Digitally signed by DS TATA AIG GENERAL INSURANCE COMPANY LIMITED

Date: 2020.05.30 15:59:48 IST

Reason: Digital sign
Location: Mumbai

Auto Secure - Private Car Package Policy

Date : 30/05/2020
Name : Mr Lakshmi Narayana rao Burgula
Your Policy Details
Address : 301 Lalithanjali apartments Near focus diagnostics
Policy Number : 0177790502
HYDERABAD 500082 TELANGANA
Policy Period : 00:00 Hrs on 07/06/2020 To midnight of 06/06/2021
Phone : 8885200235
Premium Paid : Rs. 16925

Dear Mr Lakshmi Narayana rao Burgula,

Welcome to Tata AIG General Insurance Company Limited’s family &

we thank you for choosing our Auto Secure - Private Car Package Policy
for your vehicle insurance.

We are enclosing Policy schedule cum certificate of insurance of your

vehicle.You are requested to visit our website www.tataaig.com for
policy wording.

Kindly go through the enclosed information/declaration provided by you

and in case your policy shows No Claim Bonus, for which you are not
entitled as explained above or any other error/discrepancy then we
request you to get in touch with us within 15 days of receipt of the policy
for correction otherwise all particulars will be deemed to be correct.

You may reach us at our 24*7 helpline 1800 266 7780 for providing any
information or in case you desire to have a printed copy of policy
wording.

We, thank you once again, for choosing Tata AIG General Insurance
Company Limited for insuring your vehicle. We assure you of our best of
services at all times. Happy driving!

Sincerely ,
For Tata AIG General Insurance Company Limited

Authorized Signatory

TATA AIG General Insurance Company Limited

Regd. Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400 013
IRDA Registration No.108, CIN No : U85110MH2000PLC128425,PAN: AABCT3518Q, UIN No.: IRDAN108RP0002V01200001,
Website : www.tataaig.com 24X7 Tollfree Helpline 1800-266-7780 Tolled No: 022-6693 9500 Fax: 022 6693 8170 E-mail: Customersupport@tataaig.com
Auto Secure - Private Car Package Policy

Certificate of Insurance and Policy Schedule form 51 of the Central Motor Vehicle Rules,1989

Agent/Broker/Producer Name: DIRECT SALES - E-BUSINESS

Agent/Broker License Code: 2; Agent/Broker Contact No.: 18002667780
Certificate & Policy No.: 0177790502 Policy Type: Auto Secure - Private Car Package Policy

Period of Insurance: From: 00:00 Hrs on 07/06/2020 Date of Expiry To Midnight of 06/06/2021

Insured Name & Address Premium (Incl. GST) Rs. 16925

Mr Lakshmi Narayana rao Burgula Insured Business/Profession OTHERS

301 Lalithanjali apartments Near focus diagnostics
HYDERABAD-500082 Geographical Area: INDIA
TELANGANA
Phones:8885200235
GSTIN: Registration Authority: HYDERABAD
Place of Supply:TELANGANA
State Code:36 HPA / Hyp / Lease to: N/A

Registration No. Make & Model Engine No. Chassis No. CC/KW Mfg.Year Body Type Seating Capacity

WVWB14605ET06432
TS-09-EA-0474 VOLKSWAGEN VENTO CBZF22939 1598 2014 SALOON 5
1

IDV of Vehicle IDV of trailers Bi-Fuel/CNG/LPG IDV of non-built-in Accessories ( ) Total Insured Declared
( ) ( ) kit( ) Electrical Non-Electrical Values(IDV)( )

1st Year 497545 0 0 5000 0 502545

SCHEDULE OF PREMIUM
A.Own Damage Rs B.LIABILITY Rs

Basic OD 5393.39 Basic TP 7890.0

Add: 4% on IDV of Electric and Electronic 200.0 One Year Compulsory PA Cover for Owner Driver 375.0
Accessories (IMT 24) Rs. 1500000 ( 1 year)
A. TOTAL OWN DAMAGE PREMIUM 5593 B. TOTAL LIABILITY PREMIUM 8265
Add: Emergency Transport and Hotel 110.0 COMPREHENSIVE PREMIUM(A+B+C) 14343.0
Expenses(TA10)
Any One Accident : Rs.5000 ADD : IGST @ 18.00% 2582.0
Any One Year : Rs.10000
Premium(Incl of GST) 14343.0
Add: Loss of Personal Belongings (Sum Insured : 110.0
Rs.10000) (TA09) Road Side Assistance 137
(Inclusive of 18.00 % GST )
Add: Key Replacement (Sum Insured : Rs.25000 265.0
per occurrence limit 50% of SI) (TA15) Total amount payable 17062.0

Add: Repair Glass / Fiber/plastic(TA08) 0.0

C. TOTAL ADD ON PREMIUM 485

Drivers Clause: Persons or classes of persons 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 Vehicles Rules, 1989.
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) Any purpose in connection with Motor Trade
Limits of Liability: I/we hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance
Under Section II-1(i) of policy (Death of or bodily injury): Such amount as is necessary to meet the are issued in accordance with provisions of Chapter X and XI of Motor Vehicles Act,1988.
requirements of the Motor Vehicles Act, 1988. In witness whereof this Policy has been signed at MUMBAI on 30/05/2020
Under Section II-1(ii) of policy (Third Party Property Damage) : Rs.7,50,000.00 Receipt (s):
Under Section III:One Year Compulsory PA Cover for Owner Driver RS 1500000
Nominee :Burgula Sai Ramakrishna Relationship: Son
Number of claims covered under Depreciation Reimbursement Cover : 2 The stamp duty of Rs.0.50 paid in cash or deman draft or by pay order, vide
Basis of claim settlement for Tyre Secure cover :NA Receipt/Challan no : CSD/172/2019/4546/19 dated the : 04/10/2019

This policy does not cover pre-existing damages as per Inspection photographs and Report
Deductible Under Section I:(Compulsory Deductible : to be 1000 for vehicles less than 1500 CC, 2000
for above 1500 CC, Voluntary Excess: Rs.0, Imposed Excess: Rs.0) Franchisee: Rs.NA For TATA AIG General Insurance Company limited
Depreciation Allowance: Rs.
Deductible under Engine Secure addon cover : NA
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(s), as follows: 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. NCB will only be Authorized Signatory
allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Subject to: A) IMT Endorsement No.:24
B. TATA AIG Auto Secure endorsement No.(TA): 10,09,15,08
GSTIN : 27AABCT3518Q1ZW-MAHARASHTRA

Service Accounting Code:ALL

Policy Servicing Office : Mumbai,A-6, 6th Floor, Trade World,Kamala Mills Compound, Senapati Bapat Marg,Lower Parel, Mumbai 400013, Tel NO:022-66382333, Fax NO:022-66382390
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 Vehicles Act, 1988 is
recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".
Note :You have consented to receive one page policy document. You are advised to go through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim
Bonus or any other material information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. 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. We will specifically seek confirmation on No Claim Bonus availed by you from your previous insurer. In case we
receive confirmation that you had lodged claim with them then we will forfeit all the benefits under section I i.e. own damage section of the policy and own damage section shall be cancelled with appropriate refund of premium but coverage under third party section
will continue. Third party section may also be cancelled on submission of proof of insurance with any other insurer. You may visit company website at www.tataaig.com for detailed benefits , terms & conditions & exclusions of the policy. You may also reach us at
our 24*7 helpline 1800 266 7780 in case you desire to have a printed copy of policy wording. Our grievance redressal procedure and details about ombudsman is also available in our policy wording. This Schedule, Policy terms and conditions available on company
website and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear.
Any amendments/modifications/alterations made on this system generated policy document is not valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued, would be
valid and effective, only after written request is made to the Company and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company.

POS User ID : Auto Secure - Private Car Package Policy Date & Time is : 30/05/2020 00:00:00

TATA AIG General Insurance Company Limited, Regd. Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400 013
IRDA Registration No.108, CIN No : U85110MH2000PLC128425,PAN: AABCT3518Q, UIN No.: IRDAN108RP0002V01200001,
Website : www.tataaig.com 24X7 Tollfree Helpline 1800-266-7780 Tolled No: 022-6693 9500 Fax: 022 6693 8170 E-mail: Customersupport@tataaig.com
Auto Secure - Private Car Package Policy

Transcript of Proposal for Auto Secure - Private Car Package Policy

1. Name (Registered Owner of the Motor Vehicle)* :Mr Lakshmi Narayana rao Burgula

2. Address for Communication*:301 Lalithanjali apartments Near focus diagnostics HYDERABAD 500082 TELANGANA

3. Vehicle Details: Please refer policy schedule cum certificate.

4. Vehicle Purchased is :Roll Over 5. Vehicle Type :Indigenous

6. Fuel Type :Petrol

7. Insured's Declared Value - Please refer policy schedule cum certificate.

8. Previous Insurance Particulars* :

Policy Number* : 2311/59930746/00/000 Date of Expiry* : 06/06/2020 Type of Cover : Package

Name of the Insurer* : UNIVERSAL SOMPO GENERAL INSURANCE CO.LTD.

Accident in the previous policy period : N/A NCB in previous policy : 0% NCB claimed :N/A

9. Period of Insurance Desired from*: 00:00 Hrs on 07/06/2020 to midnight of 06/06/2021

10. Financier's Details:Please refer policy schedule cum certificate.

11. Extra Benefits opted

Un-Named Persons Personal Accident Cover for seating capacity, including driver: CSI N/A

Wider Legal Liability to Paid Driver:NO

One Year Compulsory PA Cover for Owner Driver RS 1500000

Name of the Nominee & Age:Burgula Sai Ramakrishna & 40 Relationship :Son

Name of Appointee (if Nominee is Minor) Relationship to the Nominee

12. Restriction of Cover/Discounts/Concessions/Extended Covers

Name of Automobile : N/A Membership no : N/A

Third Party Property Damage Cover restricted to Rs, 6,000/ only :NO

Is Voluntary Deductible opted : No Amount of Deductible opted : Rs.

Vehicle is fitted with Anti Theft Device approved by ARAI

13. Add on covers - Please refer policy schedule cum certificate.

Specified Person Details.

SP Certificate No: N/A SP Name: N/A

14. Bank Details (Required for Refund / Claims)

Name of the Account Holder: Mr Lakshmi Narayana rao Burgula

Name of Bank & Branch: & MUMBAI Account Number: IFSC Code of Bank:

15. Declaration for No Claim Bonus (If NCB Confirmation is not submitted but NCB claimed)

I/We declare that the rate of NCB claimed by me/us is correct and that NO CLAIM has arisen in the expiring Policy Period (Copy of Policy
enclosed). I/We further undertake that if this declaration is found incorrect all benefits under the Policy in respect of Section-1 of the Policy will
stand forfeited.
16. I hereby give my consent to receive one page insurance policy.

17. AML Guidelines:

1. I/we hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of proceeds of
crime related to any of the offence listed in Prevention of Money Laundering Act, 2002.

2. I understand that the Company has the right to call for documents to establish sources of funds.

3.The insurance company has right to cancel the insurance contract in case I am/have been found guilty by any competent court of law under any
of the statutes, directly or indirectly governing the prevention of money laundering in India.

Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions, please read sales brochure carefully before concluding a sale.
TATA AIG General Insurance Company Ltd. Regd. Office: 15th floor, Tower A, Peninsula Business Park,Ganpatrao Kadam Marg, Off Senapati Bapat Marg, Lower Parel, Mumbai400 013.
IRDA Registration No.108, CIN No : U85110MH2000PLC128425,PAN: AABCT3518Q, UIN No.: IRDAN108RP0002V01200001
Website: www.tataaig.com 24X7 Tollfree Helpline 18002667780 Tolled No: 022-6693 9500 Email:Customersupport@tataaig.com