.
0.00
0.00
13. Enhanced PA cover, Paid Driver, CSI Rs.0.00 0.00
Less: ADD:
10. Discount for Anti-theft devices (IMT 10) 0.00 Legal Liability:
11. Automobile Association Discount (IMT 8) 0.00 10. To Paid Driver (IMT 28) 50.00
12. Voluntary Deductible(IRDAN102A0006V01200910)of Rs.0 0.00
11. To Paid Employees (IMT 29) 0.00
(IMT 22 A)
13. 50% Discount for Vehicles specially designed/modified
for blind,handicapped and mentally challenged persons 0.00 12. For any other extra 0.00
(IMT 12)
[Link] Car Discount (IMT 9) 0.00 13. TOTAL LIABILITY PREMIUM (B) 3,586.00
15. Deduct:20% No Claim Bonus -476.40 14. Add: Underwriting Loading % 0.00
16. Add: Underwriting Loading 0.00 15. NET PREMIUM (A + B) 5,492.00
Add: Additional Cover for Package Policies
17. Depreciation Waiver (IRDAN102A0011V02201213) 0.00
18. Windshield Glass (IRDAN102A0004V01200910) 0.00
19. Cash in Lieu of Spare Car ,Limit per [Link] (
0.00
IRDAN102A0007V01200910)
20. Full Invoice Price Insurance (IRDAN102A0008V01200910) 0.00 ADD: SGST 494.28
21. Life Time Road Tax (IRDAN102A0005V01200910) 0.00
22. Loss of Baggage (IRDAN102A0009V01200910) 0.00
23. NCB Protector Cover (IRDAN102A0002V01201314) 0.00 ADD: CGST 494.28
24. Engine Aggravation Cover(IRDAN102A0001V01201314) 0.00
25. Key Replacement Cover (IRDAN102A0001V01201516) 0.00
26. Tyre Cover Clause (IRDAN102A0003V01201718) 0.00
27. TOTAL OWN DAMAGE PREMIUM (A) 1,906.00 16. TOTAL PREMIUM PAYABLE 6,480.56
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous year. b) The insured is entitled for a No Claim Bonus (NCB)
on the Own Damage Section of the policy, if no claim is made or pending during the preceding year(s), as per the details given below:

Period of Insurance % of NCB on OD Premium Subject to IMT Endt. Nos. & Memorandum 28
(refer Terms & Conditions for relevant wording)
The preceding year 20 Under Hire Purchase/Lease Agreement /Hypothecated with
Preceding two consecutive years 25 Nominee Name Nominee Age Relationship with

Preceding three consecutive years 35

Guardian Name Guardian Age Guardian Relation
Preceding four consecutive years 45

Preceding five consecutive years 50 Date and Signature of Proposal/Renewal notice 04/04/2021

In Witness whereof this Policy has been signed at Chennai on 04/04/2021 , I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of
Insurance are issued in accordance with the provisions of Chapter X and Chapter XI of the Motor Vehicles Act, 1988.
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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE
OF CERTAIN TERMS AND RIGHT OF RECOVERY" under Policy Terms and Conditions.
For Royal Sundaram General Insurance Co. Limited

Signature Not Verified

Digitally signed by TAIKAD MAHADEVAN SHYAMSUNDER

Date: 2021.04.04 21:04:45 IST
Reason: For RoyalSundaram
Location: Chennai
Authorised Signatory
Consolidated Stamp Duty Paid to Govt of TamilNadu This document is digitally signed, hence counter signature / stamp is not required.
GSTIN : 33AABCR7106G1ZQ Base Product UIN: IRDAN102RP0004V02201617 PAN Number : AABCR7106G
For Legal interpretation, English version will hold good. Enhanced PA Cover Clause UIN: A0020V01201920
8165888fae39498fcbe85aadb74e4c29

For Motor Claim Intimations Call us first 1800 568 9999 (24/7 Tollfree)
Registered Office: 21, Patullos Road, Chennai - 600002 | IRDAI Reg. No.102 | CIN: U67200TN2000PLC045611
Customer Care 1860 425 0000,1860 258 0000 | Email: [Link]@[Link] | Visit: [Link]
Accident though unforeseen, it is painful. There cannot be a more distressful feeling on a trip, than having to forcefully wait and look
out for help or wonder what to do in case of a roadside mishap.
Royal Sundaram brings to you a 24X7 helpline and provide Roadside Accident Assistance service along with your Private Car
Package Policy without any additional cost.
In case of any roadside emergency, all you have to do is call us. Appropriate/possible assistance will be provided by the Service
Providing Company (SPC).
• The moment you call the SPC's 24 hr helpline, the call center swings into action. Within moments you will be on a conference call
with one of the nearest Authorised Service Providers (ASP's).
• The ASP will then assess the situation and reach you in the shortest possible time.
• Every situations is unique and hence suitable and possible assistance will be rendered
Please quote your policy number, vehicle number and contact details. Give your correct location with a land mark and inform the
executive with accurate details of your problem.
What is the reach time* at the time of emergency?
Within city limits - 60 minutes
Within state of national highways - 90 minutes
Ghat roads and other places - 120 minutes
*(Indicates the likely time taken for reaching the spot under normal circumstances)
Whether all types of vehicles are provided with this assistance?
Only private cars insured under the Private Car Package Policy with Royal Sundaram are provided.
What is to be done at the time of deficiency in service?
Adequate care has been taken to handle the situation professionally. In case of any deficiency in service, you can lodge a complaint at
the above mentioned number or mail us at [Link]@[Link] immediately.
Scope of cover for Roadside Accident Assistance

Scope of Service Facilitation Labo Parts / Cost Tow Cost

[Link]
Materials

1 Emergency Towing Assistance Accident

In the event of a user's vehicle meet with accident and he

/ she becomes immobilized while on the road, SPC will Free
assist the user by arranging for the vehicle towing service Free Free Actuals* NA upto50kms#(From the
to tow the vehicle to the nearest authorized/designated spot of accident)
garage of repairs.

2 Cab Service

If a user's vehicle breaks down and cannot be repaired on

the spot, SPC will assist the user by organizing cab as an Free NA NA Cab ChargesActuals* NA
alternate mode of transport.

3 Accommodation

If a user's vehicle is immobilized and cannot be repaired

on the spot, SPC will assist the user by organizing for a Fees Vehicle Owner to x
hotel accommodation nearest possible to the location of Free NA NA NA
and handle directly
the accident.

4 Legal Assistance
If a user's vehicle meets with an accident, SPC will assist
the user by providing legal assistance over the phone on
the dos and don'ts for handling the accident situation. Fees Vehicle Owner to x
Where ever, they can provide details of legal practioners Free NA NA NA
and handle directly
for legal assistance (If available), the same will be
extended.

*Actuals to be borne by the vehicle owner/Insured

#Difference if any between the actual and eligibility to be borne by the vehicle owner/Insured
Roadside Accident Assistance service is subject to availability at all places of India except Jammu Kashmir
and North Eastern States.

Sourced By

PR15169/NOV15 Insurance is the subject matter of solicitation

 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

GST Invoice
Royal Sundaram General Insurance Co. Limited
X1:X1-T Nagar
Address: Old No : 113 & 114 , New No. 18 & 20 ,No.4B, 4th Floor, " A" Block, Mena Kampala Arcade,Sir Theyagaraya
Road,[Link],X1-T Nagar ,CHENNAI - 600017.
GSTIN: 33AABCR7106G1ZQ

Policy Number : VPC1449528000100

GST Invoice Number : VPC144952800000
Invoice Date : 05/04/2021

Address of insured:
Insured Name: Mrs.T AMBIKA
NO 27/1A VELAKANNI FLAT 1ST FLOOR
NEW COLONY 1ST MAIN ROAD
PORUR
CHENNAI
State:TAMILNADU
Pincode: 600116

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable Premium 5,492.00

SGST 9.00% 494.28

CGST 9.00% 494.28

Gross Premium 6,480.56

Indication if tax payable under reverse charge - No

Note:“This document is digitally signed”

“This document is electronically [Link] document should be issued along with the Policy [Link] document stands
invalid,if issued separately”

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:[Link]@[Link] [Link]