Policy Number: P0023200006/4103/106263

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

([Link])
IRDA REG NO. 149 DATED 22nd MAY,2012
CIN: U66000WB2009PLC136327
In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149RP0006V02201213
Date: 10/ 07/ 2025

To,
Mr. RAMANJANEYULU URUMUNDARI
S/O LINGAPPA H NO C 165 2-16
BHOOTHPUR MAKTHAL
MAHABUBNAGAR 509208
Mobile:9763047233

Agent/ Intermediary Name and Code: D2C INSURANCE BROKING PRIVATE LIMITED BRC0000329

Sub: Risk Assumption Letter

Dear Sir /Madam,

Thank you for choosing Magma- HDI General Insurance Company Limited as your preferred General Insurance Company. Please find enclos ed
Policy No. P0023200006/4103/106263, which has been issued based on the details furnished to us as below:
Insured & Vehicle Details

Name of Insured M r. R A M A N J A N E Y U L U U R U M U N D A R I

Period of Insurance 10/07/ 2025 TO 09/ 07/ 2026

Vehicle Make/Model MAHINDRA / BOLERO CAMPER SC XL 2WD BSII
RTO MAHABUBNAGAR
Vehicle Registration No. AP-31-TW-5696
Vehicle Registration Date 06/ 12/ 2010
Engine No. GHA1K54153
Chassis No. M A1ZN2GH KA 1K 63 94 5
Partial PA cover opted
Existing cover of Rs 0
Previous Policy Details
Previous Policy No 170122123340047736
Previous Policy Period 08/ 11/ 2023 TO 07/ 11/ 2024
Previous Year NCB% 50
Previous Insurer Name NIL
Previous Policy Type Package

The information provided above is based on the information received from you and accordingly, the proposal has been processed.
Coverage of risk is subject to realisation 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 dishonour or any other reason, the insurance cover shall be void ab- initio.
If you require any changes in the certificate of insurance cum policy schedule, you are requested to inform us by either writing to us at
customercare@[Link] or calling our toll free helpline on 1800 266 3202. Absence of any communication from you in this regard within a
period of 20 days of date of this letter, would mean that the issued policy is in order and as per your proposal. The Risk Assumption Letter is to be
read in conjunction with the policy and shall be considered as null and void without the same.

Thanking You,
Regards

For Magma HDI General Insurance Co Ltd.

Authorised Signatory

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 Policy Number: P0023200006/4103/106263

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149RP0006V02201213

COMMERCIAL VEHICLE PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
Policy Servicing Office OFFICE NO. 516 AND 517, 5TH FLOOR, NEELKANTH CORPORATE PARK, PLOT NO. 240, 2401/1-8, KIROL ROAD,VIDYAVIHAR (WEST) ,MUMBAI -400086 ,MAHARASHTRA , PH:
(1800) 2663202
Policy No P0023200006/4103/106263
Insured Mr. RAMANJANEYULU URUMUNDARI
Address S/O LINGAPPA
[Link] C 165 2-16 Period Of Insurance 00:00 Hrs of 10/07/2025
MAKTHAL To Midnight of 09/07/2026
MAHABUBNAGAR Agent No.: BRC0000329
TELANGANA 509208 Agent Contact No. 9810797219
Mobile:9763047233 Hypothecated With
Contact Number 9763047233
Email ID: SADARAJSHELAR@[Link]
GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & Trolley Year of
No. & RTA Location Trolley ChassisNo. Manufacture Engine No. Chassis No. Make/Model/Type of Body GVW POLICY CLASS SEATING CAPACITY
Serial ID
AP 31 TW 5696 / MAHINDRA / BOLERO Goods carriage
2010 GHA1K54153 MA1ZN2GHKA1K63945 2880 3
MAHABUBNAGAR CAMPER SC XL 2WD BSII
IDV (INSURED'S DECLARED VALUE)
Electrical/electronic
IDV of Chassis IDV of Body Trailers Non Electrical Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
302000 0 0 0 0/0 0 302000

OWN DAMAGE(A) LIABILITY(B)

Basic - OD 2,165.85 Basic - TP 15,313.00
Loss/damage to lamps/tyres/mud guards etc. - IMT-23 324.88 PA Owner Driver -SI Rs.1500000 Tenure 1 Year(s) 450.00
Sub Total 2,490.73 Under WC act-Driver/cleaner/employees-IMT 28 100.00
Total Own Damage Premium(A) 2,491.00 Sub Total 15,863.00
CGST @ 9% 224.19
SGST @ 9% 224.19
Total Liability Premium(B) 15,863.00
GST on TP Premium
CGST @ 6% 2,118.78
SGST @ 6% 2,118.78
GST on Other Liability Premium
CGST @ 9% 49.50
SGST @ 9% 49.50
Premium Computation
Total Package Premium(A+B) 17,354.00
TOTAL CGST 1,392.47
TOTAL SGST 1,392.47
TOTAL 18,139.00

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 Vehicle's Act 1988.
The Policy does not cover use for a) Organized 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 (only for Passenger Carrying Vehicles).
Persons or classes of
persons entitled to drive: Any person including Insured:
Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a [Link] also that the person holding
Goods carriage an effective learner's license may also drive the vehicle when not used for the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of
The Central Motor Vehicles Rules, 1989.
Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a [Link] also that the person holding
Non-transport Vehicles an effective learner's license may also drive the vehicle when not used for the transport of passengers 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 Excess in respect of each and every claim under Sec I of motor Under In respect of any one Under Damage to Third Party Property Rs. Under PA Owner – Driver as per
Section I policy Section II- accident -- As per Motor Section II- 750000/- in respect of any one claim or Section III: premium computation table
Compulsory : Rs. 1500/- Voluntary : Rs. 0/- Imposed : Rs. 0/- I (i) Vehicle Act I (ii) series of claims arising out of one event.
Total : Rs. 1500/-
Subject to I.M.T Endorsement Nos. IMT 21,IMT 23,IMT 28
Pollution Under Control(PUC)
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as applicable, on the date of commencement of the Policy and
undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of the Policy. Further, the Company reserves the right to take appropriate action in case of
any discrepancy in the PUC or fitness certificate at the time of issuance of policy.
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship Percentage
LINGAPPA 17/09/1959 68 FATHER 100
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.
Premium Collection Details :- [Collection No - ReceiptDate - Amount] : P/200006/23/100513046- 10/07/2025 , 18139
Premium Amount in Word's ( ) :- Eighteen Thousand One Hundred Thirty-Nine Only
In case of Claims, please contact us at 1800 266 3202 For Magma HDI General Insurance Co. Ltd.

Date of Issue : 10/07/2025

Place : Kolkata
Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 658, dated

GST Number of MHDI - 27AAGCM1685C1ZJ

GST Invoice Number - POL2709230021626
Accounting Code for Service - 997134, Motor vehicle insurance services

Place of Supply: MAHARASHTRA ( 27 )

Whether Tax is payable on Reverse Charge - No Authorised Signatory

UIN : IRDAN149RP0006V02201213

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