V3692235_SCHEDULE

FUTURE GENERALI INDIA

Insurance Company Limited

MOTOR SECURE - PRIVATE CAR INSURANCE - COMPREHENSIVE POLICY

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989

Policy Servicing Office : Off Code-24,Future Generali India Insurance Co Ltd, 2nd Floor, Baleshwar Square, Opp. ISCON Temple, S. G. Highway, Ahmedabad, Gujarat,
380054, Tel_No:079-40227101

Policy and Certificate Number : 2015-V3692235-FPV Period of Insurance i : From 00:00 hrs of 12/04/2015 To midnight of 11/04/2016.

Insured : Rohitkumar Shivrambhai Patel Covernote No :8-zzzz Dated:zzzzzzzZone: A
Address
: C/9 Shiv Parvati Soc, Nr Gopi Bunglows, Vastral Intermediary Name/Code : Girishbhai Kantilal Ravat / 60021761
Road, Ahmadabad, Gujarat, 382418
Telephone (Hom) : 9825096900

Email Id : [email protected]

INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION

Registration No., Make/Model of Vehicle Year of Engine No. Chassis No. Cubic Seating Type of Body
RTA Location Manufacture Capacity Capacity Saloon

GJ27C5712 CHEVROLET SPARK 1.0 2012 83KC2 03724 995 5
AHMEDABAD

INSURED'S DECLARED VALUE

For Vehicle-Rs. For Non-Electrical Accessories-Rs. For Trailers-Rs. For Electrical/Electronic Accessories-Rs. For Bi-Fuel Kit (CNG/LPG)-Rs. Total Value-Rs.
25,000 240,000
215,000 - - -

A-OWN DAMAGE SCHEDULE OF PREMIUM Rs.
Rs. B-LIABILITY

Basic Premium on Vehicle 4,060.44 Basic Premium Including Premium for TPPD 1,468.00
Add : Bi-Fuel Kit (CNG/LPG) 1,000.00 60.00
**Less : No Claim Discount 35% 1,771.15 Add : Bi-Fuel Kit (CNG/LPG) 100.00
Add : Add-on Premium 1,290.00 Add : Compulsory PA to Owner-Driver - Rs. 2 lacs 250.00
Add : PA to persons other than Owner/Driver
Total Own Damage Premium (A) (rounded off) 4,579.00 50.00
Total Annual Premium (A+B) 6,507.00 No. of persons 5 P.A. Limit - Rs. 100000 per person
Add : Legal Liablity to Paid Driver/Cleaner/Employees 1,928.00
Subject to Endorsement Nos. 22 ,25 ,16 ,28 ,15 ,07 6,507.00
No. of persons 1
Total Liability Premium (B) 805.00
Total Premium for the Policy Period 7,312.00
Service Tax (Including Cess)
Total Premium (rounded off)

Hypothecation Agreement with:- HDFC BANK LTD

LIMITATIONS AS TO USE – As per Motor Vehicle Rules, 1989 :- The Policy covers DRIVERS CLAUSE :- Any person including the insured: Provided that a person driving
use of the vehicle for any purpose other than: a) Hire or Reward, b) Carriage of goods holds an effective driving license at the time of the accident and is not disqualified from
(other than samples or personal luggage), c) Organized racing, d) Pace making, e) Speed holding or obtaining such a license; Provided also that the person holding an effective
testing, f) Reliability Trials, g) Any purpose in connection with Motor Trade 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-I (i) : Death of or bodily injury - Under Section II-I (ii) : Damage to Third Party Property-Rs. Under Section III : PA Owner – Compulsory

Such amount as is necessary to meet the requirements 750000/- in respect of any one claim or series of claims arising Driver as per premium computation Deductible Under

of Motor Vehicles Act, 1988 out of one event. table Sec I - Rs. 1,000.00

SPECIAL CONDITIONS – ADDITIONAL EXCESS –

The nominee for Compulsory PA to owner driver cover is 01) LEGAL HEIR, aged: 21 Years, Relationship: Legal Executor, Nomination %: 100%

IMPORTANT - 1. All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2. 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 the inception irrespective of whether a seperate communication is sent or not.

**We have granted you No Claim Bonus, in good faith, based on your declaration. In case it is found later that the declaration is not correct, the Own Damage cover for your vehicle
under the Policy will stand cancelled ab initio. You shall not be entitled to any refund or claims under the policy. Kindly, therefore, revalidate your declaration and arrange to remit the
difference in premium, if the declaration is incorrect.

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.

Receipt No : Z5022487 For FUTURE GENERALI INDIA INSURANCE CO. LTD.

Date of Issue : 25/04/2015

Place of Issuance : Mumbai*

*Address as mentioned below.

This policy is not valid unless it is countersigned by an authorised signatory

For registration of your Motor claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable) (Authorised Signatory)

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 verison will be good.

For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this schedule.
The stamp duty of Rs. 0.50 paid by GRAS DEFACE NO.0003288260201415, dated 21/01/2015.Mudrank 2004/4125/CR/690/M-1,dated 31/12/2004.

Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013, Maharashtra
Care Lines:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected], Website: www.futuregenerali.in
IRDA Regn. No 132, CIN - U66030MH2006PLC165287, Service Tax Registration Number: AABCF0191RSD002

FUTURE GENERALI INDIA

Insurance Company Limited

Forming part of policy number:-2015-V3692235-FPV Annexure Premium Amount - Rs.
1,290.00
Serial No. Motor Add-on Cover
0001 Add-on Description 1,290.00

Plan 1

- Total Premium
Forming part of policy number:-2015-V3692235-FPV Motor Add-on Cover Details

Zero Depreciation Cap
Theft Or Loss Of Keys
Loss Of Personal Belongings - Maximum payable amount Laptop: Rs. 50,000 ;Maximum payable amount Mobile: Rs. 25,000
Road Side Assistance
Please refer the attached detailed policy wordings for the above mentioned coverages.

Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg, Elphinstone Road, Mumbai-400013, Maharashtra
Care Lines:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected], Website: www.futuregenerali.in
IRDA Regn. No 132, CIN - U66030MH2006PLC165287, Service Tax Registration Number: AABCF0191RSD002