HDFC ERGO General Insurance Company Limited

Certificate of Insurance cum Policy Schedule 2302205520425601000

Standalone Motor Own Damage Cover - Private Car

2302205520425601000

Vehicle Details Policy Details

MR TARUN GROVER Make TOYOTA KIRLOSKAR Policy No. 2302 2055 2042 5601 000
D1 D2 32 KASHIPUR BY PASS ROAD PRAGATI VIHAR Model INNOVA CRYSTA-2.4 ZX AT 7 STR Period of From 30 Jun, 2024 00:01 hrs
RUDRAPUR UDHAM SINGH NAGAR UDHAM SINGH NAGAR Insurance
Registration No UK-06-BD-3100 To 29 Jun, 2025 23:59
UTTARAKHAND - 263153 Tel. 99XXXXXXX0
RTO UDHAM SINGH NAGAR Issuance Date 27/06/2024
Chassis No. MBJAB3EM402573444 Invoice No. 205520425601000
Cubic Capacity /Watts 2393 Seats 7 Customer Id 101524394248
Year of Manufacture 2022 Body Type MUV
Engine No. 2GDA651514 EIA No. Not provided
Odometer reading:
Payment Details : PMR19506090271218 , Bank Name:BIZDIRECT
Email ID : taxxxxxxxxx16@gxxxx.com
Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Year 1 From 30/06/2024 To 29/06/2025 1978200 0 0 0 0 1978200
Own Damage Policy Period
From Date & Time 30/06/2024 00:01 hrs To Date & Time 29/06/2025 Midnight
Premium Details (`)
Own Damage Premium(a) (`) Liability Premium(b) (`)
Basic Own Damage 13056 Total Premium (a+b) 30878
Total Basic Premium 13056 GST 18% : Central Tax 9% ( `2779 ) + State Tax 9% ( `2779) 5558
Less: No Claim Bonus (20%) 2611
Total - Less 2611
Add on Coverages
Zero Depreciation IRDAN125RP0001V01201920/A0014V01201920 7913
Emergency Assistance Cover IRDAN125RP0001V01201920/A0013V01201920 350
Engine and Gear box Protection IRDAN125RP0001V01201920/A0006V01201920 2769
Cost of Consumable Items IRDAN125RP0001V01201920/A0007V01201920 1978
Return to Invoice - A. Purchase Invoice value - 6924
(IRDAN125RP0001V01201920/A0010V02202324)
Emergency Assistance Wider IRDAN125RP0001V01201920/A0014V01201920 499
Total - Add on 20433
Net Own Damage Premium (a) 30878 Total Premium 36436
Geographical Area India Compulsory Deductible (IMT-22) 2,000 Voluntary Deductible 0
Previous Policy No. 2302205520425600000 Valid 30/06/2023 to 29/06/2024 of HDFC ERGO GENERAL INSURANCE CO.LTD. NCB 0%
Policy Holder declare that no claim has been made in the previous year policy. If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.
Compulsory PA cover for owner driver has not been provided to the insured basis his/her declaration of not holding an effective driving license Or having Alternate PA / Stand alone CPA policy with minimum sum
insured of Rs 15 Lakhs.
Hypothecated(IMT-7) with:CANARA BANK,Default

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. Persons or Class 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. Limits of Liability 1. Under Section II-1 (i) of the policy - Death of or bodily injury - Such amount as is
necessary to meet the requirements of the Motor Vehicles Act, 1988. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 750000 3. P. A. Cover under Section III for Owner - Driver(CSI): `
NA Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request and the same is also available at our website.

I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act 1988.The stamp duty of Rs. 0.50
paid b y Demand Draft, vide Receipt/Challan no. NO.LOA/ENF-1/CSD/34/2023/6045 dated 27/12/2023 as prescribed in Government of Maharashtra Order No. Mudrank No. 2017/CR.97/M-1, dated the 09th January
2018. I / We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not required to
prepare an invoice in terms of the provisions of the said sub-rule. 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". Disclaimer: The Policy shall be void from inception if the premium in full i s not realised by the company. In the event of misrepresentation, fraud or non-disclosure of
material fact, the Company reserves the right to cancel the Policy. Please note that the insured vehicle was pre-inspected and a report was prepared accordingly. The existing damages to the vehicle as mentioned
in the report shall not be paid by the Company. The policy is issued basis the information provided by you, which is available with the company. In case of discrepancy or non recording of relevant information in the
policy, the insured is requested to bring the same to the notice of the company within 15 days. GST for this invoice is not payable under reverse charge basis.
Important Notice - The policy coverages is only for Own Damage and Third Party Liability in connection to vehicle is not covered in the policy.
Active TP Policy No: 2302205520425600000 Valid From 30/06/2022 to 29/06/2025 of HDFCERGO

Branch :dehradun - 3rd floor, ncr developers, 24a cantt road, dehradun dehradun

For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
Goods & Services Tax Registration No: 05AABCL5045N1ZE HSN Code 997134
Agent Name : Silky Sachdewa For HDFC ERGO General Insurance Company Ltd
Agent Code : 201458692815 Tel No. : 91-9012512212

Duly Constituted Attorney

Scan the code for Instant Policy Info, Register/Track Claim, Renewal and Modifications in policy.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN :IRDAN125RP0001V01201920. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
Certificate of Insurance cum Policy Schedule 2302205520425601000

Standalone Motor Own Damage Cover - Private Car

2302205520425601000

"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings."

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN :IRDAN125RP0001V01201920. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
HDFC ERGO General Insurance Company Limited
2302205520425601000

Proposal Form cum Transcript Letter For Standalone Motor Own Damage Cover - Private Car

Vehicle Details Proposal Details

Make TOYOTA KIRLOSKAR Proposal No. 202406250022808
Model INNOVA CRYSTA-2.4 ZX AT 7 STR Period of From 30 Jun, 2024 00:01 hrs
Registration No UK-06-BD-3100 Insurance To 29 Jun, 2025 23:59
RTO UDHAM SINGH NAGAR Issuance Date 27 Jun 2024
2302205520425601000
Chassis No. MBJAB3EM402573444 Invoice No. 205520425601000
MR TARUN GROVER Cubic Capacity Customer Id 101524394248
2393 Seats 7
D1 D2 32 KASHIPUR BY PASS ROAD PRAGATI VIHAR RUDRAPUR
UDHAM SINGH NAGAR UDHAM SINGH NAGAR - 263153 Year of Manufacture 2022 Body Type MUV
UTTARAKHAND - Tel. 99XXXXXXX0 Engine No. 2GDA651514
Odometer reading:
Payment Details : PMR19506090271218 , Bank Name:BIZDIRECT
Email ID : taxxxxxxxxx16@gxxxx.com
Policy Year Policy Period For the Vehicle (`) Trailer (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)
Year 1 From 30/06/2024 To 29/06/2025 1978200 0 0 0 0 1978200
Own Damage Policy Period
From Date & Time 30/06/2024 00:01 hrs To Date & Time 29/06/2025 Midnight
Premium Details (`)
Own Damage Premium(a) (`) Liability Premium(b) (`)
Basic Own Damage 13056 Total Premium (a+b) 30878
Total Basic Premium 13056 GST 18% : Central Tax 9% ( `2779 ) + State Tax 9% ( `2779) 5558
Less: No Claim Bonus (20%) 2611
Total - Less 2611
Add on Coverages
Zero Depreciation IRDAN125RP0001V01201920/A0014V01201920 7913
Emergency Assistance Cover IRDAN125RP0001V01201920/A0013V01201920 350
Engine and Gear box Protection IRDAN125RP0001V01201920/A0006V01201920 2769
Cost of Consumable Items IRDAN125RP0001V01201920/A0007V01201920 1978
Return to Invoice - A. Purchase Invoice value - 6924
(IRDAN125RP0001V01201920/A0010V02202324)
Emergency Assistance Wider IRDAN125RP0001V01201920/A0014V01201920 499
Total - Add on 20433
Net Own Damage Premium (a) 30878 Total Premium 36436
Geographical Area India Compulsory Deductible (IMT-22) 2,000 Voluntary Deductible (IMT-22A) 0
Previous Policy No. 2302205520425600000 Valid 30/06/2023 to 29/06/2024 of HDFC ERGO GENERAL INSURANCE CO.LTD. NCB 0%
Policy Holder declare that no claim has been made in the previous year policy. If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.
Compulsory PA cover for owner driver has not been provided to the insured basis his/her declaration of not holding an effective driving license Or having Alternate PA / Stand alone CPA policy with minimum sum
insured of Rs 15 Lakhs.
Hypothecated(IMT-7) with:CANARA BANK,Default
Agent Name : Silky Sachdewa Agent Code : 201458692815 Tel No. : 91-9012512212
Anti rebate clause
Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended) : 1. No person shall allow o r 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 the 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 prospectuses or tables of the insurer: provided that acceptance by an
insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if
at the time of such acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees..

Terms and Conditions

I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C:
1 ) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract between me/us and
HDFC ERGO General Insurance Company Limited.
2) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately.
3) I/We also shall endeavor to procure the renewal notice and pass on the same to HDFC ERGO General Insurance immediately upon the receipt of such renewal notice.
4 ) Any person who, knowingly and with intent to defraud the Insurance Company o r other persons, files a proposal for insurance containing any false information, o r conceals for the purpose of misleading,
information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a denial of insurance benefits.
GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details provided during policy
issuance. For any subsequent changes or addition (i.e. if GSTIN not entered at the time of policy issuance ) on policy schedule, changes shall be carried out through fresh policy issuance with prospective effect.
5) I understand the Proposal No. 202406250022808 is issued to me basis on above information.
6) It has been declared by you that you are not a Politically Exposed Person and the source of funds to purchase this policy are from salary/business income.
Transcript Declaration : In case disagreement or objection or any other changes with respect to information and contents mentioned herein above,please contact our toll free number and register your objections /
changes / disagreement to the conte nt of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days from date of your receipt of this transcript along.

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN :IRDAN125RP0001V01201920. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com