2311Policy Holder declare that no claim has been made in the previous year policy.28/02/2014Mr False Private Car Package PolicyIf declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited.OG-14-2202-1801-0000727320 Agent Name :JALPA SANDIP MODIAgent Code :200567745738Tel No. : 91-9825956256Nilesh Amratbhai Panchal

Insured Nam e MR NILESH AMRATBHAI PANCHAL RTO AHMEDABAD

CorrespondenceAddress

B-1-128 MADHUVRUND TENAMENTNR NILKANTHIMAHADEVGHATLODIA AHMEDABADAHMEDABAD,GUJARAT, 380001

RegistrationAddress

B-1-128 MADHUVRUND TENAMENTNR NILKANTHIMAHADEVGHATLODIA AHMEDABADAHMEDABAD, GUJARAT,380001

Mobile 9825956256 Phone E Mail Registration No. GJ-01-RB-8901

Period of Insurance From Date & Time 17/05/2014 00:01hrs To Date & Time 16/05/2015 Midnight Policy Issuance Date 27/05/2014

Make Model - Variant Engine No Chassis No Mfg Yr Seats Body Type CC

MARUTI RITZ -V D I B S IV 1 9 8 51 7 2 4 2 7 8 59 2 0 1 2 5 H ATC H B AC K 1 2 4 8

Insured's DeclaredValue (IDV)

The Vehicle (`) For Trailer(`) Non Electrical Acc.(`) Electrical Acc.(`) CNG/LPG Kit(`) Total IDV (`)

475,500 0 0 0 0 475,500

Nam ed Persons & Nom inee (IMT-15)

Nom inee (Owner Driver) Appointee

Prem ium Details (`)

Own Damage Premium (a) L iab ility Premium (b )

B a s ic O w n D a m a g e : 1 0 1 4 7 B a s ic Th ird P a rty L ia b ility : 1 3 3 2

L L to P a id D riv e r (IMT-2 8 ) 5 0

P A C o v e r fo r O w n e r D riv e r o f ` 2 0 0 0 0 0 1 0 0

T o tal B as ic Premium 1 0 1 4 7

P A C o v e r fo r Un -N a m e d P e rs o n s o f ` 1 0 0 0 0 0 E a c h (fo r 5 P e rs o n s ) (IMT-1 6 ) 2 50

L e s s : o th e rs 1 0 1 5

L e s s : N o C la im B o n u s (2 0 % ) 1 8 2 6

T o tal - L es s 2 8 4 1

A d d o n C o v erages N et L iab ility Premium (b ) 1 7 3 2

Z e ro D e p re c ia tio n 1 6 6 4

T o tal Pac k age Premium (a+ b ) 1 0 7 0 2

S e rv ic e Ta x (In c lu d in g E d u c a tio n C e s s & H ig h e r E d u c a tio n C e s s , w h e re v e r a p p lic a b le ) 1 3 2 3

T o tal - A d d o n 1 6 6 4

N et Own Damage Premium (a) 8 9 7 0 T o tal Premium 1 2 0 2 5

G eo grap h ic al A rea India C o mp uls o ry Ded uc tib le (IM T -2 2 ) ` 1000.00 V o luntary Ded uc tib le (IM T -2 2 A ) ` 0.00

Pay ment Details : F u n d Tra n s fe r N o . 8 4 1 4 4 1 Dated : 1 6 /0 5/2 0 1 4 Drawn o n H D F C C RE D IT C ARD C O L L E C TIO N AC

Prev io us Po lic y N o . O G -1 4 -2 2 0 2 -1 8 0 1 -0 0 0 0 7 2 7 3 V alid fro m 1 7 /0 5/2 0 1 3 to 1 6 /0 5/2 0 1 4 , o f B AJ AJ AL L IAN Z G E N E RAL IN S URAN C E C O .L TD N o C laim B o nus 0 %

P o lic y H o ld e r d e c la re th a t n o c la im h a s b e e n m a d e in th e p re v io u s y e a r p o lic y . If d e c la ra tio n fo u n d in c o rre c t, b e n e fits u n d e r th e p re s e n t p o lic y in re s p e c t o f o w n d a m a g e s e c tio n w ill s ta n d fo rfe ite d .

List Of Endorsem ents

E nd t N o Des c rip tio n E ffec tiv e Date E nd Date Premium (In ` )

L IM IT A T ION S A S T O U S E : Th e P o lic y c o v e rs u s e o f th e v e h ic le fo r a n y p u rp o s e o th e r th a n : a ) H ire o r Re w a rd b ) C a rria g e o f g o o d s (o th e r th a n s a m p le s o r p e rs o n a l lu g g a g e ) c ) O rg a n iz e d ra c in g d ) P a c e

m a k in g e ) S p e e d te s tin g f ) Re lia b ility Tria ls g ) An y p u rp o s e in c o n n e c tio n w ith Mo to r Tra d e . Pers o ns o r C las s o f Pers o ns entitled to d riv e: An y p e rs o n in c lu d in g th e in s u re d , p ro v id e d th a t a p e rs o n

d riv in g h o ld s a n e ffe c tiv e d riv in g lic e n s e a t th e tim e o f th e a c c id e n t a n d is n o t d is q u a lifie d fro m h o ld in g o r o b ta in in g s u c h a lic e n s e . P ro v id e d a ls o th a t th e p e rs o n h o ld in g a n e ffe c tiv e le a rn e r's lic e n s e m a y a ls o

d riv e th e v e h ic le a n d th a t s u c h a p e rs o n s a tis fie s th e re q u ire m e n ts o f Ru le 3 o f th e C e n tra l Mo to r V e h ic le s Ru le s , 1 9 8 9 . L imits o f L iab ility 1 . Un d e r S e c tio n II-1 (i) o f th e p o lic y - D e a th o f o r b o d ily in ju ry

- S u c h a m o u n t a s is n e c e s s a ry to m e e t th e re q u ire m e n ts o f th e Mo to r V e h ic le s Ac t, 1 9 8 8 . 2 . Un d e r S e c tio n II - 1 (ii) o f th e p o lic y -D a m a g e to Th ird P a rty P ro p e rty - ` 7 50 0 0 0 3 . P . A. C o v e r u n d e r S e c tio n

III fo r O w n e r - D riv e r(C S I): ` 2 0 0 0 0 0 T erms , C o nd itio ns & E x c lus io ns : As p e r th e In d ia n Mo to r Ta riff. A p e rs o n a l c o p y o f th e s a m e is a v a ila b le fre e o f c o s t o n re q u e s t & th e s a m e is a ls o a v a ila b le a t

o u r w e b s ite .

I / W e h e re b y c e rtify th a t th e p o lic y to w h ic h th e c e rtific a te re la te s a s w e ll a s th e c e rtific a te o f in s u ra n c e a re is s u e d in a c c o rd a n c e w ith th e p ro v is io n o f c h a p te r X , X I o f M. V .Ac t 1 9 8 8 . "Th e s ta m p d u ty o f

` 0 .50 p a id b y D e m a n d D ra ft, v id e Re c e ip t/C h a lla n n o 6 6 1 2 58 2 0 1 3 1 4 d a te d 2 8 /0 2 /2 0 1 4 a s p re s c rib e d in G o v e rn m e n t N o tific a tio n Re v e n u e a n d F o re s t D e p a rtm e n t N o Mu d ra n k 2 0 0 4 /4 1 2 5/C R 6 9 0 /M-1 , d a te d

3 1 /1 2 /2 0 0 4 ". S e rv ic e Ta x Re g is tra tio n N o .: AAB C H 0 7 3 8 E S T0 0 4 . IM POR T A N T N OT IC E : Th e In s u re d is n o t in d e m n ifie d if th e v e h ic le is u s e d o r d riv e n o th e rw is e th a n in a c c o rd a n c e w ith th is S c h e d u le . An y

p a y m e n t m a d e b y th e C o m p a n y b y re a s o n o f w id e r te rm s a p p e a rin g in th e C e rtific a te in o rd e r to c o m p ly w ith th e Mo to r V e h ic le Ac t, 1 9 8 8 is re c o v e ra b le fr o m th e In s u re d . S e e th e c la u s e h e a d e d

"AV O ID AN C E O F C E RTAIN TE RMS AN D RIG H T O F RE C O V E RY ". Dis c laimer: Th e P o lic y s h a ll b e v o id fro m in c e p tio n if th e p re m iu m c h e q u e is n o t re a liz e d . In th e e v e n t o f m is re p re s e n ta tio n , fra u d o r

n o n -d is c lo s u re o f m a te ria l fa c t, th e C o m p a n y re s e rv e s th e rig h t to c a n c e l th e P o lic y fro m in c e p tio n .

Policy Issuing Office: Mum bai For HDFC ERGO General Insurance Company Ltd.

Agent Name :JALPA SANDIP MODI

Agent Code :200567745738 Tel No. : 91-9825956256 Duly Constituted Attorney

HDFC ERGO General Insurance Com pany Lim ited 2311200762083500000

Certificate of Insurance cum Policy Schedule

Policy No. 2311 2007 6208 3500 000

Re g is te re d & C o rp o ra te O ffic e : 1 s t F lo o r, 1 6 5-1 6 6 B a c k b a y Re c la m a tio n , H . T . P a re k h Ma rg , C h u rc h g a te , Mu m b a i - 4 0 0 0 2 0 . C u s to m e r S e rv ic e Ad d re s s : 6 th F lo o r, L e e la B u s in e s s P a rk , An d h e ri K u rla Ro a d ,

An d h e ri (E ), Mu m b a i - 4 0 0 0 59 . T o ll F ree : 1 8 0 0 -2 -7 0 0 -7 0 0 | F ax : 9 1 2 2 6 6 3 8 3 6 9 9 | c are@ h d fc ergo .c o m | www.h d fc ergo .c o m

a ) F ire , e x p lo s io n , s e lf ig n itio n o r lig h tn in g .b ) B u rg la ry , h o u s e b re a k in g o r th e ftc ) All a c t o f G o d p e rils lik e e a rth q u a k e , flo o d , c y c lo n e e tcd ) Ac c id e n ta l e x te rn a l m e a n s , te rro ris m , rio t a n d s trik e

P ro v id e s c o v e r fo r a n y le g a l lia b ility a ris in g o u t o fth e u s e o f th e v e h ic le fo r:a ) Ac c id e n ta l d e a th / in ju ry to a n y th ird p a rtyb ) An y d a m a g e to p ro p e rty o w n e d b y th ird p a rty

Th e p o lic y p ro v id e s fo r m a n d a to ry P e rs o n a l Ac c id e n t c o v e r fo ro w n e r d riv e r a n d o p tio n a l c o v e r fo r p a s s e n g e rs c o v e rin ga c c id e n ta l d e a th a n d p e rm a n e n t to ta l d is a b ility .

W HAT ARE THE MAJOR EXCLUSIONS IN THE POLICY?

a ) G e n e ra l a g in g , w e a r & te a r, m e c h a n ic a l o r e le c tric a l b re a k d o w n , fa ilu re , d e p re c ia tio n ,

a n y c o n s e q u e n tia l lo s s

b ) D a m a g e b y a p e rs o n d riv in g w ith o u t a v a lid lic e n s e

c ) D a m a g e b y a p e rs o n d riv in g u n d e r th e in flu e n c e o f liq u o r o r d ru g s

d ) L o s s /d a m a g e a ttrib u ta b le to w a r, m u tin y , n u c le a r ris k s

e ) D a m a g e to ty re s a n d tu b e s , u n le s s d a m a g e d d u rin g a n a c c id e n t

f) Us a g e o n h ire & re w a rd (a p p lic a b le fo r a ll c la s s e s e x p e c t p u b lic c o m m e rc ia l v e h ic le s )

g ) L o s s o r d a m a g e to b o n n e t s id e p a rts , m u d g u a rd , b u m p e rs , la m p s , ty re s , tu b e s ,

h e a d lig h ts , p a in t w o rk (a p p lic a b le fo r a ll c o m m e rc ia l v e h ic le s ; u n le s s o p te d a d d itio n a lly )

h ) L o s s o r d a m a g e re s u ltin g fro m o v e rtu rn in g a ris in g o u t o f o p e ra tio n a s a to o l

(a p p lic a b le fo r m o b ile c ra n e s , d rillin g rig s , m o b ile p la n ts , n a v v ie s , s h o v e ls , g ra b s ,

rip p e rs u n le s s o p te d fo r a d d itio n a lly )

i) L o s s o f o r d a m a g e to a c c e s s o rie s b y b u rg la ry h o u s e b re a k in g o r th e ft u n le s s th e

v e h ic le is s to le n a t th e s a m e tim e (a p p lic a b le to a ll c o m m e rc ia l v e h ic le s & tw o w h e e le rs )

W HAT DO I DO IN CASE OF A CLAIM?

a ) P o lic y N o .b ) Re g is tra tio n d e ta ils / RC c o p yc ) D riv e rs d e ta ils a t th e tim e o f a c c id e n t in c lu d in g d riv in g lic e n s e n u m b e rd ) F IR o n a c a s e to c a s e b a s ise ) Re p a ir e s tim a te

1 . DE T A IL S T O K E E P H A N DY W H IL E R E G IS T E R IN G A C L A IM

a ) D u ly fille d a n d s ig n e d c la im fo rm & s a tis fa c tio n v o u c h e r

b ) Re g is tra tio n C e rtific a te (RC )

c ) D riv in g lic e n s e o f th e p e rs o n d riv in g a t th e tim e o f th e a c c id e n t

d ) P o lic y c o p y , o rig in a l re p a ir e s tim a te , re p a ir in v o ic e

e ) P a y m e n t re c e ip t fo r n o n -c a s h le s s c la im s

f) O rig in a l re p a ir in v o ic e fo r c a s h le s s c la im s

g ) AML d o c u m e n ts fo r a m o u n t m o re th a n 1 la c (P AN c a rd , 2 p a s s p o rt s iz e p h o to ,

re s id e n c e p ro o f).

h ) F o rm 3 5 & o rig in a l N O C fro m fin a n c e r in c a s e o f to ta l lo s s w h e re p a y m e n t is m a d e

to in s u re d .

i) A c o p y o f p o lic e F IR/p a n c h n a m a is re q u ire d fo r TP in ju ry /d e a th /p ro p e rty d a m a g e

a ) S p o t s u rv e y

b ) L o a d c h a lla n

c ) F itn e s s c e rtific a te

d ) Ro u te p e rm it

3 . C L A IM S DOC U M E N T S - IN C A S E OF A C C IDE N T A L DA M A G E T O IN S U R E D

V E H IC L E

a ) C a ll o u r c u s to m e r c a re To ll-fre e 1 8 0 0 -2 -7 0 0 -7 0 0 if th e v e h ic le m e e ts w ith a n a c c id e n t

b ) P ro v id e y o u r p o lic y n u m b e r fo r re fe re n c e a n d re g is te r th e c la im

c ) If y o u r v e h ic le c a n b e d riv e n , ta k e it to th e n e a re s t d e a le r / g a ra g e

d ) G e t a re p a ir e s tim a te ,fill u p th e c la im fo rm a n d a tta c h a c o p y o f th e re g is tra tio n

C e rtific a te d riv in g lic e n s e o fth e p e rs o n d riv in g a t th e tim e o f th e a c c id e n t

e ) If th e g a ra g e is w ith in o u r n e tw o rk , y o u c o u ld a v a il o f c a s h le s s c la im fa c ility . P a y fo r n o n

a c c id e n t re la te d re p a irs , d e p re c ia tio n a n d d e d u c tib le . W e w o u ld s e ttle th e re s t.

f) If th e g a ra g e is o u ts id e o u r n e tw o rk , y o u w o u ld h a v e to g e t th e c la im re im b u rs e d

s u b s e q u e n tly .

g ) S ig n th e re p a ire r’s s a tis fa c tio n v o u c h e r a n d d riv e o ff!

2 . H OW DO I F IL E A C L A IM ?

F o r Ac c id e n ta l D a m a g e to In s u re d V e h ic le (O w n D a m a g e C la im s ):

A d d itio nal d o c uments req uired fo r c o mmerc ial v eh ic les :

a ) D u ly fille d a n d s ig n e d c la im fo rm & d is c h a rg e v o u c h e r ( a fte r lo s s s e ttle m e n t )b ) O rig in a l Re g is tra tio n C e rtific a te (RC )c ) O rig in a l p o lic y c o p yd ) C o p y o f F IR lo d g e d a t th e n e a re s t p o lic e s ta tio ne ) All o rig in a l k e y s & v e h ic le in v o ic e c o p yf) N o tra c e re p o rt c o n firm in g th a t th e s to le n v e h ic le is n o t tra c e a b le

4 . C L A IM S DOC U M E N T S : IN C A S E OF L OS S DU E T O T H E F T g ) O rig in a l N O C fro m fin a n c e r in c a s e o f h y p o th e c a tio n / H P A

h ) In tim a tio n to RTO fo r th e ft o f v e h ic le

i) D u ly s ig n e d RTO tra n s fe r p a p e rs (F o rm 2 6 , 2 8 ,2 9 ,3 0 ,3 5)

j) RC e x tra c t w ith s to le n re m a rk fro m th e c o n c e rn e d RTO a fte r th e lo s s

k ) AML d o c u m e n ts fo r a m o u n t m o re th a n 1 la c (P AN c a rd , 2 p a s s p o rt s iz e p h o to ,

re s id e n c e p ro o f).

l) D e e d o f s u b ro g a tio n c u m in d e m n ity o n ju d ic ia l s ta m p p a p e r.

HOW DO I MAKE CHANGES IN MY POLICY (ENDORSEMENTS)?

a ) Re q u e s t le tte r fo r th e c h a n g e

b ) P o lic y c o p y

c ) In v o ic e c o p y (m a n d a to ry w h e re v a lu e o f a c c e s s o ry e x c e e d s ` 2 0 ,0 0 0 /-)

d ) E n d o rs e d Re g is tra tio n C e rtific a te C o p y (F o r C N G /L P G k it)

e ) C h e q u e fo r a d d itio n a l p re m iu m

C a ll u s fo r a d d itio n a l p re m iu m d e ta ils & s e n d re le v a n t d o c u m e n ts c o p y to o u r c o rp o ra te

o ffic e

a ) C o rre c tio n in re g is tra tio n n u m b e r/ lo c a tio n / a d d re s s

b ) C o rre c tio n in v e h ic le m a k e & m o d e l / c u b ic c a p a c ity / s e a tin g c a p a c ity / e n g in e & c h a s s is

n u m b e r / y e a r o f m a n u fa c tu re

a ) Re q u e s t le tte r fo r th e c h a n g e b ) P o lic y c o p y c ) Re g is tra tio n C e rtific a te c o p y

1 . C h anges related to regis tratio n o f v eh ic le o r v eh ic le d etails lik e: 2 . F o r ad d itio n o f elec tric al and no n elec tric al ac c es s o ries /C N G & L PG K it:

D o c u m e n ts Re q u ire d :

a ) Re q u e s t le tte r fo r th e c h a n g e

b ) P o lic y c o p y

c ) E n d o rs e d Re g is tra tio n C e rtific a te c o p y

d ) N O C fro m fin a n c ie r (n o t m a n d a to ry fo r d e le tio n if RC is e n d o rs e d )

3 . Do c uments req uired to c h ange financ ier d etails

(H y p o th ec atio n/L eas e/H ire-Purc h as e)

4 .C h anges / C o rrec tio n in Po lic y H o ld er's N ame / C o rres p o nd enc e A d d res s /

C o ntac t N umb ers / E -mail id / any o th er c h anges :

E m a il u s a t : c are@ h d fc ergo .c o m ORC a ll To ll-fre e : 1 8 0 0 2 7 0 0 7 0 0 / 1 8 0 0 2 2 6 2 2 6 ORF a x y o u r re q u e s t a t: 0 2 2 6 6 3 8 3 6 6 9

HOW DO I RENEW MY POLICY? HOW TO CONTACT US?

C a ll To ll-fre e : 1 8 0 0 2 7 0 0 7 0 0 / 1 8 0 0 2 2 6 2 2 6a ) V is it www.h d fc ergo .c o m to re n e w in s ta n tly o n lin e .

b ) S MS " " R E N E W < POL IC Y N O> " " to 9 9 9 9 7 0 0 7 0 0

c ) V is it o u r n e a re s t b ra n c h / y o u r a g e n t

d ) S e n d a c o p y o f th e re n e w a l n o tic e a lo n g w ith p re m iu m c h e q u e to o u r b ra n c h o ffic e /

C o rp o ra te o ffic e

e ) C a ll o u r to ll fre e n u m b e r 1 8 0 0 2 7 0 0 7 0 0 / 1 8 0 0 2 2 6 2 2 6 .

F a x : 0 2 2 6 6 3 8 3 6 6 9

E -Ma il : c are@ h d fc ergo .c o m: H DF C E R G O G eneral Ins uranc e C o mp any L imited

6 th flo o r, L e e la B u s in e s s P a rk , An d h e ri K u rla Ro a d ,

An d h e ri(E a s t), Mu m b a i - 4 0 0 0 59

W rite to u s a t

M anage Y o ur Po rtfo lio@ h d fc ergo .c o m /

S martp h o nes *

V iew y o ur p o lic y d etails T rac k y o ur c laims o nline wh enev er th e need aris es

L ink multip le p o lic ies o f y o urs elf and y o ur lo v ed o nes R ais e s erv ic e req ues t / c o mp laints & s et renewal remind ers

C h ange y o ur p ers o nal d etails o n th e go Info rmatio n ab o ut b ranc h es , garages and h o s p itals

* s up p o rts s mart p h o nes b as ed o n B lac k b erry , iPh o ne, A nd ro id & S y mb ian p latfo rms

Frequently Asked Questions (FAQs) - MOTOR INSURANCE

W HAT ARE THE MAJOR COVERS OF THE POLICY?

L o s s o r Damage to th e Ins ured V eh ic le c aus ed d ue to : L iab ility to T h ird Parties : Pers o nal A c c id ent C o v er:

Th is d o c u m e n t is a s u m m a ry o f th e b e n e fits o ffe re d . Th e in fo rm a tio n m e n tio n e d a b o v e is illu s tra tiv e a n d n o t e x h a u s tiv e . In fo rm a tio n m u s t b e re a d in c o n ju n c tio n w ith th e p o lic y w o rd in g s .

In c a s e o f a n y c o n flic t b e tw e e n th is d o c u m e n t a n d th e p o lic y w o rd in g s , th e te rm s a n d c o n d itio n s m e n tio n e d in th e p o lic y w o rd in g s s h a ll p re v a il.