Auto Secure-Standalone Own Damage Two Wheeler Policy

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Date : 11/09/2023

Name : MR RAHUL BAG Your Policy Details

Address : NEAR GARIKHANA MASTER PAN DUKAN
KUMARDHUBI PANCHMAHLI Policy Number : 3779916146 00 00
DHANBAD
DHANBAD Policy Period : From 12:00 18/09/2023 to midnight of
JHARKHAND 17/09/2024
828203 Premium Paid : `1,234.00

Phone : 8709527535

Dear MR RAHUL BAG

Welcome to Tata AIG General Insurance Company Limited's family & we thank you for choosing our Auto Secure-Standalone Own Damage
Two Wheeler 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.

Your policy has been issued based on the information and declaration provided by you. No Claim Bonus (NCB) if shownon your policy
schedule has been allowed as you had not reported any claim in the previous policy.

Kindly go through the enclosed information/ declaration provided by you and in case your policy shows No Claim Bonus (NCB), 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 daysof receipt of the
policy for correction otherwise all particulars will be deemed to be correct.

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

We assure you of our best services at alltimes. Happy driving!

Sincerely ,
For TATA AIG General Insurance Company Limited

Authorized Signature

Tata AIG General Insurance Company Limited

Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01201920
 AUTO SECURE- STANDALONE OWN DAMAGE TWO WHEELER POLICY
Certificate Of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Agent Name: HARITA INSURANCE BROKING LLP

Agent License Code : 623 Agent Contact No : 9940032139
Certificate & Policy No : 3779916146 00 00

Period of Insurance: From 12:00 Hours on 18/09/2023 Date of Expiry: To midnight 00:00 Hours of 17/09/2024
Insured Name & Address of Insured Premium (Incl. S. Tax) ` 1,234.00
Name : MR RAHUL BAG Insured Profession : SERVICE
Address NEAR GARIKHANA MASTER PAN DUKAN,KUMARDHUBI Geographical Area: India
: PANCHMAHLI,,
,DHANBAD,DHANBAD, Registration Authority: Dhanbad
JHARKHAND,828203 HPA/HYP/Lease to: I.C.I.C.I BANK LTD.
Insured GSTIN Number:

Place of Supply & Code : JHARKHAND & 20 Lessor GSTIN Number

Auto Secure- Standalone Own Damage Two Wheeler Policy Vehicle Details-
Engine
Registration Year of Cubic Seating
Make & Model Body Type Number / Chassis No.
No. Manufacture Capacity/KW Capacity
Motor Number
TVS/JUPITER 125 MD626AK46N
JH10CM7284 2022 125 2 BK4HN1537401
DRUM ALLOY 1H38847
Insured Declared Value (IDV) `
IDV of Vehicle (`) IDV of Side Car Bi-Fuel/CNG/LPG IDV of Non-Built-in Accessories (`) Total Insured Declared
(`) Kit (`) Value (IDV) (`)

82280.00 0 0 Electrical:.00 Non-Electrical:.00 82280.00

(Motor Vehicle shall in case of a Motorised Two Wheeler be deemed to include a side car attached to it)
SCHEDULE OF PREMIUM
A. OWN DAMAGE ` B. ADDONS `

Premium on Vehicle and non electrical accessories ` 1,102.94 Add: Depreciation reimbursement (TA 01) ` 329.04
Less :35% for NCB ` 386.03 B. TOTAL ADD ON PREMIUM ` 329.04
A. TOTAL OWN DAMAGE PREMIUM ` 716.91 Premium before Tax (A+B) ` 1,045.95
CGST @9% ` 94.00
SGST/UGST @9% ` 94.00
Amount Payable (Inclusive of all applicable taxes) ` 1,234.00
Bundled Two Wheeler Policy (1 Year Term for Own Damage & 5 Years for Third Party) details -

Certificate & Policy No. Policy Type Insurance Company Name TP Cover Start Date TP Cover End Date
From 12:00 Hours on
Bundled Two Wheeler Policy To midnight 23:59 Hours
on

Drivers Clause: Any Person including the insured: Provided that the person driving holds an effective driving license at the time of 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 person satisfies the requirement of Rule 3 of the Central Motor Vehicle Rules, 1989.

Limitations as to use: The Policy covers use only under a permit within a the meaning of the Motor Vehicles Act 1988 or such a carriage
falling under sub-section (3) of Section 66 of the Motor Vehicles Act, 1988.
(1) Use for hire or reward or for racing, pace making, reliability trial or speed testing.
(2) Use whilst drawing a trailer except the towing (other than for reward) of any one of disabled mechanically propelled vehicle.

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 Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01201920
Limits of Liability: Under Section III : PA to Owner Driver CSI: ` 0.00 I/We hereby certify that the Policy to which this Certificate
Nominee: NA Relationship: NA relates as well as this Certificate of Insurance are issued in
Number of claims covered under Depriciation Reimbursement cover:4 accordance with the provisions of Chapter X and Chapter XI of
Number of claims covered under Depriciation Allowance-Battery Cover:0 M.V. Act, 1988.

This Policy does not cover pre-existing damages as per Inspection Photographs and Report. In witness whereof this Policy has been signed at DHANBAD on
11/09/2023
Deductible under Section-I: ` 100.00 (Compulsory Deductible : ` 100.00, Voluntary Deductible: `
0.00, Imposed Excess: ` 0.00) Receipt No.(s):
Franchisee: ` 0.00, Depreciation Allowance-Battery Deductible-5% of claim amount subject to The stamp duty of Rs0.50 paid in cash or demand draft or by pay
minimum of RS. 500 order,vide Receipt/Challan no:LOA/CSD/120/2023/3624/23dated
the 31/08/2023
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 allowed provided the policy is renewed within 90 days of the expiry
For & On Behalf of Tata AIG General Insurance Comapny
date of the previous policy.
LTD.
Subject to: A) IMT Endorsement Number : 07

B) TATA AIG Auto Secure Endorsement Number (TA): 16

GSTIN :20AABCT3518Q1ZA JHARKHAND Service Account Code: 997134

Authorized Signatory
Policy Servicing Office : 2ND FLOOR, HARI MANGAL COMPLEX, DHANSAR MORE, DHANBAD , BIHAR DHANBAD JHARKHAND DHANBAD-828106

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.

For Roadside Assistance, Please Contact on 18005724029

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 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. 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.

For Policy wordings, please scan the below QR code :

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 Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01201920
 Transcript of Proposal for Auto Secure-Standalone Own Damage Two Wheeler Policy

1 Name (Registered Owner of the Motor Vehicle)* : MR RAHUL BAG

2 Address For Communication* : NEAR GARIKHANA MASTER PAN DUKAN,KUMARDHUBI PANCHMAHLI,,,DHANBAD,
DHANBAD,JHARKHAND,828203.

3 Vehicle Details : Please refer policy schedule cum certificate

4 Vehicle Purchased : 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* : Date of Expiry* :
Type of Cover : Bundled Two Wheeler Policy
Name of the Insurer* : Peninsula Business Park, Tower A, 15th Floor, Ganpatrao Kadam Marg, Lower Parel

Accident in the previous policy period : NCB in previous policy : 25% NCB claimed : 35%
9 Period of Insurance Desired from* : 18/09/2023 to midnight of 17/09/2024
10 Financier’s Details: Please refer policy schedule cum certificate
11 Extra Benefits opted
Personal Accident Cover for Owner Damage: CSI : 0.00

Name of the Nominee & Age: NA & 0 RelationShip : NA

Name of Appointee (if Nominee is Minor) :NA Relationship to the Nominee : NA
12 Restriction of Cover/Discounts/Concessions/Extended Covers
Name of Automobile : Membership no.:
Is Voluntary Deductible opted : Amount of Deductible opted : 0
Vehicle is fitted with Anti Theft Device approved by ARAI :

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

Charger Number:
No of Batteries: Cost of Battery: No of Chargers:
Is Battery Provided by Manufacturer(YES/NO):NO Is Battery a Part of Ex-showroom Price of the Vehicle:NO
Name of Battery Manufacturer:

14 Bank Details (Required for Refund / Claims)

Name of the Account Holder : RAHUL BAG Name of Bank & Branch :N/A
Account Number : N/A IFSC Code of Bank : N/A

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 toreceive 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 MoneyLaundering 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.

18 We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

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 Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor,G.K Marg,Lower Parel , Mumbai-400013
24*7 Tollfree Number:1800 266 7780 Fax:0226693 8170 Email:customersupport@tataaig.com website:www.tataaig.com
IRDA of India Registration No : 108 CIN:U85110MH2000PLC128425, UIN:IRDAN108RP0002V01201920