ORIGINAL FORRECIPIENT/DUPLICATEFORSUPPLIER.

TAX INVOICE/CERTIFICATECUM POLICYSCHEDULE

(FORM 51 OF THECENTRALMOTORVEHICLES RULES, 1989)
Policy Type Stand-alone OD Policy ( Private Vehicle ) Proposal No. & Date SR37262668 / 15-Feb-2025
Policy No. & Type 14712942 Period of Insurance 16-Feb-2025 to 15-Feb-2026
Policy Issued On 15-Feb-2025 (12:04) Vehicle Identification No. MBHCZFB3SNF279084
Insured Name Mr Tanneru Veerendra Nath Geographical Area INDIA
Invoice No SR37262668 Accounting Code of Service 997134
S/O VENU BABU PARCHUR BAPATLA,
Insured Address BAPATLA-523190, Andhra Pradesh
Insured State & Code Andhra Pradesh-37 Place of Supply Andhra Pradesh GSTINof Customer GSTUNREGISTERED
INSURED MOTOR VEHICLEDETAILS INSURED DECLARED VALUE(IDV) (in Rs.)
Make Maruti Vehicle 656476
Model & Variant DZIRE BS6 ZXIAMT/MARUTI DZIRE ZXI 1.2L ISSAGS Non Electrical Accessories 0
Registration No AP39NL9991 Electrical Accessories 0
Year of Manufacture 2022 CNG/ LPG Kit 0
Engine- Chassis No 4117258 - MBHCZFB3SNF279084 Total IDV 656476
Cubic Capacity 1197
Seating Capacity 5
Type Of Body Saloon
RTO Location AP39NL9991 / BAPATLA
Schedule Of Premium (Amount in Rs.)
OWN DAMAGESECTION (A) Pre-Existing Third Party Policy Details.
Vehicle 15210 Insurance Company Name National Insurance Company Limited
Elec. Accessories 0 Policy No. 56080031221147996559
Non- Elec.Accessories 0 Risk Inception Date 18-Jul-2022
Kit (IMT-25) 0 Risk Expiry Date 17-Jul-2025
Extra Premium towards Inbuilt CNG/LPG NA
Basic Premium 15210 MISP - JAYALAKSHMIAUTOMOTIVES PVT LTD, GUNTUR
Geographical Area Extn. (IMT-1) NA
Lamp, Tyres etc. (IMT 23) 0
Driving Tuition Loading On OD Premium (60%) NA Notes : ( For Stand-alone ODPolicy )
Fiber Glass Tank 0 1. Policy Issuance is the subject to the realisation of cheque.
Sub-Total Additions 0 2. Consolidate stamp dutypaid to State Exchequer
Deductibles 3. The Policy is subject to a compulsory Deductible of Rs 1000 (IMT -22)
Voluntary Deductibles (IMT 22A) 0 4. Voluntaryexcess Rs (0)
5. Subject to Endorsements IMT ,7 10,
Anti-Theft Device (IMT-10) 157 6. The Coverage under this policy is only for Own Damage and no other liability in connection with
AAI Membership (IMT-8) 0 the vehicle.
No Claim Bonus (10%) 1521 7. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from NCB to
Discount for vehicles designed for handicapped NA Non-NCB, the recoverable amount maybe more than the NCB amount.
Sub - Total Deductibles 1678
Add - On Coverages
DEPRECIATION WAIVER 4061
Engine And Gear Box Protection Cover 4718
New Vehicle Replacement 1354
Loss Of Key Cover 250
Consumable Cover 956
Net own Damage Premium (A) 24871
IGST@18% 4476.78
Total ODPremium 29348
Nominee Details : Nominee Name TANNERU ANURADHA Age 49 Relation Mother
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail Electronic Payment 324012568919 ELECTRONIC PAYMENT 14841
Financier Type Cash Financier Name NA Financier Branch NA
Limitations as to use:- The Policycovers use of the vehicle for anypurpose 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) ReliabilityTrials, g) Anypurpose in connection with Motor Trade.
Driver: Anyperson 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 mayalso drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Deductibles: 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 onlybe allowed provided the policy
is renewed within 90 days of the expirydate 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. Anypayment made bythe Companybyreason of wider terms appearing in the
Certificate in order to complywith the Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMSAND RIGHT OF RECOVERY". For Legal interpretation, English
version will hold good.
For information on ombudsman you may visit website : https://www.cioins.co.in/Ombudsman
I / We herebycertify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter Xand Chapter XI of M.V. Act, 1988.
For IFFCO TOKIO GENERAL INSURANCE COMPANY
LIMITED
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.
Authorized Signatory
Policy Issuing Office:-IFFCO Tower II Plot No. 3 Sector 29 Gurgaon Haryana 122001
GSTIN: 06AAACI7573H1ZG, CIN No.:U74899DL2000PLC107621
State Name : Haryana