LIBERTY GENERAL INSURANCE LIMITED

TWO WHEELER PACKAGE POLICY

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
IMPORTANT - 1) The Validity of this Certificate of Insurance cum Schedule is subject to realization 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.
3) In the event of misrepresentation, fraud or non-disclosure of material facts, the company reserves the right to cancel the policy from inception.
Policy Issuing Office 10th Floor, Tower A Peninsula Business Park, Ganpath Rao Kadam Marg Lower Parel MUMBAI MAHARASHTRA - 400013 Phone: +91 22 6700 1313
Fax: +91 22 6700 1606
Policy Servicing Office 10th floor, Tower A, Peninsula Business Park, Ganpat Rao Kadam Marg, Lower Parel, MUMBAI 400013 MAHARASHTRA PH: +91 22 67001313 FAX:
+91 0 0

Period Of Insurance From 00:00Hrs of 26/08/2019

To Midnight of 25/08/2020
Policy No 2012-100000-19-7021396-00-000 Policy Issued On 23/08/2019
Geographical Area India Covernote No/Ecovernote No 201210000019702139600000
Insured ANURAG SRIVASTAV Covernote Date
Address B2-14, ANUNAGAR, WAGHBIL NAKA RTO Location PIMPRI-CHINCHWAD Zone: Zone-B
400607 THANE MAHARASHTRA
UIN CODES LVG-MO-P13-25-V01-12-13
Contact Number (M) +918861695141 Customer ID 4105485922
GSTIN No/State Name NA/MAHARASHTRA

Agent Name PolicyBazaar Insurance WA Pvt Ltd

Agent Code IMD1046412 Agent Contact No 1800208878
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration Mark & Year of Licensed Carrying capacity
Engine No. Chassis No. Make/Model/Type of Body CC/HP/GVW
No. Manufacture including Driver
HERO MOTOCORP/IGNITOR DISC/Solo
MH 14 FN 0516 2016 JC59AAGGA01662 MBLJC59ADGGB00121 125 2
with Pillion
IDV (INSURED'S DECLARED VALUE)
Year IDV of Vehicle( ) Trailers( ) Side Car( ) Non Electrical Electrical/Electronic Bi Fuel kit (CNG/LPG)( Total Value ( )
Accessories( ) Accessories( ) )
1 34,456.00 0.00 0.00 0.00 0.00 0.00 / 0.00 34,456.00
Section I - OWN DAMAGE (A) Section II - LIABILITY (B)
Own Damage Premium on vehicle and accessories Third Party Premium
Basic Cover Basic Cover

Basic OD 173.24 Basic TP 752.00

TOTAL OWN-DAMAGE PREMIUM (A) 173.24 TOTAL LIABILITY PREMIUM (B) 752.00

Net Premium(A+B) Taxable Value 925.00

CGST(9% - MAHARASHTRA) 83.25

SGST(9% - MAHARASHTRA) 83.25

TOTAL POLICY PREMIUM 1,092.00

Hire Purchase/ Lease /Hypothecated with NA

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
DRIVERS CLAUSE
Persons or Classes of Person 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 and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
LIMITS OF LIABILITY
Deductible Compulsory Deductible: Rs 100/-, Under Section II-I such amount necessary Under Section II-I 100,000.00 P.A. cover for 0.00
under section Voluntary Deductible: Rs 0/-, (i) of the policy to meet the (ii) of the policy owner- Driver
-I Imposed Excess : Rs 0/-. (Death of or bodily requirements of motor (Damage to third under section
injury): vehicle Act, 1988. party property) III : CSI
Subject to I.M.T Endorsement Nos. IMT 22
NOMINATION DETAILS

Name of the Nominee Relationship with Insured Name of Appointee (if nominee is minor) Relationship with the Nominee

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.
In witness whereof this Policy has been signed at Mumbai on 23/08/2019
Receipt No: 10210000019100217747
In case of Claims, Please contact us at : Toll Free No - 18002665844,
email id - care@libertyinsurance.in
Date of Issue : 23/08/2019
Place : Mumbai

Consolidated Stamp duty has been paid as per letter of Authorization no.
CSD/05/2019/1892/19 dated 23/04/2019 issued by Main Stamp Office, Mumbai. ** Not
Applicable for the State of Jammu & Kashmir.
Invoice No. 2719011000122076 For Liberty General Insurance Limited

Branch GSTIN No : 27AABCL9950A1ZL

SAC Code : 997134; Description of Service : General
Insurance Service; Place of Supply : MAHARASHTRA/27
IRDA Regn. No. 150
CIN No. U66000MH2010PLC209656
Tax is not payable under reverse charge by the recipient
Authorised Signatory
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.