LIBERTY GENERAL INSURANCE LIMITED

Stand­alone Own Damage Policy for Private Car

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 non­disclosure 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 10th floor, Tower A, Peninsula Business Park, Ganpat Rao Kadam Marg, Lower Parel, MUMBAI MAHARASHTRA 400013 PH: +91 22 67001313 FAX: +91 22 6700
1606
Period of insurance : From 00:00 Hrs of 23/07/2022 To Midnight of 22/07/2023

Policy Issued On 18/07/2022

Policy No 2025­100000­22­7000785­00­000
Geographical Area India
Insured BACHALA DAYASAGAR Covernote No/Ecovernote No 202510000022700078500000
Address FLAT­2 ,BLOCK­3, MARINA APTS MODERN LAYOUT ROAD, BEHIND Covernote Date
GATEWAY INTERNATIONAL SCHOOL, KAZHIPATTUR, CHENNAI , RTO Location SHOLINGANALLUR Zone Zone­A
TAMIL NADU­603103 UIN CODES IRDAN150RP0001V01201920
KANCHIPURAM TAMIL NADU 603103 Customer UIN

Contact Number (M) +919396161666 Customer ID 4109669986

GSTIN No/State Name NA/TAMIL NADU

Agent Name Policybazaar Insurance Brokers Private Limited

Agent Code IMD1046412 Agent Contact No 8800556374
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Year of
Manufacture/Date Licensed Carrying
Registration Trailer Trailer Trailer
Of Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW/KW capacity including
Mark & No. Registration/Invoice Registration No. Chassis No. IDV
Driver
Date
TN 14 W 2020/24­07­ HYUNDAI/VENUE 1.0 SX
G3LCLM027557 MALFC81ALLM120853 998 5
3886 2020/24­07­2020 TURBO IMT/Suv
IDV (INSURED'S DECLARED VALUE)
IDV of Vehicle( ) Trailers( ) Side Car( ) Non Electrical Accessories Electrical/Electronic Bi Fuel kit (CNG/LPG)( ) Total Value ( )
( ) Accessories( )
700,000.00 0.00 0.00 0.00 0.00 0.00 / 0.00 700,000.00
PREMIUM COMPUTATION
OWN DAMAGE (A)
Own Damage Premium on vehicle and accessories Net Premium(A+B) Taxable Value 7,033.00
Basic Cover IGST(18% ­ TAMIL NADU) 1,265.94
Basic ­ OD 4,377.80 TOTAL POLICY PREMIUM 8,299.00
DISCOUNTS UNDER OWN DAMAGE SECTION
No claim bonus 25% 1,094.45
TOTAL OWN­DAMAGE PREMIUM (A) 3,283.35
ADD ON COVERS (B)
Passenger Assist IRDAN150RP0001V01201920/A0006V01201920 250.00
Depreciation Cover IRDAN150RP0001V01201920/A0003V01201920 3,500.00
TOTAL ADD­ON COVER PREMIUM (B) 3,750.00

Hire Purchase/ Lease /Hypothecated with SUNDARAM FINANCE LTD­Chennai

LIMITATION AS TO USE : The Policy covers use of vehicle for any purpose other than: a) Hire or Reward b)Carriage of goods(other than sample of personal luggage) c)
Organized racing d)Pace Making e)Speed Testing f)Reliability Trial 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
EV Charger Protection
Compulsory Deductible Voluntary Deductible Imposed Excess Theft Excess
Deductible
1000 0 0 0
Subject to I.M.T Endorsement Nos. AD01,AD04,IMT 22,IMT 7

Live TP Policy Details :

TP Insurer Name TP Insurer Address TP Policy Number TP Policy Start Date TP Policy End Date
The New India Assurance Co. 87, M.G Road, Fort, Mumbai,
11300031212001668491 23/07/2021 22/07/2023
Ltd Maharashtra ? 400 001
In witness whereof this Policy has been signed at Mumbai on 18/07/2022
Receipt No: 10210000022100265876
In case of Claims, Please contact us at : Toll Free No ­ 18002665844,
email id ­ care@libertyinsurance.in
Date of Issue : 18/07/2022
Place : Mumbai

Consolidated Stamp duty has been paid as per letter of Authorization no. For Liberty General Insurance Limited
LOA/CSD/333/2022/1779/22 Dated 26/04/2022 issued by Main Stamp Office, Mumbai. ** Not
Applicable for the State of Jammu & Kashmir.
Invoice No. 2722011000893744
Branch GSTIN No : 27AABCL9950A1ZL
SAC Code : 997134; Description of Service : General Insurance
Service; Place of Supply : TAMIL NADU/33
IRDA Regn. No. 150
CIN No. U66000MH2010PLC209656
% DSUnknown
q

Tax is not payable under reverse charge by the recipient

1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m

Authorised Signatory
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q

IMPORTANT NOTICE Digitally signed by:

The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule. SACHIN JOSHI
This policy provides only Own Damage cover to the insured vehicle and no other liability is covered under the policy
Date: 2022-07-19
02:52:08 IST
Location: Mumbai
Liberty General Insurance Limited
10th Floor, Tower A, Peninsula Business Park,
Ganpath Rao Kadam Marg, Lower Parel
MUMBAI ­ 400013
Phone: +91 22 6700 1313 Fax: +91 22 6700 1606
Email: care@libertyinsurance.in
IRDA registration number: 150 • CIN: U66000MH2010PLC209656

INFORMATION SUMMARY ­ PROPOSAL

(Under Regulation 8(2) of the IRDA (Protection of Policyholders Interests) Regulations, 2017 or any amendment or repealment thereto)
To, Date: 18/07/2022
BACHALA DAYASAGAR
FLAT­2 ,BLOCK­3, MARINA APTS MODERN LAYOUT ROAD, BEHIND GATEWAY INTERNATIONAL SCHOOL, KAZHIPATTUR,
(M) +919396161666
dayabachala@gmail.com

Dear Customer,

We thank you for choosing us for your insurance requirement. We, at Liberty General Insurance Limited, believe 'Insurance' is not only an assurance to compensate in the event of an
unfortunate circumstance, but one that signifies protection and support you can count on when you need it the most. We are firmly committed to stand beside you and fulfill your insurance
requirement whenever the need arises.

We write to inform you that we have received the below details for insuring your under mentioned vehicle;

Product Stand­alone Own Damage Policy for Private Car Period of insurance : From 00:00 Hrs of 23/07/2022 To Midnight of 22/07/2023
Name

Policy No: 2025­100000­22­7000785­00­000

Motor Vehicle details

Licensed
Year of Manufacture/Date Vehicle
Registration Trailer Chassis Make/Model/Type of Carrying
RTO Location Of Registration/Invoice Engine No. Chassis No. Sub CC/HP/GVW/KW
Mark & No. No./Registration No. Body Capacity
Date Class
Including Driver
2020/24­07­2020/24­07­ HYUNDAI/VENUE 1.0
TN 14 W 3886 SHOLINGANALLUR 2020
G3LCLM027557 MALFC81ALLM120853 /
SX TURBO IMT/Suv
998/ 5

IDV (INSURED'S DECLARED VALUE)

IDV of Vehicle( ) Trailers( ) Side Car( ) Non Electrical Accessories Electrical/Electronic Bi Fuel kit (CNG/LPG)( ) Total Value ( )
( ) Accessories( )
700,000.00 0.00 0.00 0.00 0.00 0.00 / 0.00 700,000.00

Add on Covers Hire Purchase/Lease/Hypothecated with: Voluntary deductible

Passenger Assist
IRDAN150RP0001V01201920/A0006V01201920
SUNDARAM FINANCE LTD­Chennai 0
Depreciation Cover
IRDAN150RP0001V01201920/A0003V01201920

Previous policy details

Previous Policy Number Previous Insurer Name Previous Policy Period Previous Policy Type Previous Year NCB Claim made in Previous Policy
11300031212001668491 New India Ins 23/07/2021 to 22/07/2022 Bundled Cover 20 NO
Liability Policy Details :
Name of the Insurer Policy Number Period of Insurance
The New India Assurance Co. Ltd 11300031212001668491 From 23/07/2021 To 22/07/2023

The above information provided has been recorded by us under Regulation 8 (2) of the Insurance Regulatory & Development Authority (Protection of Policyholders Interests) Regulations,
2017 or any amendment or repealment thereto and believing the furnished information as correct, we have issued the enclosed insurance policy for your said vehicle. We are hereby
providing the information for your confirmation and records.

For any further assistance please feel free to write to us on care@libertyinsurance.in or call us on our Toll Free number 1800 266 5844 (between 8:00am to 8:00pm, 7 days of the
week), you can also visit our nearest branch, our representatives will be glad to help you.

To enable us to serve you better, we request you to check your contact details and communicate to us by any of the above medium incase any changes required.

In the absence of any communication from you in this regards within a period of 15 days of receipt of this letter, we would take this as a confirmation that the issued policy is in order and as
per your requirement. Incase, any of the above information is found to be incorrect subsequently, the company may, at its sole discretion cancel the policy or any part thereof as deemed fit.

Correct No Claim Bonus (NCB) declaration on the part of insured is extremely important for a seamless customer experience and if the NCB declaration is found to be incorrect, all benefits
under Section I (Own Damage) of the Policy stand forfeited. Hence, we strongly recommend that you verify the NCB details on your policy and in case of any correction, write to us at
ncbconfirmation@libertyinsurance.in or call us on 18002665844 not later than 15 days from the date of this letter.

Liberty General Insurance Limited,

Authorized Signatory
Call Toll Free No : 1800 266 5844 www.libertyinsurance.in

% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q

Digitally signed by:

SACHIN JOSHI
Date: 2022-07-19
02:52:08 IST
Insurance is the subject matter of the Solicitation IRDAN150RP0001V01201920 Location: Mumbai