Auto Secure - Private Car Package Policy

Name : Mr SANDEEP GUPTA +91 99**84**07 med********@gmail.com

Valid from → Valid till

Address : B3 /30 SECOND FLOOR SECTOR 16 ROHINi, OD Cover Period 30 Jan '25 (00:00 Hrs) 29 Jan '26 (Midnight)
SECTOR 9-110085,
TP Cover Period 30 Jan '25 (00:00 Hrs) 29 Jan '26 (Midnight)
DELHI
CPA Cover for Owner 30 Jan '25 (00:00 Hrs) 29 Jan '26 (Midnight)
Driver Period

Premium amount : ₹ 8562

Dear Mr SANDEEP GUPTA,

Welcome to Tata AIG General Insurance Company Limited family & we thank you for choosing our policy for your motor vehicle insurance. Your Policy No. 6204162969 has
been issued based on the information and declaration provided by you. You are requested to visit our website www.tataaig.com for full policy wordings

In case of a claim, notify us first

To Register Claim
Less deductions on repair
5900+ network claims 4 hr TAT for claims Download the
garages *No salvage value inspection Tata AIG App Visit Call us at

deducted
OR tataaig.com OR 1800 266 7780

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

Policy Details Vehicle Details

Policy No & Certificate No : 6204162969 00 00 Registration no : DL 13 CC 5222

Insured Name : Mr SANDEEP GUPTA Registration Authority : DELHI DL 13

Address : B3 /30 SECOND FLOOR SECTOR 16 ROHINi, Make/Model : HONDA/AMAZE

SECTOR 9-110085,
Fuel Type : PETROL
DELHI
Variant : 1.2 S MT I-VTEC
Period of Insurance OD cover period : 30 Jan '25 (00:00 Hrs) to 29 Jan '26 (Midnight)

TP cover period : 30 Jan '25 (00:00 Hrs) to 29 Jan '26 (Midnight) Engine Number/Battery Number : L12B32511807/NA

CPA to Owner driver cover Period : 30 Jan '25 (00:00 Hrs) to 29 Jan '26 (Midnight) Chassis number : MAKDF153BFN107166

Policy Issuance Date : 24 Jan '25 Engine/Battery Capacity (CC/ KW) : 1198

Customer / Lessor GSTIN : NA Seating Capacity (including driver) : 5

Customer ID : NA Mfg Year : 2015

Customer contact number : 99**84**07 Date of Registration : 01/04/2015

Proposal No : PR/25/6200304204 Body Type : SEDAN

Covernote no / Issuance date : NA Trailer Regn No. / Chassis No. : NA

Alternate Policy No : NA HP/HYP/Lease : NA

Zone : A

Geographical Area : India

Insured Declared Value (IDV)

Vehicle IDV (₹) Electrical Accessories (₹) Non Electrical Accessories-Vehicle IDV (₹) Bi-Fuel/CNG/LPG Kit (₹) Trailer/Side car IDV (₹) Total IDV (₹)

2,63,588.00 0.00 0.00 27,000.00 0.00 2,90,588.00

 Auto Secure - Private Car Package Policy

Schedule Of Premium

Section I Own Damage (A) Section II Liability (B)

Own Damage Premium On Vehicle & Accessories Third Party Premium
Basic Own Damage Basic TP premium ₹ 3,416.00
Premium on Vehicle and non electrical accessories ₹ 1,590.03
Add: CNG / LPG kit TP (IMT 25) ₹ 60.00
Add: CNG / LPG Kit (IMT 25) ₹ 1,080.00
PA Benefits
Total Own Damage Premium (A) ₹ 2,670.03
1Year(s) Compulsory PA cover for Owner Driver 15,00,000.00 ₹ 375.00

Section I Add On Covers

Legal Liability
(Add) Loss of personal belongings (TA 09) ₹ 135.00
Add: Legal liability to paid driver (IMT 28) ₹ 50.00
Sum Insured:10000
Number of persons:1
(Add) Emergency transport and hotel expenses (TA 10) ₹ 135.00
Total Liability Premium (B) ₹ 3,901.00
Any One Accident :5000
Any One Year :10000 Net Premium (A+B+C) ₹ 7,256.00

(Add) Key Replacement (TA 15) ₹ 315.00 SGST/UGST @9% ₹ 653.04

Sum Insured: 25000per occurrence limit 50% of SI CGST @9% ₹ 653.04
(Add) Repair of Glass, Rubber & Plastic Parts (TA08) ₹ 0.00 Road Side Assistance ₹ 136.88
(Inclusive of All Applicable Taxes)
(Add) Emergency Medical Expenses (TA22) ₹ 100.00

Sum Insured:25000

Total Add On Premium (C) ₹ 685.00

Total Policy Premium ₹ 8,562.00

Agent Name : hriday goel Agent License Code : AGINEGJPG5335K • Agent Contact No. : 9599597752(or landline)

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 other than for the purpose of driving tuitions 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

Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) 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 Certifitate, as applicable, during the subsistence of the Policy.

Limits of Liability: Under Section II-1 (i) of policy (Death of or bodily injury) : Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988
Under Section II-1 (ii): of policy (Third Party Property Damage) : ₹ 7,50,000 • Under Section III : PA to Owner Driver CSI : ₹ 15,00,000

Nominee details :
Name of the Nominee :RAJNISH GUPTA • Nominee Age :49 • Relationship of the Nominee with the Insured :Brother

Number of claims covered under Depreciation Reimbursement Cover :NA • Basis of claim settlement under Tyre Secure Cover :NA

This Policy does not cover pre-existing damages as per Inspection Photographs and Report. Inspection Lead no NA

Deductible under Section - I : ₹ 1,000.00 (Compulsory Deductible ₹ 1,000, Voluntary Deductible: 0.00, Imposed Excess: 0.00) Franchisee:NA

Deductible under Engine Secure: NA Add-On Cover : Repair of Glass, Rubber & Plastic Parts,Loss of personal belongings,Emergency transport and hotel expenses,Key
Replacement,Road Side Assistance,Emergency Medical Expenses

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 date of the previous policy.

Subject to: (A) IMT Endorsement No. :25,28,32,22

GSTIN: 07AABCT3518Q1ZY DELHI Service Accounting Code : 997134
TATA AIG Auto Secure endorsement No. (TA): 08, 09, 10, 15, 19, 22

I/We hereby certify that the Policy to which this Certificate relates as well as this For & On Behalf of Tata AIG General Insurance Company Ltd.
Certificate of Insurance are issued in accordance with provisions of Chapter X Digitally Signed by: Shammi Kapoor
docit-digital-sign
and XI of Motor Vehicles Act, 1988. Date: 24/01/2025
In witness whereof this Policy has been signed at Mumbai on: Receipt (s) :
Location: Mumbai
PD300012513887 24/01/2025

Consolidated Stamp Duty has been paid to the State Exchequer.

Policy Number :6204162969/00/00 • GSTN Number :07AABCT3518Q1ZY DELHI

Service Accounting Code : 997134

Policy Servicing Office :KIRTINAGAR, PLOT NO 35, 3RD FLOOR, DLF KIRTI NAGAR INDUSTRIAL AREA, NAJAFGARH ROAD, KIRTI NAGAR, NEW DELHI-110015, KIRTINAGAR 110015 • Tel.
No :7400010489

Roadside Assistance : Please Contact On: 18002679000

 Auto Secure - Private Car Package Policy

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 information and declaration provided by you. Transcript of
Information & Declaration is also provided herewith to enable you to go through the same again and if any error/ discrepancy is found in respect of vehicle details, No Claim
Bonus or any other information provided by you, 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 to be correct. You may visit the company website at www.tataaig.com for detailed benefits, terms & conditions and exclusions of the
policy issued and held by you. 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 are available at the company website www.tataaig.com. You may also reach us at our 24*7 helpline 1800 266 7780 for grievance
redressal procedure and details about ombudsman. Please note that any mis-representation, fraud, non-disclosure of material facts or non-cooperation of the insured 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 intimate you to pay the No claim Bonus Amount within 20
days. In case we don’t receive the No Claim Bonus recovery then it will be adjusted against claim amount payable to you if any. This Schedule, Policy terms and conditions
available on the company website and Endorsements mentioned herein above shall be read together and any word or expression to which a specific meaning has been
attached to/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 the Company shall not be liable for any liability whatsoever arising from such changes unless written request is made to
the Company and the Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement.

Receipt

Receipt No.: PD300012513887 Receipt Date: 24/01/2025 Policy No.: 6204162969 00 00

Utilized from the receipt for

Sr. No. Policy Number Mode of Payment Total Premium (₹) policy (₹) Balance (₹)

1 6204162969 00 00 cheque 8699 8699 0

Payer Name: SANDEEP GUPTA

Note:
1. This is a computer generated receipt and does not require a signature
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void
3. Amounts received by cheque shall be subject to realisation
4. Any amount received in excess of the Premium is being/shall be refunded by the Company

GSTIN : 07AABCT3518Q1ZY DELHI Service Accounting Code : 997134

Revenue (consolidated) Stamp Duty duly paid vide challan No.NA date NA for applicable cases
Issuance of this receipt does not amount acceptance of the risk by Tata AIG General Insurance Company Limited. The insurance cover for the risk shall be as per the terms
and` conditions of the insurance policy if and when issued.

Transcript of Information/Declaration
Insured and Vehicle Details
1. Name (Registered Owner of the Motor Vehicle) : Mr SANDEEP GUPTA
2. Vehicle Details : HONDA / AMAZE / 1.2 S MT I-VTEC / SEDAN
3. Address for Communication : B3 /30 SECOND FLOOR SECTOR 16 ROHINi, SECTOR 9-110085, DELHI, India
4. Vehicle Type : SEDAN
5. Fuel Type : PETROL
6. Insured’s Declared Value : ₹ 263,588
7. Date of Registration : 01/04/2015
8. Proposed Period of Insurance
OD cover period : 30 Jan '25 (00:00 Hrs) to 29 Jan '26 (Midnight)
TP cover period : 30 Jan '25 (00:00 Hrs) to 29 Jan '26 (Midnight)
CPA cover period : 30 Jan '25 (00:00 Hrs) to 29 Jan '26 (Midnight)

Previous Insurance Details

Name Of The Insurer: LIBERTY VIDEOCON GENERAL INSURANCE COMPANY LTD. Name Of The Insurer: NA
1. Policy Number: 201120010223100076700000 1. Policy Number: NA
2. Date of expiry: 29 Jan '25 2. Date of expiry: NA
3. Type of cover: Package 3. Type of cover: TP/CPA
4. Address if the Insurer: NA 4. Address if the Insurer: NA
5. Claim in Previous Policy Period: Yes 5. Claim in Previous Policy Period: NA
6. NCB in previous policy: NA 6. NCB in previous policy: NA
7. NCB Claimed: NA 7. NCB Claimed: NA
8. Period of insurance 8. Period of insurance
OD cover period: NA(00:00 Hrs) to NA(Midnight) TP cover period: NA (00:00 Hrs) to NA (Midnight)
TP cover period: NA(00:00 Hrs) to NA(Midnight)
CPA cover period: NA to NA

Nominee Details
1. Name of Nominee: RAJNISH GUPTA
2. Age of Nominee: 49
3. Relationship: Brother
4. Name of Appointee (if Nominee is minor): NA
 Auto Secure - Private Car Package Policy

Restriction of Cover / Discounts / Concessions / Extended Covers

1. ARAI Membership Number: NA
2. Third Party Property Damage Cover restricted to ₹ 6,000/ only: No
3. Is Voluntary Deductible opted: No
4. Amount of Deductible opted: NA
5. Vehicle is fitted with Anti Theft Device approved by ARAI: NA
6. Add-on Covers opted: Repair of Glass, Rubber & Plastic Parts,Loss of personal belongings,Emergency transport and hotel expenses,Key Replacement,Road Side
Assistance,Emergency Medical Expenses
7. PUC Certificate Number and PUC Expiry Date: NA - NA

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 Own Damage Section I of the Policy will stand forfeited.
I hereby give my consent to receive one page insurance policy

AML Guidelines :

I / we hereby confirm that all premiums paid / payable in future will be from bonafide sources and not paid out of proceeds of crime and that such premiums are
not disproportionate to my/our income. I / we understand that the Company has the right to call for documents to establish sources of funds and to cancel the
insurance policy in case I / we are found guilty by any competent court of law under any of the statutes, directly or indirectly governing the prevention of money
laundering law in India.
I / we are not Politically Exposed Persons * nor are their close relatives/family members/ associates. I / we shall keep the company informed if we subsequently
become a Politically Exposed Person/close relative / family member / associate of Politically Exposed Persons.
"Politically Exposed Persons" shall have the meaning assigned to it under Prevention of Money-Laundering (Maintenance of Records) Amendment Rules, 2023 as
amended from time to time.

Disclaimer : Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms & conditions, please refer sales brochure/ policy wordings on www.tataaig.com carefully,
before concluding a sale. Purchase of Tata AIG General Insurance Company Limited products are purely on voluntary basis. #Add On covers can only be purchased with the base product and on payment
of an additional premium

Prohibition of Rebates: - Section 41 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015.
1. No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in
India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except
such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for penalty which may extend to ten lakhs.

Grievance Redressal Procedure : As per Regulation 17 of IRDA of India (Protection of Policyholders Interests) Regulation, 2017.

Section 64 VB of the Insurance Act 1938 : Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.

Auto Secure - Private Car Package Policy - UIN : IRDAN108RPMT0002V02200001.Repair of Glass, Rubber & Plastic Parts - UIN : IRDAN108RP0002V01200001/A0005V01200910 (TA 08) . Loss of personal belongings
- UIN : IRDAN108RP0002V01200001/A0054V01201819 (TA 09) . Emergency transport and hotel expenses - UIN : IRDAN108RP0002V01200001/A0055V01201819 (TA 10) . Key Replacement - UIN :
IRDAN108RP0002V01200001/A0056V01201819 (TA 15) . Road Side Assistance - UIN : IRDAN108RP0002V01200001/A0022V01201213 (TA 19) . Emergency Medical Expenses - UIN :
IRDAN108RP0002V01200001/A0008V01202021 (TA 22)

Tata AIG General Insurance Company Limited

Registered Office : Peninsula Business Park, Tower A, 15th Floor, G.K. Marg, Lower Parel, Mumbai - 400013, Maharashtra, India • 24x7 Toll Free No: 1800 266 7780 • Email : customersupport@tataaig.com •
website : www.tataaig.com
• IRDA of India Registration No: 108 • CIN: U85110MH2000PLC128425

TAGIC/PS/MRPC/Jan 22/06 Ver1 /All 2536