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MAGMA HOUSE, 24 Park Street , Kolkata -700016

(www.magma-hdi.co.in)

Date : 30/06/2014

To,
Mr MINY RAJ MODI Mobile No: 9713300650
Alternate No: 9713300650
E-1/87 ARERA COLONY BHOPAL BHOPAL E-mail ID:
462001,
BHOPAL,
MADHYA PRADESH.

Agent/ Intermediary Name and Code: BRC0000011

Dear Mr MINY RAJ MODI

(Customer ID: 20000398147)

We extend our warm welcome to you as an esteemed customer of Magma HDI General Insurance Co Ltd.

At the onset, we wish to thank you for choosing Magma HDI as your preferred insurer and subscribing to MHDI Motor
Comprehensive Policy. Your policy no is P0015200013/4101/106559.

We look forward to a long lasting relationship. In order for us to serve you better, we request you to update your above
mentioned contact information.

This will enable us to update you on new offerings & servicing your requirements including claims. We are available to
address all your service related queries through our Toll Free No 1800 3002 3202 and e-mail id customercare@magma-
hdi.co.in and we shall get back to you at the earliest.

You may also contact us through your servicing agent.

Assuring you of our best services at all times.

Best Regards

For Magma HDI General Insurance Co Ltd.

Authorised Signatory

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MAGMA HOUSE, 24 PARK STREET , KOLKATA -700016

PRIVATE CAR PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM SCHEDULE
IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realisation of the premium cheque.
2) No Claim Bonus will only be allowed provided the Policy is renewed within 90 days of the expiry date of the previous policy.
Policy Servicing Office 3RD FLOOR, T-5, "CITY CENTRE", PLOT NO-1, PRESS COMPLEX, ZONE-1, M.P.NAGAR BHOPAL- 462011
BHOPAL - 462011 MADHYA PRADESH
PH: FAX:
Policy No P0015200013/4101/106559 Period Of
From 00:00 Hrs of 02/07/2014
Geographical Area India Insurance
Insured Mr MINY RAJ MODI To Midnight of 01/07/2015
Address E-1/87 ARERA COLONY BHOPAL BHOPAL Agent No BRC0000011
462001 BHOPAL MADHYA PRADESH Agent Contact no.:
Business / Profession None Covernote No
Contact Number 9713300650 Covernote Date
PG/IR No. Zone Zone-B

Hire Purchase/ Lease /Hypothecated

ICICI BANK LTD
with
Carrying on or engaged in the business or occupation of and no other for the purposes of this Insurance
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Licensed
Carrying
Trolley Serial Trolley Chassis Year of
Registration Mark & No. Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW capacity
ID No. Manufacture
including
Driver
MERCEDES-BENZ E-CLASS E-
MP 04 CH 9009 2011 65191130408463 WDD2040036L044118 2143 5
250 D BENZ 250 D/SALOON
IDV (INSURED'S DECLARED VALUE)
Non Electrical Accessories Electrical/electronic
IDV of Vehicle Trailers Bi-Fuel kit(LPG/CNG) Other accessories Total Value
Accessories
2074500 0 0 0 0/0 0 2,074,500.00
A-OWN DAMAGE B-LIABILITY
Own Damage Premium on vehicle and accessories Third Party Premium
Basic Cover Basic Cover
Basic - OD 27,740.22 Basic - TP 4,109.00
EXTENSIONS UNDER OWN DAMAGE SECTION PA Benefits
Add On Cover Basic 8,294.89 PA Owner Driver 100.00
TOTAL OWN-DAMAGE PREMIUM 36,035.00 Legal Liability
LL to Paid Driver IMT 28 50.00
TOTAL LIABILITY PREMIUM 4,259.00
TOTAL POLICY PREMIUM 40,294.00
Service Tax(Including education cess & higher education cess) 4,980.34
TOTAL 45,274.00
Disclaimer: The exclusions in this policy are as specified in the pre inspection report ID: , Inspection Company:
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)Use in connection with Motor Trade
The Policy does not cover use for a) Organised racing, b) Pace Making, c) Reliability Trials, d) Speed Testing, e) Use whilst drawing a trailer except the towing
(other than for reward) of any one disabled Mechanically propelled vehicle (only for Passenger Carrying Vehicles).
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
Driver
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
Clause :
Vehicles Rules, 1989.
LIMITS OF LIABILITY
Under Excess in respect of each and every Under In respect of any Under Damage to Third Party Property Rs. Under PA Owner – Driver as per
Section I claim under Sec I of motor policy Section II- one accident -- As Section II-I 750000/- in respect of any one claim Section premium computation table
Compulsory : Rs. 2000/- Voluntary : I (i) per Motor Vehicle (ii) or series of claims arising out of one III:
Rs. 0/- Imposed : Rs. 0/- Total : Rs. Act event.
2,000.00/-
Subject to I.M.T Endorsement Nos. IMT 7,IMT 22,IMT 28
NOMINATION DETAILS
Name Of the Nominee Date of Birth of Nominee Age of Nominee Relationship With Insured Percentage
SANCHIKA MODI 07/08/1978 35 Wife 100
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 Magma HDI General Insurance Co. Ltd.
In case of Claims, please contact us at 1-800 - 3002 - 3202

Date of Issue : 30/06/2014

Place : Kolkata

Consolidated Stamp Duty on the issue of General Insurance Policies Paid vide G.O No. G.O No. 1060-F.T., dated
05.08.2013 Authorised Signatory
Service Tax Registration no : AAGCM1685CSD001
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.

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RECEIPT

Receipt Number PIS/200013/15/100083731

Receipt Date 30/06/2014
Business Channel

Received with thanks from Mr MINY RAJ MODI

(Customer ID : 20000398147 a total sum of Rupees Forty-Five Thousand Two Hundred Seventy-Four Only

Instrument Type Instrument No. Date Bank Name Branch Name Amount
CHEQUE 000636 30/06/2014 BANK OF BARODA TATYATOPE BRANCH 45,274.00

Total Amount Rs. 45,274.00

Note:

* The insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy as detailed in Policy Document.

* Receipt is Subject to realisation of cheque(s)

For & on behalf of

Magma HDI General Insurance Company Ltd.

Authorised Signatory