Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

Service Branch Address:

No.56/1, 2nd floor, 9th main road, 5th block,Jayanagar,XM-BANGALORE JAYA NAGAR,BENGALURU - 560041.

Jun 14, 2019

Mr.BASAVESH M .
NO. 422. IST FLOOR. IST BLOCK. Your policy is
SIR M VISHWESHWARAIAH LAYOUT.
NEAR KENGERI UPANAGARA
due for renewal
BENGALURU, KARNATAKA on 14/06/2020
560060
Telephone :
Mobile : 9980955448

Certificate of Insurance and Policy No. VPV0288348000100 Policy Period: Period of insurance
From 00:00:00 hours on 15/06/2019 To Midnight of 14/06/2020

Dear Customer,

Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are
delighted to have you as our customer.
We are enclosing the following
1. Certificate of Insurance & Policy Schedule pertaining to the insurance of your
vehicle
2. Claims Guide for preferring a claim for your vehicle loss or damage
The Certificate of Insurance & Policy Schedule is an important document that
you may be required to produce whilst your vehicle is in use. We request you to
verify the above documents and ensure everything is in order. In case of any
discrepancies, please contact us immediately.
To read the “policy” & “add on” terms, conditions, exceptions and applicable
endorsement, please log on to our website www.royalsundaram.in
Should you have any queries, please contact our Customer Service helpline
number 1860-425-0000. You may also write to
[email protected]
Assuring you of our best services at all times.
Yours sincerely,

Authorized Signatory

Note:
Please read through the claims guide provided in this pack to understand the claim process. For better understanding you can refer or
download the vernacular claims guide available in our website.
To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in

37b73dda3e36eb0c32c025f2f9ae1b7d
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

Service Branch Address:

No.56/1, 2nd floor, 9th main road, 5th block,Jayanagar,XM-BANGALORE JAYA NAGAR,BENGALURU - 560041.

Jun 14, 2019

Mr.BASAVESH M .
NO. 422. IST FLOOR. IST BLOCK.
SIR M VISHWESHWARAIAH LAYOUT.
NEAR KENGERI UPANAGARA
BENGALURU, KARNATAKA
560060
Telephone :
Mobile : 9980955448
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Passenger Carrying Vehicle Policy
Certificate of Insurance and Policy No. Policy Period:Period of insurance
VPV0288348000100 From 00:00:00 hours on 15/06/2019 To Midnight of 14/06/2020

INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date

Mr.BASAVESH M . India BENGALURU 23/06/2018

INSURED'S DECLARED VALUE (IDV) (in Rs.)

For the For Value of Total
Non Electrical Accessories Electrical / Electronic Accessories
Vehicle Trailers CNG Kit IDV
575,000 0 0 0 0 575,000
VEHICLE DETAILS
Registration Number KA04AB6900 Type of Body Saloon
Engine Number D3FAHM428129 Cubic Capacity 1120
Chassis Number MALA741DLHM286703J Year of Manufacture 2017
Make of the Vehicle Hyundai Motors Ltd. Gross Vehicle Weight (Kgs) 0
Maximum Licensed carrying capacity
Model Description XCENT CRDI PRIME Taxi + 5
including driver
Total Premium (in Rs.) 28,737
LIMITATIONS AS TO USE: Persons or Classes of Persons entitled to Drive:
The Policy covers use only under a Permit within the meaning of the Any person including the Insured
Motor Vehicles Act, 1988 or such a carriage falling under Sub-section 3 • Provided that a person driving holds an effective driving licence at
of Section 66 of the Motor Vehicles Act, 1988. the time of the accident and is not disqualified from holding or
The Policy does not cover use for obtaining such a License.
a) Organised racing • Provided also that the person holding an effective Learner's Licence
may also drive the vehicle and that such a person satisfies the
b) Pace Making
requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.
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.
LIMITS OF LIABILITY:
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.
Under Section II-1 (ii) of the Policy - Damage to Third Party Property - Rs 750000 (as per IMT 20) - In respect of any one claim or series of claims
arising out of one event.
Personal Accident cover for Owner - Driver under section IV: CSI - Rs.1,500,000/-
Deductible under Section -I : Rs.500 in respect of each and every claim.(Compulsory Deductible[Rs.500] and Imposed Deductible[Rs.0])

Document Code: Certificate of insurance & policy schedule continued in Page 2

999999999999
37b73dda3e36eb0c32c025f2f9ae1b7d

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:[email protected] www.royalsundaram.in
 CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Passenger Carrying Vehicle Policy

Policy No. VPV0288348000100

Premium in Premium in
A - OWN DAMAGE B - LIABILITY
Rs. Rs.
1.Basic premium on Vehicle and Non-Electrical Accessories 14,423.00 1.Basic premium including premium for TPPD 7,147.00
2.Electrical & Electronic accessories @ 4%(IMT 24) 0.00 2.Discount for Statutory TPPD 0.00
3.Bi-Fuel kit (CNG/LPG) @ 4% (IMT 25) 0.00 3. Passenger Liability Premium 3,520.00
4. Bi-fuel Kit (CNG) @ 4% / Inbuilt CNG Kit -Endt. IMT-25 0.00

ADD: ADD:
0.00 5. Personal Accident Benefits Under Section IV
4. Trailer 315.00
- Rs.1,500,000/-
5. Loading for Imported Vehicle - 30% of OD 0.00 6. PA to Paid Driver/ Cleaners Endt. IMT-17 0.00
6. Geographical Area Extn.Endt.IMT-1 0.00 7. Geographical Area Extn.Endt.IMT-1 0.00
7. Driving Tution - 60% of OD 0.00 8. Indemnity to Hirer IMT-44 0.00
8. Fibre Glass Tanks 0.00
9. Addl Pre-Tyre & Mudguards-15% of OD 0.00 Legal Liability:
10. Additional Towing Charges. Rs.0 0.00 9. To Paid Driver/ Cleaner/ Coolies Endt. IMT-40 50.00
11. Theft and Conversion Risk IMT-43 0.00 10. NFPP - Employees Endt. IMT-37 0.00
12. For any Other extra 0.00 11. NFPP Other than Employees Endt. IMT-37A 0.00
Less: 12. For any other extra 0.00
13. Discount for Anti-theft Devices Endt. IMT-10 0.00
14. 50% Discount for vehicles specially designed/modified 0.00
13. TOTAL LIABILITY PREMIUM (B) 11,032.00
for physically and mentally challenged persons
15. Deduct 20% NCB -2,884.60
16.Add: % Discount moderation 0.00 14.Add: %Underwriter Loading 0.00
15.NET PREMIUM (A + B) 24,353.00
Add: Additional Cover for Package Policies
17. Depreciation Waiver Clause (IRDAN102A0001V01201011) 1,783.00 ADD: SGST 2,192.00
18. Windshield Glass (IRDAN102A0002V01201011) 0.00 ADD: CGST 2,192.00

21.TOTAL OWN DAMAGE PREMIUM (A) 13,321.00 16.TOTAL PREMIUM PAYABLE 28,737.00
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy. b) The insured is entitled for a No Claim Bonus (NCB)
on the Own Damage Section of the policy, if no claim is made or pending during the preceding year(s), as per the details given below:
Subject to IMT. Endt. Nos. & Memorandum 40,7,22,38 & RSMOAC 501(refer Terms &
Period of Insurance % of NCB on OD Premium Conditions for relevant wording)
Under Hire Purchase/Lease Agreement /Hypothecated with MAHINDRA AND
The preceding year 20 MAHINDRA FINANCIAL SERVICES LTD

Preceding two consecutive years 25

Nominee Name Nominee Age Relationship with
Preceding three consecutive years 35 0
Guardian Name Guardian Age Guardian Relation
Preceding four consecutive years 45 0

Preceding five consecutive years 50

Date and Signature of Proposal/Renewal notice 14/06/2019
In Witness whereof this Policy has been signed at Chennai on 14/06/2019 in lieu of Cover note No. dated Receipt No. CBCMOR4644558. 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 the Motor Vehicles Act, 1988.

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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE
OF CERTAIN TERMS AND RIGHT OF RECOVERY" under Policy Terms and Conditions.

For Royal Sundaram General Insurance Co. Limited

Consolidated Stamp Duty Paid to Govt of TamilNadu

Authorised Signatory

This document is digitally signed, hence counter signature / stamp is not required.

GSTIN : 29AABCR7106G1ZF UIN: IRDAN102P0007V02201617 PAN Number : AABCR7106G

For Legal interpretation, English version will hold good.
37b73dda3e36eb0c32c025f2f9ae1b7d
 GST Invoice
Royal Sundaram General Insurance Co.
Limited XM:XM-BANGALORE JAYA NAGAR
Address: No.56/1, 2nd floor, 9th main road, 5th block,Jayanagar,XM-BANGALORE JAYA NAGAR,BENGALURU - 560041.
GSTIN: 29AABCR7106G1ZF

Policy Number : VPV0288348000100

GST Invoice Number : VPV028834800000
Invoice Date : 15/06/2019

Address of insured:
Insured Name: Mr.BASAVESH M .
NO. 422. IST FLOOR. IST BLOCK.
SIR M VISHWESHWARAIAH LAYOUT.
NEAR KENGERI UPANAGARA
BENGALURU
State:KARNATAKA
Pincode: 560060

Accounting code of service : 997134

Description of service: Motor vehicle insurance services

Taxable Premium 24,353.00

SGST 9.00% 2,192.00

CGST 9.00% 2,192.00

Gross Premium 28,737.00

Indication if tax payable under reverse charge - No

Note:“This document is digitally signed”

“This document is electronically generated.This document should be issued along with the Policy document.This document stands
invalid,if issued separately”