TwoWheeler-LiabilityPolicy

Page 1 of 1

HDFC ERGO General Insurance Company Limited

TWO WHEELER LIABILITY ONLY POLICY

POLICY NO. 2320200261769500000

Insured Name: MR. VIKASH YADAV S/O BIKRAM SINGH YADAV KOSLI, REWARI, REWARI HARYANA- 123302 Phone (Res): Mobile: 91-9999999999 Make Model-Variant Reg. No Engine No Chassis No Hypothecated With Period of Insurance Nominee [Owner Driver] Nominee [Named Passenger] HERO HONDA KARIZMA - STANDARD KL-01-AP-1029 00984 00995 FROM(TIME)19:06 Nominee Name(Relationship): Nominee Name(Relationship): Registration Address KOSLI, REWARI, REWARI HARYANA- 123302 E Mail: RTO Location Manufacturing Year Seating Capacity (of Side Car, If any) Type of Body Cubic Capacity DATE 19/05/2012 KOSLI 2006 2 OPEN 223 MIDNIGHT

Fax:

Vehicle Details

TO DATE 18/05/2013 Appointee (Relationship):

PREMIUM DETAILS (INR)

Liability Only (B)
Basic Third Party Liability Personal Accident : Owner Driver of Rs. 1,00,000 Employees of Insured Paid Drivers Total Add Sub Total Additions Less Sub Total(Deductions) Total Endt No Description 11 50 (IMT.20) 355.00 0.00 Net Premium 0.00 0.00 355.00 0.00 Service Tax* 355.00 50.00 50.00 305.00 Total Premium 305.00

Total Premium

38.00

343.00 Endt No Description Endt No Description

LIST OF ENDORSEMENTS
Endt No Description

Geographical Area: INDIA

*Including Education Cess & Higher Education Cess

LIMITATIONS AS TO USE: The policy covers use for any purpose other than a) hire or reward b) Organized racing or c) Speed testing Persons or Classes of Persons entitled to drive: 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 to Third Parties: 1. Under 1(i) of the Policy - Such amount as is necessary to meet the requirements of the Motor Vehicles Act 1988. 2. Under 1(ii) of the Policy - Rs. 6,000 Personal Accident cover for Owner-Driver (CSI) - Rs. . Terms, Conditions and Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request. Further the Indian Motor Tariff is also available and displayed at: 1. All the RTO offices 2. All HDFC ERGO General Insurance Company Limited offices / General insurance companies registered with IRDA. I / We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V.Act l988. "The stamp duty of Re .50 paid by Demand Draft, vide Receipt/Challan no 91232 dated 11/01/2012 as prescribed in Government Notification Revenue and Forest Department No Mudrank 2004/4125/CR 690/M-1, dated 31/12/2004". Service Tax Registration No.: AABCH0738EST004 Disclaimer: The Policy stands cancelled or void in the event of Cheque Dishonour. The company may cancel the policy by sending 7 days notice in case of any fraud, misrepresentation, non disclosure of material fact or non cooperation of the insured as per Regulation 7(n) of IRDA (Protection on Policy Holder`s interests) Regulations, 2002. In Case of any Claim, Please Call us at Our 24 Hour Call Centre Numbers. In the event of an accident, the insured should inform company immediately to arrange Spot Survey.

For a copy of terms & conditions visit www.hdfcergo.com or write to us at the below mentioned address or SMS "PTC Policy Number" to 9999700700

Policy Issuing Office

Mumbai

For HDFC ERGO General Insurance Company Limited

Agent Code 21034930 Phone No Agent Name : JAYESH SOJITRA

Duly Constituted Attorney
Corporate Office : 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri(E), Mumbai 400 059.Toll-Free No. 1800-2-700-700 Fax 91 22 66383699 care@hdfcergo.com www.hdfcergo.com Registered Office: Ramon House, H.T.Parekh Marg, 169, Backbay Reclamation, Mumbai 400 020, India.

http://124.247.218.38/Configurator/UnderwrittingMasters/Reports/frmTwoWheelerLia... 5/19/2012