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Royal Sundaram General Insurance Co. Limited
No. 176 DandE, Trivandrum Road, Tirunelveli - 627003, Tamil Nadu (State Code-33)
Ph: - Helpdesk No: 18604250000
GSTIN: 33AABCR7106G1ZQ
CERTIFICATE CUM INSURANCE POLICY SCHEDULE CUM PAYMENT RECEIPT
Policy No. Private Car Package Policy Issued at: 16:59 Hours on 30/04/2021 [UIN : ] Proposal No. & Date
HOP0728472 Period of Insurance OD: 17/05/2021 (00:00 Hrs) To 16/05/2022 (Midnight) P16761232, 30/04/2021
Insured's Name MR. NANGAMUTHU D GSTIN Previous Policy No.
Insured's Address 5/226,A-25, KUMARASAMY NAGAR 1ST STREET, MUTHIAPURAM(POST), TUTICORIN NA HOP0702628
TUTICORIN - 628005 Tamil Nadu (State Code-33)
Chassis No. Engine No. Model CC Body Color Body Type Previous Insurer
MAKDD173DEN201810 L12B33022396 BRIO/1.2 VX MT 1198 NA Hatchback Royal Sundaram
Geographical Area Date of First Sale Mfg. Year Place of Fuel Type Registration No.
India 17/05/2014 2014 Seating Cap. Registration Petrol TN 69 AL 3344
5 Tuticorin
INSURED'S DECLARED VALUE (Rs.)
Vehicle: 227588 Electrical Accessories: 0 Non Electrical Accessories: 0 Bi Fuel Kit: NA Total IDV: 227588
SCHEDULE OF PREMIUM
[Link] Damage Premium Amount (Rs.) B. Liability Premium Amount (Rs.)
Basic Premium Third Party Liability
Vehicle 4194 Basic Third Party Liability Premium including TPPD 3221
Non Electrical Accessories 0 Sub Total (Third Party Liability) 3221
Electrical Accessories (IMT–24) 0 PA Cover
Compulsory PA Cover for Owner Driver
Bi Fuel kit (IMT–25) 0 325
Nominee: [Link] (WIFE) (58Years)
Basic Premium Total 4194 Optional PA cover for Paid Driver (IMT–17) 100
Add Geographical Area Ext. (IMT–1) 0 Optional PA Cover (200000 Per Person) for 5 Persons (IMT–16) 500
Sub Total 4194 Sub Total (PA Cover) 925
Deductibles Legal Liability
Voluntary Deductibles (IMT-22A) 0 Paid Driver (IMT–28) 50
Anti Theft Device (IMT–10) 105 Employees (for 0 persons) (IMT–29) 0
AA Membership (IMT–8) 0 Sub Total (Legal Liability) 50
Geographical Area Ext.(TP) 0
Handicap (0%) 0
NCB (0%) 0
Sub Total (Deductibles) 105
Add-Ons 0
Net Own Damage Premium(A) 4089 Net Liability Premium(B) 4196
Note:- Total Premium (A + B) 8285
1. Issue of Policy is subject to realisation of cheque if premium is paid by cheque. SGST(9%) 746
2. Consolidated stamp duty paid to State Exchequer. CGST(9%) 746
3. The Policy is subject to a compulsary deductible of Rs. 1000 (IMT–22) Gross Premium Paid 9777
CPA Insurer Name:NA, Valid From:NA, Valid To:NA, CPA Sum Assured:NA,
Limitations as to use: The Policy covers use of the vehicle for any purpose other than: (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organised
Racing (4) Pace Making (5) Speed Testing (6) Reliability Trials (7) Any purpose in connection with motor trade.
Driver's Clause: Any person including the Insured: Provided that the person driving holds an effective and valid 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 & that such a person satisfies the requirements of Rule 3
of the Central Motor Vehicles Rules, 1989.
Limits of Liability: Limit of the amount of the Company's Liability Under Section II-1 (i) in respect of any one accident: as per motor vehicles act, 1988. Limit of the amount of the
Company's Liability Under Section II–1 (ii) in respect of any one claim or series of claims arising out of one event: UPTO Rs. 7,50,000.
Cover Under Section III for Owner-Driver is Rs. 15 lakhs.
No Claim Bonus: 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-20%, Preceding
two consecutive years-25%, Preceding three consecutive years-35%, Preceding four consecutive years-45%, Preceding five consecutive years-50% of NCB on OD Premium. No Claim
Bonus only be allowed provided the policy is renewed with in 90 days of the expiry date of the previous policy.
HP/Lease/Hypothecation with: -- You agree to receive the policy document (without enclosing the terms & conditions of policy)
Subject to I.M.T Endt. Nos. & memorandum: 10,16,17,22,28 printed herein. from the company and you authorise the company to display Terms & Conditions of the policy
on its website that enables access by you.
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 reasons 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.
[Link] 30-04-2021
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SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply: Tamil Nadu (State Code-33), Invoice Number: HOP0728472, Payment Receipt No:
HOP0728472, Payment mode: Cash
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.
For & On Behalf of
Royal Sundaram General Insurance Co. Limited
Broker Name: SMC Insurance Brokers Pvt. Ltd.
Broker Code: 289
Broker Contact No.:1800 2666 2666
Authorised Signatory
Claim Assistance Number:
MISP Code: 171000147, MISP Name: ANTON MOTOCORP PVT LTD
1800 2666 2666
For Renewal Please Contact : SOUTHERN HONDA, ANTON MOTOCORP PVT LTD, [Link]. 13/1, TUCKERAMMAL PURAM, NAGERCOIL MAIN ROAD, Tirunelveli - 627007, Tamil Nadu, Ph:
STD-
[Link] 30-04-2021