Policy No.

: 2018-V5437778-FPV Date : 22/01/2018

Rajendrakumar Mafatlal Patel
15, Nilkanthnagar Soc,,
B/h Tripada Soc,,
Ghatlodia., To Activate Road Side Assistance(RSA) Cover,
Ahmadabad, SMS "ACTIVATE POLICY V5437778 " To 9222211100
Gujarat, Pincode : 380061
(Standard SMS charges applicable)
Telephone(Mob) : 8980012425
Email Id : [email protected]
60042255 - SPC

Dear Rajendrakumar Mafatlal Patel

Welcome to the Future Generali Experience.
We thank you for choosing Motor Secure insurance policy. Your Policy No. is 2018-V5437778-FPV . Motor Secure policy offers your
vehicle and yourself protection against any unforeseen vehicle accidents and loss to third party property or life arising there from as per
the coverage mentioned in the attached policy terms and conditions. We request you to kindly go through the same to acquaint yourself
with the available coverage .
Our initiatives will provide you with the highest standards of service, convenience and quality in motor insurance. Some of our
customerconveniences are as mentioned below:
1. Preferred Garages: We have a wide network of preferred garages that offer direct settlement facilities.
2. We also arrange a pickup facility for the damaged vehicle from the place of accident to our preferred garage for repairs. You
just have to call us. Expenses incurred for such facility is subject to the limit of towing charges as mentioned in the attached
policyterms and conditions.
3. Multiple Modes of Claim notification-In the unfortunate circumstances of an accident, you may notify us for a claim by
sending an SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable) or by calling us at 1800-220-233/
1860-500-3333/022-67837800 or by sending an email to [email protected] or walk into any of our nearest offices.

It will always be our endeavour to constantly better your experience by innovating and evolving our basket of conveniences. We strive to
deliver service which is personalized and is totally transparent. It is our aim to be with you in your time of need.
The policy has been issued on the basis of the proposal form . A copy has been enclosed for your reference . Please confirm that the
proposal form contains the correct information and is signed by you.

Please note : Transfer of benefits under this insurance policy is not automatic on the sale of the vehicle. The transferee must apply
within 14 days from the date of transfer of vehicle in writing to the insurance company with full details in a duly signed fresh proposal
form alongwith evidence of sale and transfer fees of ₹. 50/- + Goods and Service Tax.
**NCB has been allowed 20% on the basis of your declaration of 'No Claims' in your expiring policy. In case, we find that this
declaration is incorrect and/or false, all benefits under the Policy in respect of Section I of the policy will stand forfeited.
Once again, thank you for choosing to insure your vehicle with Future Generali and we look forward to being of service to you.
Assuring you of our best services at all times.
For Future Generali India Insurance Co. Ltd.

( Authorized Signatory )

Please review the communication address, email or contact nos. noted on this letter for correctness. In case
of any change please contact our nearest branch or call our care lines mentioned above. This will ensure you
do not miss out on 'Service Updates' and 'Renewal Reminders'.
Now you can buy Health, Personal Accident, Travel, Home, Motor insurance & also renew your Future
Generali Private Car Insurance policy online. Visit us at www.futuregenerali.in
For any service request please sms SERVE to 9222211100. To provide feedback on our service, kindly sms
HAPPY or UNHAPPY to 9222211100. We will call you back.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Tax Invoice

INSURED DETAILS
Policy Number : 2018-V5437778-FPV Address of Service Provider: Off Code-24,Future Generali India Insurance Co
Ltd, 2nd Floor, Baleshwar Square, Opp. ISCON
Temple, S. G. Highway, Ahmedabad, Gujarat,
Invoice Number : 201724PNT0054843
Pincode - 380054

Reverse Charge : No Area Code : S.G.Road Ahmedabad

Name of : Rajendrakumar Mafatlal Patel FGI State Code : 24
Insured/Proposer
Address : 15, Nilkanthnagar Soc,, B/h Tripada Soc,, FGI GSTIN Number : 24AABCF0191R1ZF
Ghatlodia., Ahmadabad, Gujarat, Pincode- 380061
State Code : 24 Intermediary Name \ Code : Direct
GSTIN / UIN Number : - Date of Issue / Invoice : 22/01/2018
Date
Period of Insurance : From 00:00 hours of 24/01/2018 HSN : 997134
To Midnight of 23/01/2019 Nature of Service : General Insurance Service

Received with thanks from Rajendrakumar Mafatlal Patel a sum of ₹ 22,756.00 towards Premium on the above mentioned policy.

PARTICULARS TAX(%) PREMIUM ( ₹ )

Gross Premium 19,285.00
Add : CGST 9% 1,735.65
Add : SGST 9% 1,735.65
Add : Cess -
Total (Rounded to nearest rupee) 22,756.00

NOTE :
1. In case of payment by cheque, in the event of dishonour of cheque for any reason whatsoever, insurance cover provided under this receipt automatically stands
cancelled from the inception irrespective of whether a seperate communication is sent or not.
2. Excess amount, if any, will be adjusted against subsequent policies, or will be refunded on demand.

For FUTURE GENERALI INDIA INSURANCE CO. LTD.

(Authorised Signatory)

Signature Not Verified

Digitally signed by DS Future
Generali India Insurance Co.
Ltd.
Date: 2018.01.22 20:53:18 IST
Location: Mumbai
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 22/01/2018

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Future Secure Motor Insurance- COMPREHENSIVE POLICY
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE - Form 51 of the Central Motors Vehicles Rules, 1989
Policy Servicing : Off Code-24,Future Generali India Insurance Co Ltd, 2nd Floor, Baleshwar Square, Opp. ISCON Temple, S.
Office G. Highway, Ahmedabad, Gujarat, Pincode- 380054., Tel_No: 079-40227101
Policy No. : 2018-V5437778-FPV Period of Insurance : From 00:00 hrs of 24/01/2018 To
Insured : Rajendrakumar Mafatlal Patel Midnight of 23/01/2019.
Address : 15, Nilkanthnagar Soc,, B/h Covernote No : - Dated: Zone: A
Tripada Soc,, Ghatlodia., Intermediary Name/Code : Direct
Ahmadabad, Gujarat, 380061 Telephone : 1800-220-233,1860-500-3333
GSTIN Number : - FGI GSTIN Number : 24AABCF0191R1ZF
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No., Make/Model of Vehicle Engine No. Chassis No.
RTA Location
GJ01RJ4371 HONDA CITY 1.5 VX MT 313303 005335
AHMEDABAD (I-DTEC)
Year of Manufacture Cubic Capacity Type of Body Seating Premium
Capacity
2015 1498 Saloon 5 22,756.00
DRIVERS CLAUSE :- 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.
LIMITATIONS AS TO USE - As per Motor Vehicle Rules, 1989 :- 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.
Geographical Area : INDIA
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 be good.
For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this
schedule.
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.
**NCB has been allowed 20 % on the basis of your declaration of 'No Claims' in your expiring policy. In case, we find that this
declaration is incorrect and/or false, all benefits under the Policy in respect of Section I of the policy will stand forfeited.
LIMITS OF LIABILITY
Under Section II-I (i) : Death of or bodily injury - Such amount Under Section II-I (ii) : Damage to Third Party Property- ₹
as is necessary to meet the requirements of Motor Vehicles Act, 750000 /- in respect of any one claim or series of claims arising
1988 out of one event.
Under Section III : PA Owner – Driver as per premium Compulsory DeductibleUnder Sec I - ₹ 1,000.00
computation table
Hypothecation Agreement with:- NIL
SPECIAL CONDITIONS – NIL
ADDITIONAL EXCESS – NIL
The nominee for Compulsory PA to owner driver cover is 01) Legal Heir, aged :36 Years, Relationship : Legal Executor,
Nomination % : 100%

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
Policy No : 2018-V5437778-FPV Period Of Insurance : From 00:00 hrs of 24/01/2018 To Midnight of 23/01/2019
INSURED'S DECLARED VALUE
For Vehicle-₹ For Non Elec For Side Car-₹ For Elec Accessories- For Bi-Fuel Kit Total Value-₹
Accessories - ₹ ₹ (CNG/LPG) - ₹
828,800 - - - - 828,800
SCHEDULE OF PREMIUM
PARTICULARS ₹ ₹
A-OWN DAMAGE
Basic Premium on Vehicle 13,604.75
**Less : No Claim Discount 20% 2,720.95
Add : Add-on Premium 5,138.56
Total Own Damage Premium (A) (rounded off) 16,022.00
B-LIABILITY
Basic Premium including Premium for TPPD 2,863.00
Add : Compulsory PA to Owner-Driver Rs. 2 lacs 100.00
Add : PA to persons other than Owner/Driver (No. of persons 5) PA Limit Rs. 100000 per person. 250.00
Add : Legal Liability to Paid Driver/Cleaner/Employees (No. of persons 1) 50.00
Total Liability Premium (B) 3,263.00
Total Annual Premium (A+B) 19,285.00
Total Premium for the Policy Period 19,285.00
Goods and Service Tax 3,471.30
Total Premium (rounded off) 22,756.00
Class of Vehicle: Private Car Subject to Endorsement Nos. 22,16,28,15
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 FUTURE GENERALI INDIA INSURANCE CO. LTD.

Date of Issue : 22/01/2018

Place of Issuance : Mumbai*

*Address as mentioned below ( Authorized Signatory )

Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 22/01/2018
For registration of your Motor Claims SMS MOTORCLAIM to 9222211100 (Standard SMS charges applicable)
The stamp duty of Rs. 0.50/- paid by GRAS DEFACE NO. 0004717624201718, dated 21/12/2017. Mudrank 2004/4125/CR/690/M-1,dated
31/12/2004.

Product UIN : 1/RD/FGIICL/MOTORS/FS/07-08

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 Annexure
Forming part of policy number:- 2018-V5437778-FPV
Motor Add-on Cover
Serial No. Add-on Description Premium Amount -₹.
(Before Tax)
1 Road Side Assistance 250.00
2 Zero Depreciation Cap 3,421.99
3 Theft Or Loss Of Keys 733.28
4 Loss Of Personal Belongings - Maximum payable amount Laptop:Rs. 50,000 ;Maximum 733.29
payable amount Mobile: Rs. 25,000
Please refer the attached detailed policy wordings for the above mentioned coverages.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287
 ENDORSEMENTS
(Attached to and forming part of policy)

IMT.15. PERSONAL ACCIDENT COVER TO THE INSURED * The Capital Sum Insured (CSI) per passenger is to be inserted.
OR ANY NAMED PERSON OTHER THAN PAID ** The registered sitting capacity of the vehicle insured is to be inserted.
DRIVER OR CLEANER IMT.22. COMPULSORY DEDUCTIBLE
(Applicable to private cars Including three wheelers rated as private cars (Applicable to Private Cars, three wheelers rated as private cars,all
and motorized two wheelers with or without side car [not for hire or reward]) motorized two wheelers, taxis, private car type vehicle plying for public /
In consideration of the payment of an additional premium It rs hereby agreed and private hire, private type taxi let out on private hire)
understood that the Company undertakes to pay compensation on the scale Notwithstanding anything to the contrary contained in the policy it is hereby
provided below for bodily Injury as hereinafter defined sustained by the insured understood and agreed that the insured shall bear under Section 1 of the policy in
person in direct connection with the vehicle insured or whilst mounting and respect of each and every event (including event giving rise to a total
dismounting from or traveling in vehicle Insured and caused by violent accidental loss/constructivetotal loss) the first Rs……* (or any less expenditurewhich may be
external and visible means which independentlyof any other cause shall within six incurred) of any expenditure for which provision has been made under this policy
calendar months of the occurrence of such Injury result In:- and/or of any expenditure by the insurer in the exercise of his discretion under
Details of Injury Scale of Compensation Condition no ….** of this policy.
i) Death 100% If the expenditure incurred by the insurer shall include any amount for which the
ii) Loss of two limbs or sight of two eyes or one 100% insured is responsiblehereunder such amount shall be repaid by the insured to the
limb and sight of one eye insurer forthwith.
For the purpose of this Endorsementthe expression“event” shall mean an event or
iii) Loss of one limb or sight of one eye 50%
series of events arising out of one cause in connection with the vehicle insured in
iv) Permanent Total Disablement from 100%
respect of which indemnity is provided under this policy.
injuries other than named above
Subject otherwise to the terms conditions limitations and exceptions of this Policy.
Provided always that :- * (i) to insert amount as appropriate to the class of vehicle insured as per GR. 40
(1) compensationshall be payable under only one of the items (i) to (iv) above In of the tariff.
respect of any such person arising out of any one occurrence and total liability of (ii) in respect of a vehicle rated under the Tariff for Private Car and in respect of a
the insurer shall not in the aggregate exceed the sum of Rs.........*during any one motorised two wheeler not carrying passengersfor hire or reward, if any deductible
period of insurance in respect of any such person. in addition to the compulsorydeductibleprovided in this endorsementis voluntarily
(2) no compensation shall be payable in respect of death or Injury directly or borne by the insured, the sum representingthe aggregate of the compulsory and the
indirectly wholly or in part arising or resulting from or traceable to (a) Intentional voluntary deductibles is to be inserted.
self Injury suicide or attempted suicide physical defect or infirmity or (b) an ** to insert Condition no 3 in respect of a vehicle rated under Tariff for Private Car
accident happening whilst such person Is under the influence of Intoxicating liquor / Two wheelers or Condition no 4 in respect of a vehicle rated under the Tariff for
or drugs. Commercial Vehicles.
(3) Such compensation shall be payable only with the approval of the insured IMT. 28. LEGAL LIABILITY TO PAID DRIVER AND/ OR
named in the policy and directly to the injured person or his/her legal
representative(s) whose receipt shall be a full dischargeIn respect of the Injury
CONDUCTOR AND / OR CLEANER EMPLOYED
of such person. IN CONNECTION WITH THE OPERATION
Subject otherwise to the terms exceptions conditions and limitations of this policy. OF INSURED VEHICLE
*The capital Sum Insured (CSI) per passenger is to be inserted. (For all Classes of vehicles)
IMT.16. PERSONAL ACCIDENT TO UNNAMED In consideration of an additional premium of Rs. 50/-notwithstanding anything to
the contrary contained in the Policy it is hereby understood and agreed that the
PASSENGERS OTHER THAN INSURED AND THE
insurer shall indemnify the insured against the insured’s legal liability under the
PAID DRIVER OR CLEANER Workmen's Compensation Act, 1923 , the Fatal Accidents Act, 1855 or at
(For vehicles rated as Private cars and Motorised two wheelers [not for hire Common Law and subsequent amendments of these Acts prior to the date of this
or reward] with or without side car) Endorsement in respect of personal injury to any paid driver and/or conductor
In consideration of the payment of an additional premium it is hereby understood and/or cleaner whilst engaged in the service of the Insured in such occupation in
and agreed that the insurer undertakes to pay compensation on the scale provided connectionwith the vehicle insured herein and will in addition be responsiblefor all
below for bodily injuries hereinafter defined sustained by any passenger other than costs and expenses incurred with its written consent.
the insured and/or the paid driver attendant or cleaner and/or a person in the employ Provided always that:
of the insured coming within the scope of the Workmen’s Compensation Act,1923 (1). this Endorsement does not indemnify the insured in respect of any liability in
and subsequentamendmentsof the said Act and engaged in and upon the service of cases where the insured holds or subsequently effects with any insurer or group of
the insured at the time such injury is sustained whilst mounting into, dismounting insurers a Policy of Insurance in respect of liability as herein defined for insured's
from or traveling in the insured motor car and caused by violent, accidental external general employees;
and visible means which independently of any other cause shall within three (2). the insured shall take reasonable precautions to prevent accidents and shall
calendar months of the occurrence of such injury result in : comply with all statutory obligations;
Details of Injury Scale of Compensation * (3) the Insured shall keep record of the name of each paid driver conductor
i) Death 100% cleaner or persons employed in loading and/or unloading and the amount of wages
ii) Loss of two limbs or sight of two eyes or 100% and salaries and other earnings paid to such employees and shall at all times allow
one limb and sight of one eye
the Company to inspect such records on demand.
Ill) Loss of one limb or sight of one eye 50%
(4) in the event of the Policy being cancelled at the request of the Insured no refund
iv) Permanent Total Disablement from injuries 100%
other than named above
of the premium paid in respect of this Endorsement will be allowed.
Subject otherwise to the terms conditions limitations and exceptions of the Policy
Provided always that : except so far as necessary to meet the requirements of the Motor Vehicles Act,
(1) compensationshall be payable under only one of the items (i) to (iv) above in 1988.
respect of any such person arising out of any one occurrence and total liability of *In case of Private cars/ motorised two wheelers(not used for hire or reward) delete
the insurer shall not in the aggregate exceed the sum of Rs. ………. * during any this para.
one period of insurance in respect of any such person.
(2) no compensation shall be payable in respect of death or injury directly or
indirectly wholly or in part arising or resulting from or traceable to (a) intentional
self injury suicide or attempted suicide physical defect or infirmity or (b) an
accident happening whilst such person is under the influence of intoxicating liquor
or drugs.
(3) such compensation shall be payable only with the approval of the insured
named in the policy and directly to the injured person or his/her legal
representatives(s)whose receipt shall be a full discharge in respect of the injury of
such person.
(4) not more than....** persons/passengersare in the vehicle insured at the time of
occurrence of such injury.
Subject otherwise to the terms exceptions conditions and limitations of this policy.

Future Generali India Insurance Company Limited, Corp. & Regd. Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat Marg,
Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: [email protected],
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287