Policy Number : P0024200028/4102/105242

DEVELOPMENT HOUSE, 24 Park Street , Kolkata -700016

In case of any query, assistance or claims, please contact us at 1800 266 3202
UIN: IRDAN149RP0002V02201213

TWO WHEELER PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE /TAX INVOICE
Policy Servicing Office 2ND FLOOR, F FORT, SOUTH SARANIA ,ULUBARI, G S ROAD, GUWAHATI, ASSAM ,KAMRUP -781007 ,ASSAM , PH: (1800) 2663202
Policy No P0025400039/4101/100640
Insured CENT PLY
Address M/S: A DIVN CENTURY PLYBORD, PALASBARI Period Of Insurance 07:02 Hrs of 28/10/2024
KAMRUP To Midnight of 27/10/2025
ASSAM 78128 Agent No.: BRC0000157
Mobile:9365000936 Email ID: support@[Link]
Contact Number Toll Free No.: 18002660101
Email ID: CENYPLY128@[Link]
GST Number Unregistered
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & No. & RTA
Year of Manufacture Engine No. Chassis No. Make/Model/Type of Body CUBIC CAPACITY SEATING CAPACITY
Location
AS 01 AQ 0052 / MAHINDRA/BOLERO SLX
2010 71666 82461 2523 7
GUWAHATI
IDV (INSURED'S DECLARED VALUE)
IDV of Vehicle Non Electrical Accessories Electrical/electronic Accessories Bi-Fuel kit(LPG/CNG) Other accessories Total Value
58800 0 0 0/0 0 58800
OWN DAMAGE(A) LIABILITY(B)

Basic OD 492.74 Basic TP 714.00

Sub Total 492.74 Sub Total 5714.00

Less:
No claim bonus 50% 246.37
Sub-Total Deductions 246.37
Total Own Damage Premium(A) 246.00
Total Liability Premium(B) 5714.00
Premium Computation
Total Package Premium(A+B) 960.00
CGST @ 9% 286.40

SGST @ 9% 286.40
TOTAL 6,133.00

LIMITATIONS AS TO USE - The Policy covers use of the vehicle for any purpose other than a) Hire or Reward b)Carriage of goods (other than samples or personal luggage) c)Organized racing d)Pace
making e)Speed testing f) Reliability Trials g)Use in connection with Motor Trade
Driver 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 [Link] also that the person holding an effective Learner's license
Clause : may also drive the vehicle 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. 100000/- Under PA Owner – Driver as per
Section I policy Section II-I accident -- As per Motor Section II-I in respect of any one claim or series of claims Section III: premium computation table
Compulsory : Rs. 100/- Voluntary : Rs. 0/- Imposed : Rs. 0/- (i) Vehicle Act (ii) arising out of one event.
Total : Rs. 100/-
Subject to I.M.T Endorsement Nos. IMT 22
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 Percentage
Suchil Kalita 26/03/1990 33 100
Date of Signature of proposal 28/11/2023
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/200028/24/100701496- 28/11/2023 , 1133
Premium Amount in Word's ( ) :- One Thousand One Hundred Thirty-Three Only
For Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1800 266 3202

Date of Issue : 28/11/2023

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. 1879, dated 16.10.2023
GST Number of MHDI - 18AAGCM1685C1ZI
GST Invoice Number - POL1811240001494
Accounting Code for Service - 997134, Motor vehicle insurance services

Place of Supply:ASSAM ( 18 )
Authorised Signatory
Whether Tax is payable on Reverse Charge - No
UIN : IRDAN149RP0002V02201213
This is a valid Tax invoice in terms of Sub-rule 2 of Rule 54 of CGST Rule 2017. Further, being an Insurance Company, issuing of e-invoice and QR Code
are not applicable on us in terms of Notification No 13 and 14 of 2020 dated 21st March 2020 issued from Central Board of Indirect Taxes and Customs.
I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover
notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
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 be good. Please note that any
misrepresentation, non disclosure or withholding of material facts will lead to cancellation of policy ab initio with forfeiture of premium and non consideration of claim, if any.

As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 31st October of the next financial year.
For Complete details of coverage , terms, conditions & exclusion please refer the standard policy wording attached with this schedule

IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
3) This document is digitally signed, hence counter signature / stamp is not required.
4) For detailed terms & conditions please refer our website [Link]