CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE

1
POS - Goods Carrying Vehicles Package Policy
Product Code: 3003 UIN: IRDAN115P0013V01200203

Insured Name : NANDLAL YADAV Policy No : 3003/200336445/00/B00

Address : S/O MAKARDHWAJ SINGH, R/O CHIUTAHA PALIYA Period of Insurance : Jun 10, 2020 16:12 to
DILDARNAGAR, GHAZIPUR, GHAZIPUR, UTTAR PRADESH Midnight of Jun 09, 2021
233001
Telephone No : - Mobile No: 7559416997 E-Policy No :
Email Address : IZONEGZP@[Link] Policy Issued On : Jul 15, 2020
Nominee Name : - Named Passenger's Nominee: Covernote No : 200336445
Relationship : - - RTO Location : UTTAR PRADESH-GHAZIPUR
Age : - Hypothecated To : MAGMA FINCORP LTD,GHAZIPUR
GSTIN Number (Customer) : Vehicle Class : Public Carrier
Servicing Branch Name : Lucknow Category :
Invoice Number : 100620209414
Servicing Branch Address : Chamber I Fourth Eldeco Corporate Gomti Nagar Lucknow Uttar Pradesh 226024
Registration No. Make Vehicle Model Model Build Type of GVW Mfg Yr Carrying Chassis No. Engine No. Trailer Chassis
SubClass Body Capacity No.
TATA PARTIALLY MB1NACHD3H
UP61AT0721 TRUCKS LPT 3718 Open 42000 2017 3 HJPZ144904 0
MOTORS BUILT PJB1807
Body IDV Chassis IDV Trailer Electrical / Electronic Accessories Non Electrical Accessories CNG / LPG Unit Total IDV
(`) (`) (`) (`) (`) (`) (`)
281261 1868739 0 0 0 0 2150000

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 11452 Basic Third Party Liability 41561
IMT-23 Loading 1695 Total 41561
Sub Total 13147 Add:
Legal Liability to Paid Driver 50
Legal Liability for Cleaner/Conductor 100
Sub-Total 150
Total Own Damage Premium(A) 13147 Total Liability Premium(B) 41711
Total Package Premium (A+B) 54858 415
Premium Taxable @ 12% (Basic TP Liability) 41561
- CGST @ 6% 2493.66
- SGST @ 6% 2493.66
Premium Taxable @ 18% (Other than Basic TP Liability) 13297.00
CGST @ 9% 1196.73
- SGST @ 9% 1196.73

Total Tax Payable in ` 7381

Total Premium Payable in ` 62239

Geographical Area: India Applicable IMT Clauses: 7 , 23

Compulsory Deductible: ` 1500 Voluntary Deductible: ` 0

Premium Collection No. 1114736276 Premium Amount ` 62239 Receipt Date 09-06-2020
GSTIN [Link] 09AAACI7904G1ZL HSN/SAC code 9971 / GENERAL INSURANCE SERVICES

Limits of Liability: (a) Under Section II-I(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-I(ii) of the policy: Damage to Third Party Property ` 750000/-; PA Cover for Owner-Driver under Section III: CSI ` 0/-. The Compulsory Personal Accident
cover has not been opted in this policy on account that, the Owner driver has a separate existing Personal Accident cover against Death and Permanent Disability (Total
and Partial) for Sum Insured of at least Rs.15 lacs. Limitations as to Use: The Policy covers use only under a permit within the meaning of the Motor Vehicles Act,1988 or
such a carriage falling under sub section(3) of Section 66 of the Motor Vehicles Act,1988. The policy does not cover 1) Use for organised racing, pace making, reliability
trails or speed testing, 2) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled mechanically propelled vehicle 3) Use of carrying
passengers in the vehicles; except employees(other than the driver) not exceeding the number permitted in the registration document and coming under the purview of
Workmens's Compensation Act, 1923. Driver's Clause: 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. 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 i s recoverable from the insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For
Legal interpretation, English version will hold good. Disclaimer: Please visit [Link] for the policy wordings, for complete details on terms and conditions
governing the coverage and NCB. This document i s to be read with the policy wordings. The policy is valid subject to realization of cheque. We accept premium only via
legally recognized modes. In case of dishonour of premium cheque, the company shall not be liable under the policy and the policy shall be void ab-initio. In case of any
discrepancy with respect to the policy, please revert within 15 days from the policy start date. This policy is underwritten on the basis of the information provided by you
and as detailed in the Risk Assumption Letter shared with you along with the policy. On renewal, the benefits provided under the policy and/or terms and conditions of the
policy including premium rate may be subject to change. Grievance Redressal: For resolution of any query or grievance you may contact us on our toll free no. 1800 2666,
or visit any of our branch offices. You can also write to us at customersupport@[Link]. For detailed grievance redressal mechanism please visit the "Grievance
Redressal" section on our website [Link].
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 M.V. Act, 1988. In witness whereof, this Policy has been signed at Mumbai on Jul 15, 2020 in lieu of Covernote no. 200336445. The stamp duty of ` 0.5 paid
vide deface no. CSD356202011872020 dated Mar 17, 2020.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
CORP/SUP/OPI/2014/1777

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