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Title2312100095928100000
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0 TTwo Wheeler Package Policy

Correspondence
Address

Registration
Address

Make Model - Variant Engine No Chassis No Mfg Yr Seats(Incl.of side car) Body Type CC

Insured's Declared
Value (IDV)

Vehicle (`) Side Car (`) Non Electrical Acc. (`) Electrical Acc. (`) CNG/LPG Kit (`) Total IDV (`)

17,820 0 0 0 0 17,820

Named Persons & Nominee (IMT-15)
Nominee (Owner Driver) Appointee

Premium Details (`)
Own Damage Premium (a) Liability Premium (b)
Basic Own Damage: 314 Basic Third Party Liability: 538

PA Cover for Owner Driver of `100000 50

Total Basic Premium 314




Sub Total – Addition 588

Less: No Claim Bonus (50%) 157 Net Liability Premium (b) 588

Total - Less 157
Total Package Premium (a+b) 745



Service Tax (Including Swachh Bharat Cess 0.50% as applicable) 14.50% 108
Net Own Damage Premium (a) 157 Total Premium 853

The total Premium amount is inclusive of NCB 50%

Geographical Area India Compulsory Deductible (IMT-22) ` 100 Voluntary Deductible (IMT-22A) ` 0

Valid from 25/11/2014 to 24/11/2015 of UNITED INDIA INSURANCE CO.LTD. No Claim Bonus 50%
If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.

List of Endorsements

Endt No Description Effective Date End Date Premium (In ` )

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) Any purpose in connection with Motor Trade. Persons or Class 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 when not used
for the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989. Limits of Liability 1. Under Section II-1 (i) of the
policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988. 2. Under Section II - 1(ii) of the policy -Damage to Third Party Property- ` 100000 3.P.A.
Cover under Section III for Owner - Driver(CSI): ` 100000 Terms, Conditions & Exclusions: As per the Indian Motor Tariff. A personal copy of the same is available free of cost on request & the same is also
available at our website.

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 1988. "The stamp duty of ` 0.50
paid by Demand Draft, vide Receipt/Challan no 116615201314 dated 31/10/2013 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. 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." Disclaimer: The Policy shall be void from inception if the premium cheque is not realized. In the event of misrepresentation, fraud or non-disclosure of material fact, the Company reserves
the right to cancel the Policy from inception.

Policy Issuing Office : LEELA BUSINESS PARK, 6TH FLR, ANDHERI - KURLA RD, MUMBAI, 400059. Phone No. : +91-22-66383600
Policy Issuing Office: Mumbai For HDFC ERGO General Insurance Company Ltd.

Agent Name: POLICYBAZAAR INSURANCE WEB AGGREGATORS
PVT. LTD
Agent Code: 201714906552 Tel No.: 91-11-27561382


Duly Constituted Attorney

2312100095928100000HDFC ERGO General Insurance Company Limited

Certificate of Insurance cum Policy Schedule

Policy No. 2312 1000 9592 8100 000

Registered & Corporate Office: 1st Floor, 165-166 Backbay Reclamation, H. T . Parekh Marg, Churchgate, Mumbai - 400020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road,
Andheri (E), Mumbai - 400 059. Toll Free : 1800-2-700-700 (Accessible from India only) | Fax : 91 22 6638 3699 | [email protected] | www.hdfcergo.com

Insured Name K.ESWARAN RTO KANCHEEPURAM
7/2B, Thirupur Kumaran Street, Iyyappa naga West,
Kanchipuram
TAMIL NADU 631 501

7/2B, Thirupur Kumaran Street, Iyyappa naga West,
Kanchipuram
TAMIL NADU 631 501

HERO HONDA SPLENOR PLUS O7M 15E 41074 O7M 16F 28378 2007 2 OPEN 97

Mobile 9791188800 Phone - E Mail [email protected] Registration No. TN-21-AB-5169

Period of Insurance From Date & Time 06/10/2015 00:01 hrs To Date & Time 05/10/2016 Midnight Policy Issuance Date 05/10/2015

Payment Details: Fund Transfer No. TW1601000867 Dated : 05/10/2015 Drawn on BizDirect
Previous Policy No. 0113053114p106784179

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