UP75 Y6496 Samsung Triple camera ---PAGE END--- UP75y6496 Samsung Triple camera ---PAGE END--- seren For-11th By-ManishPo Bharts 3 cas ClETah RT gT gfd.wwem E0 MARUT SUZUKI UP75Y ---PAGE END--- O 3mni E UP75Y 6496 camera Samsung Triple ---PAGE END--- 60 50 70 H 40 80 LE km -90 30 0718102 -100 20- -110 10 km/h 120 Samsung Triple camera ---PAGE END--- ETRA Samsung Triple camera ---PAGE END--- MA3EVB11S01701100GG 0TOCE2S Samsung Triple camera ---PAGE END--- Samsung Triple camera ---PAGE END--- 1 E Y Samsung Triple camera ---PAGE END--- 8 8 o E 1 E1 BEEE B E: EB E8 F H a E R B B 11 IE E E 1 8 6 A a S ---PAGE END--- his policy is sourced and serviced by: Support laruti Insurance Broking Private Limited 33774477 prefix 011/022/033/044 4 National Insurance Company Ltd. National Insurance DAI Regn.No.58 A Govt.of India Undertaking CERTIFICATE CUM POLICY SCHEDULE ORIGINALFOR RECIPIENT/DUPLICATE FOR SUPPLIER. TAX INVOICE/CERTIFICA IPOLICY SCHEDULE (FORM51 OF THE CENTRALMOTOR VEHICLES RULES,1989 Ponoy Tope I Dage Pelisybrivte Vehile Proposal No.Date R67070751/29-Aug-2018 Policy No.&Type 45050631181142343222 Period of Insurance 00:00:00 AM 30-Aug-208 to minigir on9-Aug-2i 29-Aug-2018(00:00 Vehicle Identification No. MA3EVB11S01701100 Policy Issued On Insured Name Mr.Anil Chaturvedi Geographical Area INDIA 4131181739391 Accounting Code of Service 997134 Invoice No S/Q SHRI SHIV DAYAL CHATURVEDI- 987-PATEL NAGAR BAKEWAR LAKHANA, Insured Address ETAWAH-206001,Uttar Pradesh Insured State&Code Uttar Pradesh-09 Place of Supply Uttar Pradesh GSTIN of Customer GSTUNREGISTERED INSURED MOTOR VEHICLE DETAILS INSURED DECLARED VALUE(IDV(in Rs.) Make Maruti Vehicle 192117 Model&Variant Omni 8 Seater/MARUTI OMNI E MPI STD BSIV Non Electrical Accessories 0 UP75Y6496 Electrical Accessories 0 Registration No Year of Manufacture 2016 CNG/LPG Kit 3000 4911574-1701100 Total IDV 200117 Engine-Chassis No Cubic Capacity 796 Seating Capacity Type Of Body Saloon RTO Location UP75Y6496/ETAWAH Schedule Of Premium (Amount in Rs.) OWNDAMAGE SECTION(A) LIABILITY SECTION(B [Vehicle 2920 Basic Third Party Liability 1850 Elec.Accessories 0 Third Party Liability for Bi-fuel Kit 60 Non-Elec.Accessories 0 Compulsory PA Cover Premium 100 Kit (IMT-25 320 PA Cover for 8 Person of Rs (200000 each (IMT-16 800 Extra Premium towards Inbuilt CNG/LPG NA Legal Liability(WCto Driver IMT-28 50 Basic Premium 3240 Legal Liability to Employees (IMT-29) 0 Geographical Area Extn.IMT-1 NA Legal Liability to Passenger (IMT 46) 0 Lamp,Tyres etc.IMT 23 0 Driving Tuition Loading On TP Premium (60%) NA Driving Tuition iLoading On OD Prenium 60% NA Net Liabity rremu 2KE Fiber Glass Tank 0 Total Premium (A+B) 7591 Sub-Total Additions 0 CGST @9% 683 Deductibles SGST @9% 683 Voluntary Deductibles IMT 22A 0 Gross Premium Paid 8957 Anti-Theft Device(IMT-10 0 Note: AAI MembershipIMT-8) 0 No Claim Bonus (25% 810 Policy Issuance is the subject to the realisation of cheque. NA 2. Consolidate stanup duty paid to State Exchequer Discount for vehicles designed for handicapped The Policy is subject to a compulsory Deductible of Rs 1000 IMT-22 Sub-Total Deductibles 810 Voluntary excess Rs 0 4. Add-On Coverages Subject to Endorsements IMT 257 28,16, NIL Depreciation 1401 Engine Protect 400 Invoice Protect Add On soo Net own Damage Premium (A) 4731 Age 27 Relation Wife Nominee Details: Nomince Name POONAM CHATURVEDI Bank Name Amount Payment Method Cheque No./Transactiou No. Payment Detail STATE BANK OF INDIA 8957 Cheque 903639 Financier Branch ETAWAH Financier Type FinancedFinaucier Name MAHINDRA AND MAHINDRA FINANCIAL SERVICES LTD noliev if nn clam is made or nendine during the preceding year (s as per the following: The ---PAGE END---