ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE B

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R91567808 / 27-Jun-2019
Policy No. & Type 11428353 Period of Insurance 27-Jun-2019 to 26-Jun-2020
Policy Issued On 27-Jun-2019 (00:00) Vehicle Identification No. MA3FHEB1S00913347
Insured Name Mr. Badugu Kiran Kumar Geographical Area INDIA
Invoice No R91567808 Accounting Code of Service 997134
Insured Address S/O VENKATREDDY,D.No:74-3-8/1,SRINIVASAENCLAVE,FLATNO:D1,KATARINAGAR,PRAKASH NAGAR,RAJAHMUNDRY 8008666679,
RAJAMUNDRY-533104, Andhra Pradesh
Insured State & Code Andhra Pradesh-37 Place of Supply Andhra Pradesh GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 318256
Model & Variant Swift New VDi/MARUTI SWIFT VDI BS IV Non Electrical Accessories 0
Registration No AP05DF3666 Electrical Accessories 0
Year of Manufacture 2015 CNG/ LPG Kit 0
Engine- Chassis No 584674 - 913347 Total IDV 318256
Cubic Capacity 1248
Seating Capacity 5
Type Of Body Saloon
RTO Location AP05DF3666 / RAJAMUNDRY
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 4570 Basic Third Party Liability 3221
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [1 Year] 325
Kit (IMT-25) 0 PACover for 0 Person of Rs (0) each (IMT- 16 )
Extra Premium towards Inbuilt CNG/LPG NA Legal Liability (WC) to Driver (IMT-28) 50
Basic Premium 4570 Geographical Area Extn. (IMT-1) NA
Geographical Area Extn. (IMT-1) NA Legal Liability to Employees (IMT-29) 0
Lamp, Tyres etc. (IMT 23) 0 Legal Liability to Passenger (IMT 46) 0
Driving Tuition Loading On OD Premium (60%) NA Driving Tuition Loading On TP Premium (60%) NA
Fiber Glass Tank 50 Net Liability Premium (B) 3596
Sub-Total Additions 0 Total Premium (A+B) 11717
Deductibles IGST @18% 2109.06
Voluntary Deductibles (IMT 22A) 0 Gross Premium Paid 13826
Anti-Theft Device (IMT-10) 0 MISP - S B MOTOR CORP.
AAI Membership (IMT-8) 0 Note :
No Claim Bonus 0 0
1. Policy Issuance is the subject to the realisation of cheque.
Discount for vehicles designed for handicapped NA 2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 0 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
Depreciation waiver 3501 5. Subject to Endorsements IMT ,7 28,
Engine & Gear Box Protection Cover 0
New Vehicle Replacement 0
Net own Damage Premium (A) 8121
Nominee Details : Nominee Name PRAVEENA Age 32 Relation Wife
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Auto Debit 32012715 HSBC BANK LTD 13826
Financier Type Financed Financier Name SYNDICATE BANK Financier Branch INNISPETABRANCH
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.
Driver: 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.
Limits of Liability: Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is necessary to meet there requirements of the Motor Vehicles Act, 1988. Under Section II -1(ii) of the Policy - Damage to
Third Party Property - Rs.7.5 lakhs - (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Cover for Owner - Driver under section III (CSI) Rs 1500000 - Deductible under section-I : Rs
1000(Compulsory Deductible Rs 1000 Imposed Deductible Rs. 0 and Voluntary Deductible Rs 0)
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 per the following: The preceding
year/20%, Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50%. No Claim Bonus will only be allowed provided
the policy is renewed within 90 days of the expiry date of the previous 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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For Legal interpretation, English
version will hold good.
For information on ombudsman you may visit website : http://www.gbic.co.in/ombudsman.html
I / We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X and Chapter XI of M.V. Act, 1988.
For IFFCO TOKIO GENERAL INSURANCE COMPANY LIMITED

Authorized Signatory
Policy Issuing Office:-IFFCO Tower II Plot No. 3 Sector 29 Gurgaon Haryana 122001
GSTIN: 06AAACI7573H1ZG, CIN No.:U74899DL2000PLC107621
State Name : Haryana