ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRALMOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R131427010 / 08-Jun-2021
Policy No. & Type 50240031211146561421 Period of Insurance 10-Jul-2021 to 09-Jul-2022
Policy Issued On 08-Jun-2021 (00:00) Vehicle Identification No. MA3EWDE1S00582497
Insured Name Mr. Deeban Durai K Geographical Area INDIA
Invoice No 4131215014667 Accounting Code of Service 997134
Insured Address S/O:LATE.MR.K.S.KARUMALAI,5/15/4-1,GANDHI NAGAR FIRST STREET, PUTHU PALLIPALAYAM ROAD,KOMARAPALAYAM, ,, ,
NAMAKKAL-638183, Tamil Nadu
Insured State & Code Tamil Nadu-33 Place of Supply Tamil Nadu GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 137698
Model & Variant WagonR New Vxi/MARUTI WAGON R VXI Non Electrical Accessories 0
Registration No TN34T0238 Electrical Accessories 0
Year of Manufacture 2013 CNG/ LPG Kit 0
Engine- Chassis No 1664852 - MA3EWDE1S00582497 Total IDV 137698
Cubic Capacity 998
Seating Capacity 5
Type Of Body Saloon
RTO Location TN34T0238 / TIRUCHENGODE
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 1336 Basic Third Party Liability 2072
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PACover Premium [1 Year] 275
PACover for 5 Person of Rs (100000) each (IMT- 16 ) 250
Kit (IMT-25) 0
Legal Liability (WC) to Driver (IMT-28) 50
Extra Premium towards Inbuilt CNG/LPG NA Geographical Area Extn. (IMT-1) NA
Basic Premium 1336 Legal Liability to Employees (IMT-29) 0
Geographical Area Extn. (IMT-1) NA Legal Liability to Passenger (IMT 46) 0
Lamp, Tyres etc. (IMT 23) 0 Driving Tuition Loading On TP Premium (60%) NA
Net Liability Premium (B) 2647
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 3298
Fiber Glass Tank 0 CGST @9% 296.82
Sub-Total Additions 0 SGST @9% 296.82
Deductibles Gross Premium Paid 3892
Voluntary Deductibles (IMT 22A) 0 MISP - NEXGEN VENTURES PRIVATE LIMITED, CHENNAI
Anti-Theft Device (IMT-10) 33
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus (50%) 652
Discount for vehicles designed for handicapped NA 1. Policy Issuance is the subject to the realisation of cheque.
2. Consolidate stamp duty paid to State Exchequer
Sub - Total Deductibles 685 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Add - On Coverages 4. Voluntary excess Rs (0)
5. Subject to Endorsements IMT ,7 10, 28, 16,
Nil Depreciation Plus 0
Engine Protect 0
Invoice Protect 0
Net own Damage Premium (A) 651
Nominee Details : Nominee Name K KALAI MANI Age 69 Relation Mother
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Net Banking 110180231424 ELECTRONIC PAYMENT 3892
Financier Type Financed Financier Name STATE BANK OF INDIA Financier Branch SIPCOT PERUNDURAI
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 National Insurance Company Limited

Authorized Signatory
Policy Issuing Office:-Chennai Natmar Business Hub, Second Floor, 169, Anna Salai, Chennai
GSTIN: 33AAACN9967E1ZA, CIN No.:U10200WB1906GOI001713
State Name : Tamil Nadu