SHRIRAM GENERAL INSURANCE COMPANY LIMITED

IRDAI REGN. NO. - 137

E-8,EPIP,SITAPURA INDUSTRIAL AREA,JAIPUR,

RAJASTHAN-302022
B
CONTACT(TOLL FREE): 1800 – 30030000, 1800 – 1033009
CERTIFICATE CUM POLICY SCHEDULE
Stand-alone Motor OD (THREE Wheeler) Policy -
Zone B Stand-alone Motor OD (THREEWheeler)
Policy -
UIN No.IRDAN137RP0003V01201920 - SAC Code: 997134

Issue Office 10008-Address-E - 8, RIICO INDUSTRIAL Issue Office Phone No.

AREA, SITA PURA, JAIPUR, RAJASTHAN -
302022
INDIA 10008/31/22/066028
CIN NO.U66010RJ2006PLC029979

Geographical Area Policy No.

Insured's Code/ Name IN-22338256 / MR P NAGARAJU GSTIN No. Of Insured Unregistered
Insured Address S/O: P NAGAYYA, DEVALAPALLI,KALAKADA, ANNAMAYYA(DT), ANDHRA PRADESH - 517325

Insured State Code 37 NCB Discount (%) 0

Executive K CHIDAMBARAM - NA0000005022 Period of Insurance From 00:00 Hrs of 17/07/2023 To
Midnight Of 16/07/2024
Agent Details M/S.SHRIRAMCITY UNION FINANCE LTD - Person NC0000001038 - Mr.VEMURI PHANI BABU -
BG0000000022- Mobile No.-N.A - N.A / N.A
PAN No. N.A
Prop No. - TR No. N.A - N.A Prop Issue Date N.A
Gross Premium 483 IGST 87
CGST 0 SGST/UTGST 0
Previous Insurer Cholamandalam MS General Insurance Co Ltd Total 570
Previous Policy No. 3397/00215589/000/00
TP Insurer and Address CHOLAMANDALAM MS GENERAL INSURANCE TP Policy No. 3397/00215589/000/00
CO LTD -MADANAPALLE
TP Policy Start Date : 10/03/2022 TP Policy End Date 09/03/2023
REGISTRATION ENGINE NO. & CHASSIS NO. MAKE - MODEL TYPE OF BODY / CUBIC CAPACITY/ DATE OF SEAT CAP.
MARK & PLACE FUEL TYPE YEAR OF MANF. REGN. / (INCL.
DELIVERY DRIVER)
AP - 03 - TC - S3F8146758 & PIAGGIO VEHICAL / MONOCOQUE / 436.5 / 2013 16/01/2013 3+1
2906 & MBX0000ZFRG726947 2013 DIESEL
PRAKASH
AM
IDV FOR THE IDV SIDE CAR SI FOR NAMED NON ELECTRICAL ELECTRICAL CNG/LPG kit SI TOTAL VALUE
VEHICLE PERSON ACCESSORIES ACCESSORIES
0.00 0 0 0 0 0 0.00
SCHEDULE OF PREMIUM
A. OWN DAMAGE
OD TOTAL 6318.00
TOTAL PREMIUM 6318.00
ADD : IGST 18.00% 1137.00
PREMIUM AMOUNT 7455.00

The above Total OD Premium is inclusive of all applicable Loading/Discounts viz ( Automobile Association, Voluntary Excess, Anti-Theft, Handicap
Person, Driver Tuition, Fibre Glass,CNG/LPG Unit, Geographical Extn, Imported Vehicle etc. wherever applicable ).

Deductibles under Section-I : Compulsory Deductible Rs.100 , Imposed Excess Rs.500

Subject to IMT Endorsement Printed herein/attached to : IMT-22, IMT-7
Hypothecation Agreement with: SHRIRAM CITY UNION FINANCE LTD
Hire Purchase/Lease Agreement with:

PreInspection Survey: Dented Part : N.A,Broken Part : N.A, Scratched Part : N.A ,Claim not payable for : N.A
Preinspection Report: Not Applicable
Driver's Clause
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. The insurance under this policy
is subject to conditions, clauses, warranties, endorsements as per forms attached.Warranted that in case of dishonour of premium cheque(s) the
Company shall not be liable under the policy and the policy shall be void abinitio (from inception). I/We hereby certify that the policy to which the
certificate relates as well As this certificate of insurance are issued in accordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act,
1988. In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at JAIPUR-I. If the
declared details of TP Policy found incorrect than OD claim will be repudiated.This Policy covers only Own Damage Risk with no other Liability in
connection with Private car /Two Wheeler vehicle including third party cover.

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 MVAct, 1988 is recoverable from the Insured. See the Clause headed " AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY ".
POLICY IS SUBJECT TO EXCLUSION OF DAMAGES NOTED DOWN BY OUR AUTHORISED REPRESENTATIVE DURING THEIR INSPECTION.
Note: In case of new vehicle, Insured have to submit registration documents within a period of 15 days from the date of issue of Registration Certificate of Vehicle.
In case of Claims/Grievance, Please contact us at: Toll Free No – 180030030000, 18001033009 Email id - chd@shriramgi.com
For instant renewal of your insurance policy, Log on to www.shriramgi.com or contact us at our Head office no. - 0141-4828400

PLACE : Head Office - 8

For and on behalf of
We will contact you through phone,e-mail, letters, registered AD, sms, etc for renewal before/after the
Shriram General Insurance Co.Ltd.
expiry date of your policy. If you do not want us to contact you, kindly send an e-mail for the same on
dnd@shriramgi.com
Consolidated Stamp Duty paid vide Inspector General Registration and Stamp Ajmer order No. F7(77)Gen
/2021/Part-I/7609 dated 17-05-2021
For NEFT/RTGS/IMPS or any other online payment kindly visit our website "www.shriramgi.com".

All the Amounts mentioned in this policy are in Indian Rupees Note :- Claim intimation after 48 hours will be
GSTIN No. 08AAKCS2509K1Z3 considered as delayed intimation.

Authorized Signatory