GOODS CARRYING VEHICLE PACKAGE POLICY

CERTIFICATE OF INSURANCE AND POLICY SCHEDULE

As per provisions of Motor Vehicle Act 1988
CERTIFICATE CUM POLICY NUMBER: V0859976
Important: 1) The validity of this certificate of Insurance cum policy is subject to realization by the company of the premium cheque paid by the Insured.

INSURED NAME MR. FAYAZA SHESHAGERI PHONE NO 9902305093 E-MAIL [email protected]

POLICY/INVOICE ISSUED DATE 28/08/2025
GEOGRAPHICAL AREA INDIA
PROPOSER ADDRESS SO SABJANSAB AP AKKIALUR TQ HANGAL, DT REGISTRATION DATE 27/08/2022
HAVERI, HANGAL, KARNATAKA, INDIA, 581102 RTO ZONE HAVERI
CUSTOMER ID 1311905
NOMINEE NAME LEGAL HEIR
RELATIONSHIP WITH PROPOSER FATHER
NOMINEE AGE 60
PERIOD OF INSURANCE 28/08/2025 14:47 To 27/08/2026 23:59 APPOINTEE / GUARDIAN NAME NA
FINANCIER DETAIL NA APPOINTEE / GUARDIAN NA
RELATIONSHIP
POLICY ISSUANCE OFFICE KARNATAKA,BANGALORE EIA ACCOUNT NUMBER NA
PARTICULARS OF VEHICLE INSURED
REGISTRATION NUMBER KA-27-C-4825 MANUFACTURING YEAR / MONTH 2022 / 08
MAKE ASHOK LEYLAND MODEL / VARIANT DOST PLUS RLS GVW 2750
ENGINE NUMBER ENH048059P CHASSIS NUMBER MB1AA22E5NREA6274
CC/KW 1478 CARRYING CAPACITY 2
FUEL TYPE DIESEL GVW 2750
BODY TYPE OPEN
PREVIOUS YEAR POLICY DETAILS
PREVIOUS YEAR POLICY VD327066 PREVIOUS YEAR INSURER NAME FUTURE GENERALI INDIA
NUMBER INSURANCE CO. LTD.
INSURED'S DECLARED VALUE (Rs.)
VEHICLE IDV BODY IDV TRAILER IDV NON-ELECTRICAL ELECTRICAL OR CNG KIT LPG KIT TOTAL IDV
ACCESSORIES ELECTRONIC
ACCESSORIES
590000.00 0 0 0 0 0 0 590000.00
SCHEDULE OF PREMIUM (AMOUNT IN Rs.)
A. Own Damage B. Liability
Own Damage Premium 1528.00 Basic Third Party Liability 16049.00
CNG-Kit 0 Restricted TPPD (Limit: 6000) 0
LPG-Kit 0 CNG Kit-TP 0
Electrical or Electronic accessories 0 LPG Kit-TP 0
Non-Electrical Accessories 0 Geographical Extension (TP) 0
Geographical Area Extension (IMT-1) 0 Trailer-TP 0
Fibre Glass Fuel Tank 0 IMT34-TP 0
Lamp,Tyre Mudguards (IMT - 23) 229.00 Compulsory PA for owner driver 330.00
Trailer-OD 0 PA to Paid Driver ( Sum Insured:100000, No of Drivers:1 ) 60.00
Imported Vehicle 0 LL To Paid Driver/Conductor(No of Persons : 1): 50.00
Driving Tuition-OD 0 Legal Liability Cleaner/Conductor/Coolies (No of 0
Persons:0)
IMT34-OD 0 Legal Liability To Fare Paying Passenger 0
Handicap 0 LL To Non-Fare Paying Passengers Including Employees 0
Use of Vehicle confined to Sites 0 LL To Non fare paying passenger Excluding Employees 0
LL to person employed under WCA (max 6) 0
LL to persons employed under WCA excluding paid driver 0
Own Damage Premium before NCB 1757.00
NCB (35%) -615.00
Total Own Damage Premium: 1142.00 Total Liability Premium: 16489.00
TOTAL PACKAGE PREMIUM (A+B) 17631.00
NET PREMIUM 17631.00
OWN DAMAGE AND OTHER LIABILITY COVERS 1582.00 BASIC LIABILITY 16049.00
CGST(9%) 143 CGST(6%) 963
SGST(9%) 143 SGST(6%) 963
UGST(9%) 0 UGST(6%)
IGST(18%) 0 IGST(12%)
KERALA CESS(%) 0 KERALA CESS(%) 0
OWN DAMAGE AND OTHER LIABILITY COVERS 1868.00 TOTAL BASIC LIABILITY(INCLUDING GST) 17975.00
(INCLUDING GST)
TOTAL TAX PAYABLE 2212
TOTAL PREMIUM 19842
POLICY SUBJECT TO THE FOLLOWING IMT(S): 21,23,15,39,17
DEDUCTIBLE UNDER SECTION - I :(i) Compulsory deductible Rs 500/- for vehicle not exceeding GVW 7500 , Rs 1000/- for vehicle exceeding GVW 7500
but not exceeding 16500 GVW and Rs 1500/- for vehicle exceeding GVW 16500.
INTERMEDIARY CODE / NAME 1001084 / Landmark Insurance Brokers Pvt. Ltd.
INTERMEDIARY CONTACT NUMBER 18004194199
INTERMEDIARY EMAIL ID [email protected]
LIMITS OF LIABILITY : (a) Under Section II (1) (i) of the Policy-Death of or bodily injury to any person so far as it is necessary to meet the requirements of the
Motor Vehicle Act, 1988. (b) Under Section II (1)(ii) of the Policy-Damage to property other than property belonging to the insured or held in trust or in the custody of
control of the insured up to the limits specified- (i) TPPD 7,50,000/-. (ii) PA cover for owner driver under section III CSI Rs 1500000/-.

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’S CLAUSE: Any person including the Insured provided that a person driving holds a valid 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 a valid 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.
For RAHEJA QBE GENERAL INSURANCE COMPANY LIMITED

IMPORTANT : In case of payment by cheque, in the event of dishonor of cheque for any reason whatsoever, insurance cover provided under this
document automatically stands cancelled from inception
We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance is issued in accordance with the provisions of Chapter X and
Chapter XI of the Motor Vehicle Act 1988
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.

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 table.
% of Discount on Own Damage Premium
Period of Insurance % of NCB on OD Premium
The Preceding Year 20%
Preceding Two Consecutive Years 25%
Preceding Three Consecutive Years 35%
Preceding Four Consecutive Years 45%
Preceding Five Consecutive Years 50%

"It is hereby declared and agreed that all pre-existing damages to the vehicle having occurred prior to the commencement of cover are excluded from
the scope of the policy".
The policy wording with detailed terms, conditions and exclusions are available on our website www.rahejaqbe.com
Statutory Provisions:
"As per Section 146 of the Motor Vehicle Act, 1988 it is Mandatory to have your vehicle insured against third party risk.
I/We hereby certify that the Policy to which the certificate relates as well as this certificate of insurance are issued in accordance with the provision of
Chapter X and Chapter XI of M.V. Act, 1988.
*Except as provided in GR 27 Rule (g) of IMT i.e. Sale of Vehicle, No NCB will be allowed, when a policy is not renewed within 90 days of the expiry.
Note: In the event of dishonor of cheque, this policy document automatically stands cancelled from inception irrespective of whether a separate
communication is sent or not. The policy has been issued based on the information provided by you and the policy is not valid if any of the information
provided is incorrect, subject otherwise to the terms, conditions and exclusions of the Commercial Vehicle Package Policy Schedule. In witness
whereof this Policy has been signed at Mumbai on policy start date in lieu of Proposal/Cover note No. as mentioned in the policy.
Updating Registration Number of vehicles within 15 days of policy inception is MANDATORY as per IRDA. Kindly provide the same to your Agent/Our
Call centre/Policy issuing Branch (Applicable for policies issued without Registration No of vehicles).
It is warranted that the insured named herein/owner of the vehicle holds valid Pollution Under Control (PUC) Certificate and/or valid/fitness certificate as
applicable on the date of commencement of the policy and undertakes to maintain and renew a valid and effective PUC and/or fitness certificate, as
applicable during the subsistence of the Policy.
Note: Kindly acknowledge the receipt of this policy. In case you find any variations against your proposal or any discrepancy in the policy, kindly
contact us immediately. In the unfortunate event of a claim, please call quoting your Policy No.on Toll Free No : 1800 102 7723 (9 am to 8 pm, Monday to
Saturday) and register your claim immediately within 7days from the date of loss. You can also reach us at [email protected].
Stamp Duty of Rs.0.50/- is paid as provided under Article 47(B) of Indian Stamp Act, 1899 and included in Consolidated Stamp Duty Paid to the
Government of Maharashtra Treasury vide Order of Addl.Controller Of Stamps, Mumbai at General Stamp Office, Fort, Mumbai - 400001., vide this Order
no. ENF-1/LOA/CSD/15/2025/781 Validity Period Dt. 31/03/2025 To Dt.31/03/2030
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.

UIN : IRDAN141RP0008V02200910
Name of Product/Add-on Product UIN
Compulsory PA Owner Driver IRDAN141RP0004V02201819

Raheja QBE General Insurance Company Limited, IRDAI Registration Number – 141.
Fulcrum, 501 & 502, A wing, 5th Floor, International Airport Project Road,
Sahar, Andheri East, Mumbai - 400059.
Telephone : +91 22 4231 3888 Facsimile : +91 224231 3777
Invoice No:V0859976 Date:28/08/2025 Branch GST:29AADCR7145R1ZJ
Place of Supply:KARNATAKA,BANGALORE Description of Service: Motor Insurance Service
GST:Service Code : 997134 CIN :U66030MH2007PLC173129 Client GSTN :
Trade logo displayed belongs to R Raheja Investments Pvt. Ltd.& QBE Insurance Group Ltd. and used by Raheja QBE General Insurance Company
Limited under License.
TOLL FREE NUMBER: 1800 - 102 - 7723
(9 am to 8 pm, Monday to Saturday)