ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER.

TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)
Policy Type Package Policy( Private Vehicle ) Proposal No. & Date R200534760 / 24-Dec-2024
Policy No. & Type 42060031241150716760 Period of Insurance 28-Dec-2024 to 27-Dec-2025
Policy Issued On 24-Dec-2024 (00:00) Vehicle Identification No. MBHCZC63SKL522606
Insured Name Mr. Yugvir Singh Malik Geographical Area INDIA
Invoice No 4131248831444 Accounting Code of Service 997134
Insured Address S/O SH.SHER SINGH MALIK #H.NO-15,PATEL NAGAR TEH.& DISTT.-,,
BHIWANI-127021, Haryana
Insured State & Code Haryana-06 Place of Supply Haryana GSTIN of Customer GSTUNREGISTERED
INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE (IDV) (in Rs.)
Make Maruti Vehicle 258300
Model & Variant NEW SWIFT LXI BS-VI/MARUTI SWIFT LXI Non Electrical Accessories 0
Registration No HR16W5911 Electrical Accessories 0
Year of Manufacture 2019 CNG/ LPG Kit 0
Engine- Chassis No 1145899 - MBHCZC63SKL522606 Total IDV 258300
Cubic Capacity 1197
Seating Capacity 5
Type Of Body Saloon
RTO Location HR16W5911 / BHIWANI
Schedule Of Premium (Amount in Rs.)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle 2428 Basic Third Party Liability 3416
Elec. Accessories 0 Third Party Liability for Bi-fuel Kit 0
Non- Elec. Accessories 0 Compulsory PA Cover Premium to Owner-Driver (1 Year) 275
PA Cover for 5 Person of Rs (200000) each (IMT- 16 ) 500
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 2428 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) 4241
Driving Tuition Loading On OD Premium (60%) NA
Total Premium (A+B) 5424
Fiber Glass Tank 0 CGST @9% 488.16
Sub-Total Additions 0 SGST @9% 488.16
Deductibles Gross Premium Paid 6400
Voluntary Deductibles (IMT 22A) 0 Point of Sale - JAGMOHAN MOTORS LTD, BHIWANI
Anti-Theft Device (IMT-10) 61
AAI Membership (IMT-8) 0
Notes :
No Claim Bonus (50%) 1184
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 1245 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 10, 28, 16,
Nil Depreciation Plus 0 6. Fastag ID :-6080320090839007
Engine Protect 0 7. OD Premium rates are different for NCB/Non-NCB class of customer. In case of change from NCB to
Non-NCB, the recoverable amount may be more than the NCB amount.
Invoice Protect 0
Net own Damage Premium (A) 1183
Nominee Details : Nominee Name ARUN KUMAR MALIK Age 40 Relation Son
Payment Method Cheque No./Transaction No. Bank Name Amount
Payment Detail
Electronic Payment 113586552314 ELECTRONIC PAYMENT 6400
Financier Type Not Financed Financier Name NA Financier Branch NA
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 : https://www.cioins.co.in/Ombudsman
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
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:-Rohtak Division II, Narain Shopping Complex, Civil Road, Rohtak, Haryana
GSTIN: 06AAACN9967E2Z6, CIN No.:U10200WB1906GOI001713
State Name : Haryana