This Document is Digitally Signed

Signer: AJIT KUMAR

The Oriental Insurance Company Limited Date: Saturday, May 4, 2019 6:32 AM
Location: NOIDA

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

PRIVATE CAR PACKAGE POLICY - ZONE A

Policy No : 211200/31/2020/19172 Prev Policy No : -

Cover Note No : - Cover Note Dt :

Insured's Code : 94859344 Issue Office Code : 211200

Insured's Name : Vikram Pavuluri (GSTIN: ) Issue Office Name : DO II NEW DELHI (GSTIN:
07AAACT0627R1Z1)

Address : F008,BREN WOODS APARTMENT Address : 16/20, WEA, FIRST FLOOR,NEAR SHASTRI
CHIK PARK,
KANAGAMANGALA ROAD PADAM SINGH ROAD, KAROL BAGH
D DDANAGAM
ANGALA BENGALURU NEW DELHI

KARNATAKA 560100 NEW DELHI DELHI 110005

Tel /Fax /Email : / / 9708679096 / [email protected] Tel /Fax /Email : 011-28750963, 28758823, 28753268/ / 011-
28750844 /
[email protected]
Lead/Breakin No : /

Local Servicing Office Code : 211200

Local Servicing Office Details : DO 2 NEW DELHI,16/20, WEA, FIRST FLOOR,NEAR SHASTRI PARK,,PADAM SINGH ROAD,
KAROL BAGH,NEW DELHI,,,011-28750963, 28758823,
Agent/Broker Details
Dev.Off.Code :
Agent/Broker : BF0000004776 POLICY BAZAAR 1
Address : PLOT 119, SECTOR 44, GURGAON-122001,
HARYANA,GURGAON,HARYANA,122001
Tel /Fax /Email : 18002088787//[email protected]

Period of Insurance : FROM 00:00 ON 05/05/2019 TO MIDNIGHT OF 04/05/2020

Collection No & Dt : 3 2005017821 - 03/05/2019 GST INVOICE NO :071810073707 UIN :0

Gross Premium : 16,509 GST : 2,972 Stamp Duty : .5 Total : 19,481

Geographical Area : IND Area Extension :

Particulars of Insured Vehicle:

Registration Mark Engine No. & Type Of Body Cubic Year Of Seating Capacity
& Place Chassis No. Make - Model Capacity Manf. (including Driver)

KA 04 MQ 0629 CWX101729 SKODA-RAPID 1.5 TDI OTHERS 1498 2015 4 + 1

CR AMBITION PLUS
Bangalore North FG012084
AT

Limitations as to use:

1 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) Use 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.

Limit of Liability:Under Section II-I(1) in respect of any one accident: as per Motor Vehicles Act, 1988.
Under Section II-I(ii) in respect of any one claim or series of claims arising out of one event is Rs. 750000
P.A. Cover under Section III for Registered Owner Cum Driver (CSI) : Rs. 0
*This insurance excludes all pre-existing damages

Place : NEW DELHI

Date : 03/05/2019
Page 1 of 3
 This Document is Digitally Signed
Signer: AJIT KUMAR
The Oriental Insurance Company Limited Date: Saturday, May 4, 2019 6:32 AM
Location: NOIDA

Attached to and forming part of policy number 211200/31/2020/19172

28753268/,9818491955,[email protected]

Insured's Declared Value

For the Vehicle For Trailers Non Electrical Electrical Value of CNG Total Value
Accessories Accessories LPG Kit

6,15,780 0 0 0 6,15,780
Nominee Details :
Nominee Name Age Relationship
Praharshini Madala 26 Spouse

SCHEDULE OF PREMIUM

A. OWN DAMAGE B. LIABILITY

BASIC OD COVER 20,216.00 BASIC TP COVER 2,863.00

MOTOR OD BASIC - NEW 20,216.00 BASIC TP TOTAL 2,863.00
BASIC OD TOTAL 20,216.00 TP TOTAL 2,863.00
ADD :ADD-ON COVER NIL DEPRECIATION 3,538.00 TOTAL PREMIUM 16,509.00
POLICY
LESS :Discount 10,108.00 STAMP DUTY 0.50

OD TOTAL 13,646.00 ADD :IGST 2,972.00

MOTOR TOTAL OD 13,646.00 TOTAL AMOUNT 19,481.00

Deductibles under Section-I : Compulsory Deductible 1000

Subject to IMT Endorsement Printed herein/attached to : IMT-22 , OIC-1:Nil Depreciation Cover

Details of IMT Endorsements are also available on the Company¿s Web Portal www.orientalinsurance.org.in

Hypothecation Agreement with: VOLKSWAGEN FINANCE LTD

Hire Purchase/Lessor Agreement with: -

In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured will comply with
the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as well as company's website.
The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OIC endorsements mentioned herein
above which are available on Company's website: www.orientalinsurance.org.in or on demand from the policy issuing office.

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void
abinitio (from inception).
Claim is not admissible if Driving License is found fake or is not valid whether or not in the knowledge of the insured.
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 Motor Vehicles Act, 1988.
In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands at DO II NEW DELHI
(GSTIN: 07AAACT0627R1Z1) on 03-MAY-19
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 MVAct, 1988 is
recoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

Place : NEW DELHI

Date : 03/05/2019
Page 2 of 3
 This Document is Digitally Signed
Signer: AJIT KUMAR
The Oriental Insurance Company Limited Date: Saturday, May 4, 2019 6:32 AM
Location: NOIDA

Attached to and forming part of policy number 211200/31/2020/19172

For and on behalf of

The Oriental Insurance Company Limited
Entered By : POLICY BAZAR

Examined By : POLICY BAZAR

AJIT KUMAR
Policy Printed By P10_DEMO IP : General Manager
Policy Printed On 04-MAY-19 06:32:42 Authorised Signatory

This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll Free No. 1800 11 8485 and 011 33208485.
CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Place : NEW DELHI

Date : 03/05/2019
Page 3 of 3