LIBERTY GENERAL INSURANCE LIMITED  

  TWO WHEELER PACKAGE POLICY
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization 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) In the event of misrepresentation, fraud or non-disclosure of material facts, the company reserves the right to cancel the policy from inception.
Policy Issuing Office 10th Floor, Tower A Peninsula Business Park, Ganpath Rao Kadam Marg Lower Parel MUMBAI MAHARASHTRA - 400013 Phone: +91 22 6700 1313
Fax: +91 22 6700 1606
Policy Servicing Office Office no.1, Alyssa, 1st Floor, Rear Portion, old no. 28 , new no. 23, Richmond Road, BANGALORE 560025 KARNATAKA PH: +91 80 67481313 FAX:
+91 0 0

 Period Of Insurance From 00:00Hrs of 16/04/2019

  To Midnight of 15/04/2020
 Policy Issued On  11/04/2019   
  Covernote No/Ecovernote No    
Policy No 2012-500201-18-7003159-00-001   Covernote Date    
Geographical Area India   RTO Location  BENGALURU  Zone:  Zone-A
Insured SANTHOSHA V . 
Address VABASANDRA VILLAGE LAKKONDANAHALLI POST HOSKOTE  UIN CODES LVG-MO-P13-25-V01-12-13 
TALUK    POSP Name:  
  562114 BANGALORE RURAL KARNATAKA   POSP Code:  
 
 Aadhaar Card/PAN:  /  
Contact Number (M) +919900602688  Customer ID  4103431055 
GSTIN No/State Name  NA/KARNATAKA   POSP Contact Number:  
     

 Agent Name   KHIVRAJ MOTORS 
 Agent Code  MIS1000132   Agent Contact No  9108694880 
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Year of Licensed Carrying capacity
Registration Mark & No. Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW
Manufacture including Driver
KA 53 EW 6691  2018  M17193  M65403  BAJAJ/PULSAR 180/Solo with Pillion  180  2  
IDV (INSURED'S DECLARED VALUE)
Year IDV of Vehicle( ) Trailers( ) Side Car( ) Non Electrical Electrical/Electronic Bi Fuel kit (CNG/LPG)( Total Value ( )
Accessories( ) Accessories( ) )
1   66,688.00  0.00  0.00  0.00  0.00  0.00 / 0.00  66,688.00 
Section I - OWN DAMAGE (A) Section II - LIABILITY (B)
Own Damage Premium on vehicle and accessories Third Party Premium
Basic Cover Basic Cover
Basic OD   837.00 Basic TP   985.00
DISCOUNTS UNDER OWN DAMAGE SECTION PA Benefits
No claim bonus 20%   167.40 PA Owner Driver   375.00
TOTAL OWN-DAMAGE PREMIUM (A)   669.60 TOTAL LIABILITY PREMIUM (B)   1,360.00
Net Premium(A+B) Taxable Value   2,030.00
CGST(9% - KARNATAKA)   182.70
SGST(9% - KARNATAKA)   182.70
TOTAL POLICY PREMIUM   2,395.00
Hire Purchase/ Lease /Hypothecated with BAJAJ FINANCE LTD-bangalore
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
  DRIVERS CLAUSE
Persons or Classes of Person entitled to drive: 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 Vehicle Rules, 1989.
  LIMITS OF LIABILITY
Deductible Compulsory Deductible: Rs 100/-, Under Section II-I such amount necessary Under Section II-I 100,000.00  P.A. cover for 1500000 
under Voluntary Deductible: Rs 0/-, (i) of the policy to meet the (ii) of the policy owner- Driver
section - I Imposed Excess : Rs 0 /-.   (Death of or bodily requirements of motor (Damage to third under section
injury): vehicle Act, 1988. party property) III : CSI
Subject to I.M.T Endorsement Nos. IMT 22,IMT 7  
  NOMINATION DETAILS

Name of the Nominee Relationship with Insured Name of Appointee (if nominee is minor) Relationship with the Nominee

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 11/04/2019  
Receipt No:   
In case of Claims, Please contact us at : Toll Free No - 18002665844,
 
email id - care@libertyinsurance.in
Date of Issue : 11/04/2019
 
Place            : Mumbai

Consolidated Stamp duty has been paid as per letter of Authorization no. dated issued by
Main Stamp Office, Mumbai. For Liberty General Insurance Limited    
Invoice No. NA
Branch GSTIN No : 29AABCL9950A1ZH
SAC Code : ; Description of Service : General Insurance
Service; Place of Supply : KARNATAKA/29
IRDA Regn. No. 150
CIN No. U66000MH2010PLC209656
Tax is not payable under reverse charge by the recipient     
  Authorised Signatory    
 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.