IFFCO Tokio General Insurance Co. Ltd.

Servicing Office of Insurer: I-107-A,1st Floor,Kirti Nagar,Gurgaon , Haryana-110015, PH-0124-2850100 STATE

CODE -07
GSTIN: 07AAACI7573H1ZE
IRDA Registration No : 106 UIN No:-NA-
TWO WHEELER PACKAGE POLICY CUM RECEIPT
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Policy No YIT/97367278 GSTIN : NA Proposal No. & Date P2024744, 18-Apr-2019 Policy For 1 Year
Policy Issued On 18-Apr-2019 (11:00) Period Of Insurance 24-Apr-2019(00:00) to 23-Apr-2020(Midnight)
PA Owner Driver 24-Apr-2019 (00:00) to 23-Apr-2020(Midnight)
Insured Name MR. BALJINDER SINGH Previous Policy No. 39010231176205189657

Insured Add. H.NO-10 KH.NO-42/10/2 VIKAS PURI CHANDRA Previous Insurer NIC
VIHAR POLE NO-NGL-F 023 NILOTHI, DELHI ,
DELHI-110041
Product Type : ADDON
Make Model Sub Model Cubic Capacity Manufacturing Year Seating capacity
YAMAHA FASCINO (FASCINO) B9C2 113 2017 2
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type Chassis No.
SOLO DL 4S CQ 4421 JANAKPURI Yes PETROL ME1SED193H0014780
Engine No. Invoice Date Vehicle IDV Elec. Accessories Non-Elec. Accessories Total IDV
E3Y4E0026986 25-Apr-2017 39,999 0 0 39,999
Schedule of Premium (Amount in Rs.)
Own Damage Premium (A) Liability Premium (B)
Basic Premium Basic Third Party Liability (Including TPPD) 720
Vehicle 684 Sub Total (Third Party Liability) 720
Non-Elec. Accessories (IMT-24) 0 PA Cover For Owner Driver of Rs. 1500000(IMT-15) 375
Elec. Accessories (IMT-24) 0 For 1 Year
Sub Total (Basic Premium) 684 PA Cover ( 100000 Per Person) for 0 Persons(IMT-16) 0
IMT 33 0 Geographical Area Extension 0
Add On Coverages (Nil Depriciation) 180 Sub Total (PA Cover) 375
Add On Coverages (RTI) Net Liability Premium (B) 1095
Geographical Area Extension (IMT-1) 0 Total Premium (A+B) 1,959
Sub Total-Addition 864 SGST(9.00%) 177
Deductibles CGST(9.00%) 177
Voluntary Deductibles (0) (IMT-22A) 0 Gross Premium Paid 2,313
Anti Theft Device (IMT-10) 0 Note: 1.Policy issuance is subject to realization of cheque
AA Membership (IMT-8) 0 2.Consolidated stamp duty paid to state exchequer
No Claim Bonus (0%) 0 3.The policy is subject to compulsory deductible of Rs.100 (IMT-22)
Handicap Discount (IMT-12) 0
Sub Total (Deductibles) 0 *Subject to IMT Endt. Nos.& Memorandum:7,22
Net Own Damage Premium (A) 864
Nominee Details
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
GURMEET KAUR 49 MOTHER --N.A-- --N.A--
Insured Declared Value :The schedule of age-wise insured declared(IDV) as shown in the below table is applicable for the purpose of Total loss including Theft/Constructive Total Loss
(TL/CTL) claims only on basis of loss date falling in the respective year. A vehicle will be considered to be a CTL, where the aggregate cost of retrieval and/or repair of the vehicle subject to terms
and conditions of the policy exceeds 75% of the IDV.
Tenure 24-Apr-2019 to 23-Apr-2020 - - - -
IDV 39999 0 0 0 0

Limitations as to use: The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4)
Pace making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Driver¶s Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining
such license. Provided also that the person holding an effective learner¶s license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle
Rules, 1989.
Limits of Liability Clause: 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 Vehicle Act 1988.Under Section II-1
(ii) of the policy-Damage to third party property is Rs.1 lakhs PA Cover Under Section III for Owner-Driver is Rs. 1500000 .
Grievance Clause: For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call at( 18001035499) or may write an email at
([email protected]). In case the insured is not satisfied with the response of the office, insured may contact the Grievance Officer of the Company at
([email protected]).In the event of unsatisfactory response from the Grievance Office, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the
redressal of grievance. Details of Insurance Ombudsman offices are available at IRDA website:www.irdaindia.org , or on the website of General Insurance Council:
www.generalinsurancecouncil.org.in or on the company website (www.iffcotokio.co.in).
The Policy wording is available on request at free of cost. The Same can be downloaded from our Website (www.iffcotokio.co.in).
Hypothecation Details: HDFC BANK LTD., DELHI - DELHI
Important Notice: The insured is not indemnified, if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 ³AVOIDANCE OF CERTAIN TERMS & RIGHT OF
RECOVERY´For legal interpretation, English version will hold good.
Disclaimer :Additional deductible: Rs.1000/- or 10% of the claim value whichever is higher for 6th or subsequent admissible claims during the policy period

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 Motor Vehicle
Act, 1988
For & On Behalf of IFFCO Tokio General Insurance Co. Ltd.

MISP Code :TTIBI/Y/157002007

SAC :997134 , Description Of Service :MOTOR VEHICLE INSURANCE SERVICES , Place OF Supply :DELHI(State Code :07) , Invoice Authorized Signatory
:YIT/97367278 Receipt No.YIT/97367278 ,Payment Mode :Cheque
Broker¶s Name & Add.: Toyota Tsusho Insurance Broker India Pvt. Ltd., No.53, (NP) Developed Plots, Industrial Estate, Ekkattuthangal,Chennai -600032.
Broker¶s Code - DB-403/08
For Renewal/Claims assistance - please contact Ins.Co. & Broker through : DELHI SCOOTERS DELHI at 011-25103418 / 9266450123