GENERAL RELIANCE Live Smart Follow us in O INSURANCE Welcome RELIANCE Selfi M / S SUDEEP LOGISTICS PRIVATE LIMITED Download Now | 314 PROGRESIVE MODEL COLONY VAIDUWADI HADAPS PUNE CITY My Policy Claim Status MAHARASHTRA India - 411013 Attach , Access or Register , Track 9326 ****** Download your policy or Submit claim documents From here on , Locator ►Video Claim you're our responsibility . Go cashless , Assistance Tap and spot from Intimate claims amongst 5000 + instantly through Welcome on board . network garages . live video streaming . Your Reliance Commercial Vehicles ( Passengers Carrying 4W > 6 & 3W > 17 ) Package Policy - Schedule , with Policy Number 170122423400001779 is now live to access your policy anytime , anywhere download our Reliance Selfi App and enjoy a host of special features . Now Live Smart With Reliance general Insurance . Tech + Best Regards , reliancegeneral.co.in 022 4890 3009 ( Paid ) D 74004 22200 ( WhatsApp ) Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Floor , Oberoi Commerz , International Business Park , Oberoi Garden City , Off Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 . Corporate Identity No. U66603MH2000PLC128300 . UIN : IRDAN103RP0012V02100001 .. Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under . License RGI / MCOM / CO / PCV / PS / Ver . 1.3 / 310118 . Page 1 of 12 ---PAGE END--- ny tan Digitally signed by Reliance reliancegeneral.co.in GENERAL RELIANCE General Insurance INSURANCE Company Limited 022 4890 3009 Date : 2024.10.19 13:21:13 74004 22200 Insence IST mited mpany surance Reliance Commercial s ( Passengers Carrying 4W 6 & 3W Package Policy - Schedule > , Policy Number : 170122423400001779 Proposal / Covernote No : R181024112295 Insured Name : M / S SUDEEP LOGISTICS PRIVATE LIMITED Period of Insurance : From 00:00 Hrs on 29 - Oct - 2024 to Midnight of 28 - Oct - 2025 Communication Address & Place of Supply : 314 PROGRESIVE MODEL Policy Issuing Branch : A Block , Heritage House , Ground floor , 6 Ramabai COLONY VAIDUWADI HADAPS PUNE CITY , PUNE , MAHARASHTRA , India , Ambedkar Road ,, PUNE , MAHARASHTRA , 411001 . 411013 . Mobile No : 9326 * ****** Tax Invoice No. & Date : R181024112295 & 19 Oct 2024 01:21 Email - ID : NA GSTIN / UIN & Place of Supply : 27AATCS2867F1ZS and MAHARASHTRA ance Insured Vehicle Details Registration No. MH12NX7150 Mfg . Month & Year JUN - 2017 Make / Model & Variant EICHER 10.75 E BUS BS 2 CC / HP / Watt 90 Engine No./Chassis No. E414CDHF147647 / MC2A5ERTOHF374555 LCC Including Driver 27 Type of Body NA Total Premium 38841 RTO Location MAHARASHTRA - Total IDV Lem 715,000.00 Reliance Manufacturer fully build in Yes Hypothecation / NA Vehicle Category Bus Vehicle Usage Type Contract Carriage Limited Vehicle Usage Sub Type Insured Declared Value ( IDV લોક ) Chassis IDV 0.00 Non Electrical Accessories 0.00 Combay Body IDV 0.00 CNG LPG Kit 0.00 Vehicle IDV 715,000.00 Trailer / Side Car 0.00 Electrical / Electronic Accessories 0.00 Total IDV 715,000.00 ance Premium Summary Own Damage - Section I Amount ( ` ) Liability - Section II Amount ( ` ) Basic OD 1,417.22 Basic Liability ( TPPD 1 ) 31,562.00 Covers for Lamps Tyres / Tubes Mudguards / Bonet / Side Total Basic Liability Premium 31,562.00 parts etc ( IMT - 23 ) 212.58 PA Benefits - Section III Total Basic Own Damage Premium 1,629.80 Legal Liability to paid driver and / or Conductor and / or Less cleaner 50.00 Deduct 20 % for NCB -325.96 TOTAL LIABILITY PREMIUM 31,612.00 Sub Total of Deductions -325.96 TOTAL PACKAGE PREMIUM ( Sec I + II + III ) 32,916.00 CGST ( @ 9.00 % ) 2962.00 SGST ( @ 9.00 % ) 2962.00 QU TOTAL OWN DAMAGE PREMIUM 1,304.00 TOTAL PREMIUM PAYABLE ( ` ) 38,841.00 Subject to I.M.T.Endt . Nos . & Memorandum printed / herein / herein / attached / attached h hereto . IMT 40,23,21 Limi GSTIN : 27AABCR6747B1ZG hinted HSN 997134 , Description services Motor vehicle Service of baanst " As the GST the amount of GST will not be refunded if the policy / e is cancelled after " forsuram per regulation Consolidated Stamp duty Paid vide Letter of " NO LOA / ENF - 1 / CSD / 50 / 2024 -25 / ( Validity Period to Date 20-08-2024 " at General Stamp Office , Mumbai . ** Not Applicable for the State of Jammu & Kashmir . thence age / SAMADHAN 9326689009 sujitlolage@gmail.com ***** * 907 E Intermediary C Intermediaryct No. E - mail ID POS UID Aadhaar No. / PAN No. Pancenter The Customer Information Sheet ( CIS ) for this product is available on our website She https://www.reliancegeneral.co.in/insurances/downloads.aspx Limits of liability PA for owner driver under section III CSI 0 ( a ) Under Section II ( 1 ) ( i ) of the Policy - Death of or bodily injury to any : person so far as it is necessary to meet the requirements of the Vehicle Act , 1988. ( b ) Under Section II ( 1 ) ( ii ) of Gener the Policy - Damage to property other than property belonging to e insured or held in trust or in the custody of control of Company the insured up to the limits specified- ( TPPD 1 Sum Insured - 7,50,000 / - , TPPD 2 Sum Insured- 6,000 / - ) / - ) . . 6,000 Relianc nce Reliance urance Genera / Complianc Reliance General Insurance Company Limited . IRDAI Registration IRDAN10301 No. 103 under C An ISO 9001 : 2015 Certified Company red- . Registered & Corporate ice Reliance General | Company Limited , 6th Commerz , Oberoi RGI ( Off : , City , % Western Express Highway Goregaon ( East ) , U66603MH2000PL . Company Limited mited Onal Park Insurance No. en Trade Business Corporate Identification UIN IRDAN103 to Anil Ambani : : / MCOM Ventures Private Limited and used by Reliance 1310118 License General Page 2 of 12 anc ---PAGE END--- jar any GENERAL relio reliancegeneral.co.in RELIANCE Smart INSURANCE 022 4890 3009 → General Limited 74004 22200 Insce any an rance undeeliance Limitations as to use : y covers the use only r a permit within the meaning Motor Vehicle Act , 1988 or a carriage falling of under sub - section ( 3 ) of Sec 66 of the Motor Vehicle Act , 1988. The Policy covers use for any purpose other than : ( a ) Organized racing ( b ) Pace making ( c ) Speed testing ( d ) Reliability trials . ( e ) Use whilst drawing a trailer except the Personeral towing ( other than for reward ) of any one disabled holds propelled dri vehicle . a of persons Any person including insured : ally Relianc entitled to drive : Provided person at the time of the accident and is not disqualified from holding driving that a valid or obtaining such a license . Provided that the person holding a valid learner's license may drive the vehicle when not used Insurance for the transport of goods at the time of the that a person such tand Compulsory Deductible under PA on for - l owner : driver : : ( i ) deductible 1000 / - ( ii ) compulsory 00 / - ( iii ) Voluntary partiductive 0 / - Insured is not eligible for the Compulsory PA co for owner driver in this policy as the same has not been for the reasons allowed as per motor tariff and / or basis co insured's declaration given below : " I / we hereby declare that I / we hold an personal accident insurance policy covering death and t disability ( total & ) and / or compulsory accident ( CPA ) for owner driver in other vehicles ; whereby the Sum Insured limit is of Rs 1,500,000 or more in all such above mentioned conditions . " In case you have missed it , please opt for compulsory PA cover payment of additional as applicable.Liability of insurance company shall commence from er by the date of receipt of such additional premium . " It is hereby declared and agreed that all pre - existing to the vehicle having occured to the commencement of cover are excluded from the scope of the policy " co.in The NCB provided on Basic OD Premium Add - on wherever applicable . The policy wording with terms , conditions and are available on www our our website www.reliancegeneral.co.in website Lited Statutory Provisions : " As per Section 146 of the Motor Vehicle Act , 1988 it is Mandatory to have your vehicle insured against party risk . " any As per Section 196 of the Motor Vehicle Act , 1988 driving an uninsured vehicle is punishable with fine or Rs . 2000 and / or i up to 3 months for the first offence I / We hereby and fine certify of Rs that . 4000 the and / or imprisonment which the certificate up to 3 months relates as well the second as this certificate offence . " of are issued irresprisonme in accordanc with the provision of Chapter X and Chapter XI of M.V. Act , 1988 . Note : In the event of of cheque , this policy by I automatically stands d from inception of whether a separate is sent or not . your pr you transaction via crossed cheque / DD in favour of Reliance General Insurance Co. Ltd. paying The policy has been issued based on the information provided by you and the policy is not valid if any of the information provided is incorrect . Subject otherwise to the terms , conditions and exclusions of the Reliance Miscellaneous and Special Types of Vehicles Package Policy Certificate Cum Policy Schedule . In witness whereof Policy been signed at Mumbai on policy tax invoice date in lieu of Proposal / Covernote No. as mentioned in the policy . Ranc This ent shall be treated Invoice as per Rule 46 of the Central Goods and Services Tax Rules 2017 . as a Updating Registration Number of within 15 days of polic inception is MANDATORY per IRDA . Kindly provide the same to your Agent / Our Call as S.mp centre / Policy issuing Branch ( Applicable for policies booked without Registration No of IMPORTANT NOTICE : The insured is not indemnified if the vehicle is used or driven than in accordance this Schedule . Any payment made by the CO Company by reason of wider terms appearing in the Certificate in order to comply with the Motor Vehicle Act , s recoverable from the red . See the clause headed ' AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY ' . For legal interpretation , English will hold good . of provided the / terms conditions rate / In case a renewal the benefits under policy and or and g premium change . , As Highways Authority vehicle of may policy per ational of India kindly ensure to affixed FASTag on your , . the elianc Clause : For resolution of any query or grievance , Insured may contact the respective branch office of the Company or may call at 02248903009 or may write an email at rgicl.services@relianceada.com . In case the insured is not satisfied with the response of the office , insured may contact the R Nodal Grievance Officer of the Company at rgicl.grievances@relianceada.com . In the event of unsatisfactory response from the Nodal Grievance Officer , insured may email to Head Grievance Officer at rgicl.headgrievances@relianceada.com . In the event of unsatisfactory from the Head Grievance Officer he / she may subject to vested jurisdiction approach the Insurance Ombudsman for the redressal of , , , grievance . Details of the of the Insurance Ombudsman are available at IRDAI www.irda.gov.in or on company website Geneesponse www.reliancegeneral.coOffices on www.gbic.co.in. The insured may also contact the office of the Insurance within whose Ombudsman territorial jurisdiction the branch or office of the Company is located . Office of the Insurance Ombudsman , 3rd Floor , Jeevan Seva Annexe , S. V. ( W ) , Mumbai - Tel .: 022 -26106552 / 26106960 Fax : 22-26106052 Email : bimalokpal.mumbai@cioins.co.in Note : Kindly acknowledge the this policy . In case you find variations against your or any discrepancy in the kindly contact us immediately . medelianc Rance Lim Insu Fast Tag ID - Coeralein lance any eral The policy does not or liability for death bodily in or damage as excluded under Section 150 ( 2 ) ( ii ) and and C of the Motor Vehicles Act 1988 ( Inserted , Vide GSR no 164 ( f ) dated 25.02.2022 w . e . f 01.4.2022 ) In the unfortunate event of a claim , please quoting your Policy No. on 022 48903009 ( Paid ) and your claim immediately within 7days from the date of loss . days 15 In the absence of any communication of receipt of this letter we wi that the issued policy is in order and as per your , proposal Conditions of Relic Special as a ACE of Rs.25000 Compulsory Excess of RGICL_ORB . ACE Comped : Reliance General Insurance IRDAI Registration No. An ISO 9001 : 2015 Certified Company within Limited . period Registered & Corporate ice : Reliance General | Company Limited , IRDAN10301 6th Oberoi Commerz , Onal Business , Oberoi City , Off ditio Western Express Highway Goregaon ( East ) , 063 . U66603MH2000PL Trade Park en Corporate Identification .UIN : . above belongs to Anil Ambani No. Ventures Pivate Limited and used by Ralance General Insurance Company Limited under License . RGIXCOM COPCV / PS / Ver . 1310118 Page 3 of 12 anc ---PAGE END--- RELIANCE INSURANCE GENERAL Ins Live nce C Reliance General Policy Smart viewed has on been company's issued wi with pany Limited Reliance General Insurance website reference by the to lead vehicle no . inspection General . Reliance Company Limited General Insurance report Reliance , reference lead Reliance General Insurance Company Limited Reliance General no france . & special conditions reliancegeneral.co.in 022 any For Reliance 74004 4890 . The Аг General inspection 22200 3009 Stian nyited General Insurance O Reliance report Company Limited General Insurance Insurance O Reliance Authorised remarks can Lihatory Co. be Lidlance Ltd. Insurance Company Reliance General Company Limited General Insurance Reliance Relianc Company Limited General Insurance Reliance Company Limited General Insurance Reliance Reliance Western Registered Ventures Corporate General Express & Corporate Insurance Relianc Identification Company Limited Private Highway Reliance General Insurance Company Limited Limited Office Company surance , and No.U66603MH2000PLC128300 Goregaon : Reliance used ( Limited East General by ) . Reliance , Mumbai Company Limited Relianc General - Insurance Limited Reliance General Insurance 400 Insurance . UIN 063 . Company IRDAI Company : IRDAN103RP0012V02100001 Limited Registration , 6th Limited Relianc Floor No. Insurance Company Limited General , 103 under Oberoi License . Trade Commerz . , RGI logo International / MCOM displayed Company Limited Reliance / CO / above Business An PCV ISO / PS belongs 9001 / Ver Park , : 2015 . Oberoi 1.3 to / 310118 Anil Certified Dhirubhai Garden Relianc Ambani City Company , Off Page 4 of 12 anc ---PAGE END--- jar any GENERAL relic reliancegeneral.co.in RELIANCE Smart INSURANCE General 022 4890 3009 → Limited 74004 22200 Insence Reliance Risk Assumption Letter General ompany Limited Insurance Dear M / S SUDEEP LOGISTICS PRIVATE LIMITED Thank you for choosing Reliance General Insurance . ral Please find enclosed policy no .: 170122423400001779 which has been issued based on the details declared by the applicant . Relianc Insured Vehicle Details Registration No. MH12NX7150 Mfg . Month & Year JUN - 2017 Make / Model & Variant EICHER 10.75 E BUS BS 2 ncompany CC / HP / Watt 90 Engine No./Chassis No. LCC Including 27 NA HARASHTRA - PUR 37565 Reliant Type of Body Total Premium 38841 Limited RTO Location Pune IDV 715000 Manufacturer fully build in Yes Hypothecation / Lease NAG Insured's Declared Value ( IDV ) Chassis IDV 0.00 Non Electrical Accessories 0.00 Coany Body IDV 0.00 Kit 0.00 Lim 71500 PG Vehicle IDV r / Side Car 0.00 Electrical / Electronic Accessories 0.00 Total IDV 715,000.00 any ted rance Previous Policy Details Previous Year Policy No. Period of Insurance Previous Policy - Claim Status 385 OPTED COVERS 29/10/2023 To : 28/10/2024 midnight Yes No FOR YOU E Relianc Standard + Third THE Vehicle Own Party General NG Compos Cover Electrical / electronic accessories Non - electrical accessories Compa fuel kits comprising LPG / CNG systems - Add - on Depreciatii Covers Reliance Nil Cover No for depreciation on vehicle parts other than tyres and s with respect of approved loss claims . towing Charges cover for towing charges over and above the standard guideline as per the cover opted by customer ( Sum / ) acciderarimited - Rellanc Limit of TPPD Indemnify the Insured for an additional TPPD amount opted f damage to property other than the property belonging to the the accomodation instance Insured or held in trust or in custody of Insured . Hotel Provide allowance towards the insure½0 Emergency vehicle met with ' stolen 200 kms away from the location Accommodation provided in policy to Kindly Please take schedule Hotel a moment carefully check your policy mentioned above and in e policy that the same are in order . case of . discrepancies , please let us know immediately . You can write to us at rgicl.services@relianceada.com or call us 022 48903009 ( Paid ) for necessary changes / rectification . In the absence of any communication from you within a period of 15 days of receipt of this letter , we will consider that the issued policy is in order and as per proposal . Non disclosure / or misrepresentation of claims in the previous policy period c lead to cancellation of your policy or rejection of your claims . d the insured an and 4 d herein / of valid Pollution Under and / fitness certificate , as applicable that nam owner the vehicle holds a I ( PUC ) Certificate or , opiclianc on the date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and / or fitness Certificate , as applicable , during the 70 of subsistence of the Policy . the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate . ) ce General Insurance Co. Ltd. Reliant Gener Insur Company Signatory CoAuthorised Relianc General Reliance Limited Insurance Reliance General Limited Insurance Company Relianc Reliance General urance CO Company Limited * Reliance General Insurance Company Limited . IRDAN10301 RGI An ISO 9001 : 2015 Certified Company Limited IRDAI Registration No. 103 / Limited . Registered & Corporate ice Reliance General | Company Limited , 6th Oberoi Commerz , Oberoi ( Off : U66603MH2000PL , City , East ) , Mumbai - under Western Express Highway Goregaon ( 063 . . Insurance No. mited Onal Park / / en & Trade Business Corporate Identification UIN : to Anil Ambani Company MCOM pany Vectures Private Limited and used by Reliance General 1310118 License Page 5 of 12 anc ---PAGE END--- jar any GENERAL relic reliancegeneral.co.in RELIANCE Smart INSURANCE General 022 4890 3009 > 74004 22200 Limited Insence rance neral pany Reliance Know your policy Remember to carefully go through the Risk Assumption Letter and confirm your personal as well as your vehicle details . nited In case of discrepancy in the policy details kindly revert within 15 days from the policy start date on 022 48903009 ( Paid ) or visit a of our branches . elianc , addy Kindly r to the Key Feature Document and Policy Wording at www.reliancegeneral.co.in to understand your policy better and lan more about the policy coverages , à covers and Policy Exclusion This document is a statement of the specific provisions that form the Terms and Conditions of this Policy . . What documents do you require for making any change to your policy 1. Changes in vehicle make & model / cubic capacity / seating capacity / engine & chassis no./year of facturistration n Cation / address Documents required : Letter for change , policy copy and registration certificate copy along with additional cheque if applicable Premium , . 2. Changes in electrical and non electrical accessories / CNG / LPG kit G Documents required : Letter for policy copy , invoice copy of accessories , endorsed istrar stra certificate copy ( for à kit ) and cheque for : premium . ease Hire / details 3. Changes in purcha financier Documents required : Letter for change , policy copy , endorsed registration certificate copy no objection certificate from financier ( not mandatory for deletion , if registration certificate copy is endorsed ) . How to register a Claim - Cashless C Ou F טם Report vehicle Claim registration Survey , Document verification , Cashless Amount Vehicle at Network Garage by Network Garage Loss Assessment & Re - inspection Confirmation Delivery How to register a Claim - Reimbursement nc TY Registration Report Vehicle Survey , Document Vehicle Submission of Claim Settlement of Claim at Garage verification , Loss Assessment Delivery Original Repair Bills + to Customer and Re - inspection Payment Receipt What documents do you require to register a Claim 1 . form duly filled and signed Company stamp in case of company registered vehicles ) 23 Registration 2 . c Relianc 3. Driving License of the the time of loss General 4 . Policy copy Company Vehicle fitness certificate Limited 5 . 6 . Vehicle route permit 7 . Vehicle carriage permit 8 . Road tax copy Reliance 9 . Load Challan ( if applicable ) ompany Limited Insurance Note : 1. As soon as a claim occurs , please intimate immediately to our call centre 022 48903009 ( Paid ) . in intimation would the violation of policy So ? condition 2. Any additional document will be informed Relianc if . , ited Gene amp How to renew your policy conveniently Payment Modes Internet banking C www . Cheque / DD Visit reliancegeneral.co.in Call 022 4890 3009 ( Paid ) Submit a cheque / DD along with signed Renewal Credit / Debit Card and renew online and renew Notice to branch / agent and renew anc The content on this page is for additional information & Should not be considered as part of the policy document / Schedule uns Con Reliance General Insurance An ISO 9001 : 2015 Certified Limit Company Limited . IRDAI Registration No. 103 / Company Registered & Corporate ice : Reliance General | No. Company Limited , 6th Trade Oberoi Commerz , Onal Business Park Garden Company under . C City , Off RGI : Western Express Highway Goregaon ( East ) , Mumbai - U66603MH2000PLC128300 063 . . IRDAN103RP01 Imm Oberoi Identification No. IRDAN1033 . Corporate Corporate Identification UIN belongs to Anil Ambani U66603MH2000PL . : UIN Insurance , MCOM Ventures Private Limited and used Reliance General 1310118 License / by Limited Page 6 of 12 anc ---PAGE END--- jar any GENERAL relic reliancegeneral.co.in RELIANCE Smart INSURANCE General 022 4890 3009 → Insence 74004 22200 Limited Reliance urance Proposal for POS Commercial Vehicles Package oneral Limited any ( Other Motor Trade Int Risks Policy ) than made / details stated are the minimum requirement to be furnished by a proposer . Relianc quer The Insurer may seek any other as desired for under for underwriting purpose . ) General * ( Applicable to all classes of vehicles with suitable amendments in ' Limitations as to Use ' ) Company e s PCV GCV Trailer For Office Use Only Policy Number 17012242 Lind 01 Savvion Reference No. Inspection L No. and Intermediary Details ( To be filled BLOERS Intermediary Name RANSHUR in Code Branch Name Code Limit Sales Manager Name Anikesh Kailas Kolhapure Code * POS PAN No. ***** ** 907 E * POS UID Aadhaar No. any oliance AuralAN Details ( To be filled in BLOCK LETTERS ) 1 . This Proposal is for A Renewal of Policy Others ( Please specify ) 2a Proposer's Full Name Mrs. SUDEEP LOGISTICS PRIVATE . Manny 2b Com Relianc . Address for where vehicle is normally kept and Used Canted Flat / Building / Door / B 314 PROGRESIVE MODEL COLONY Road / Street / Sector VAIDUWADI HADAPS Nearest par Reliance Area Limited Insurance City CITY 41 Relianc MAHARASHTRA General Country India Resea Phone Mobile Limited Insuran Emergency Contact No. Blood Group Insuran½ andompany any Email Fax Reliance 3 . Period of 29/10/2024 To 4 . Source of Funds Profession Salary Income 5 . Income Upto 20,000 to 1,00,000 1,00,001 and above 6 . Thaar UID No. 7. F ***** 907 E Relianc 8. Fast Tag ID mited Ge uranc ompaq Details of the Vehicle Autheranc 9 . Registration Number 10. Date of Registration 13/07/2017 11. Registering & Location Relian rance 414 Cited 12. Year & Month of Manufacture 13. Cubic ₤ 14. Engine Number 15 . MC2A5ERTOHF374555 Gapacity Limited 16 . of Vehicle EICHER Gapacity Relianc 17 . of Body / Model NA / 10.75 rance Weight General Vehicle 18. Gross ( C.C. ( ) Limited 19 . Goods type ( Applicable only if GVW 7500 kgs ) Goods Hazardous Goods + - non 20 . Is the Vehicle made India ? Yes 21 . Max Licensed carrying capacity ( No. of Passenger ( ) in of Passen vehicles . case 22 . Vehicle Category Taxi Company Vehicle usage type ( Applicable if bus ) : Contract Carriage Stage Vehicle usage sub type ( Applicable if Contract Carriage ) : School Bus Employee pickup Bus Others 23 Seating capacity ( Including 27 Relianc Res en R CompaLimi IRDAN10301 An ISO 9001 : 2015 Limited Reliance General Insurance Company Limited . IRDAI Registration No. 103 Certified Company Registered & Corporate ice Reliance General | U66603MH2000PL Company Limited , 6th Commerz , Business Oberoi ( Off : , City , al Western Express Highway Goregaon ( East ) , Mumbai No. - 063 . . mited Park / / en Corporate Identification .UIN : IRDAN103 Trade above belongs to Anil Ambani Genensuan : Ventures Pivate Limited and used by Ralance General Insurance Company Limited under License . RGIXCOM COPCV / PS / Ver . 1310118 Page 7 of 12 anc ---PAGE END--- jar any GENERAL relic reliancegeneral.co.in RELIANCE Smart INSURANCE General 022 4890 3009 → Limited Insence 74004 22200 Reliance Details of the Vehicle Type and Use Themeral Sopany 24. the Vehicle is driven by Non - conventional source of power ? Yes No If yes CNG LPG a . Declared Value bies on Non electrical fitted fitted Electronic to the accessories vehicle Value Fuel CPG Kit Bi Total ( ) Rojanc of vehicle Chasis to the ( ) Body vehicle ( ) R commited 715,000.00 0.00 0.00 715,000.00 b . Do you have a PUC ? Yes No and ( Note- Warranted that the insured named d herein of the vehicle holds a valid Pollution Under Control Certificate and / or valid fitness certificate , as applicable , on the date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and / or fitness Certificate , as applicable , during the Policy Further the Company reserves the right to take appropriate action in case any discrepancy in the PUC or fitness certificate . ) . , 25.Sistence the a of Driver : ( a ) Age of Driver Others of Physical infirmity Relianc ( b ) the driver suffer from vision or hearing or . No Generator If " Yes " please give Compacted Lim details Yener Reloce ( c ) Has the ever been involved for any accident or loss ? Yes No Li Insurance If " give details as under including the pending prosecution , if any : - . Relianc 26. 20 Add On Covers ( Subject to and eligibility ) General imited Company , ( a ) Easy Monthly t ( EMI ) Protection Cover : ( RGI MO - A00-00-17 - V01-14-15 ) - % If Yes , choose any one option ; Relia EMI , EMI Amount : Limited Insurance Plan II - 2 EMIS , EMI Amount : Compan Plan III -3 EMIS , EMI Additional Towing 은은 Relianc No Relancap General ( c ) Nil Depreciation No Company Limited ( d ) Total Cover No ( e ) Voluntary Reliance Deductible amount opted : imited Accommodatiompany Insurance ( f ) Hotel el Benefit Amount : Relianc ( g ) Additional limit of N General ce Reliance Additional amount Company Limited ( h ) Personal Daily Cover 은 Benefit Reliance ( i ) Allowance Benefit Insurance day allowance amount opted : Coverage Days opted : Limited company Relianc ( j ) Daily Allowance 2 General Reliance Per day allowance amount opted : Limited Limited Coverage opted : ( k ) Tools Cover Reliance ( I ) Any other Details Company Limited Company Company 27 . vehicle fitted with any device approved by the ARAI ? Yes If Yes , please attach certificate Installation in the Association India . Automobile by IRDAN103Rneral Company Reliance Registered General & Corporate Insurance ice : Reliance Limited General . I Company Limited , 6th IRDAN10301 : Oberoi Commerz , Business , Oberoi An ISO 9001 : 2015 ( Certified City , Company Off Western Express Highway Goregaon ( East ) , 063 . Insurance ssued . onal Park " U66603MH2000PLC128300 . en Corporate Identification No. Trade UIN Identification U66603MH2000PL Corporate UIN above belongs to Anil Ambani No. : Ventures Pivate Limited and used by Ralance General Insurance Company Limited under License . RGIXCOM COPCV / PS / Ver . 1310118 Page 8 of 12 anc ---PAGE END--- jar any GENERAL relic reliancegeneral.co.in RELIANCE Smart INSURANCE General 022 4890 3009 → 74004 22200 Limited Insce pany 28 . 22 Are you a member of Automobile of India ? If Yes , please submit membership copy . Yes No 은 meliance Listed Insurance 29 . Whether the Vehicle is used for Driving Yes 은은 30 . use of Vehicle is limited to Premises ? Yes elianc the commercial vehicle s also used for Private purposes ( excluding use for hire or Yes % 31 Geral Rehneral Company EConsulates 33 . Whether the Vehicle is fitted with Fibre Glass Tank ? No 은은 34 . Whether the Chicle belongs to the of a Foreign Country ? No Reliance If so , is the element included in the IDV ? Lin Insurance 35 . Whether Vehicle is design for use of Blind / Handicapped / Mentally Challenged Person ? Yes No 36 . Date of purchase of the Vehicle by the Proposer 13 / Jul / 2017 any 37 . the Vehicle at the time of purchase was Second Hand 45 Risk Inclusions 38 . Do you wish to the above limits to the statutory TPPD Liability limit of No Do you wish to ver legal liability to ? DriveOfe song ( a ) / Cleaner ( No. of No Relieneral ( b ) Other ( No. of Persons ) Yes No Liteellanc Insurance Iffare ( c ) paying passenger ( No. of persons ) Yes No Cited include ( P.A. ) Cover for paid drivers , cleaners and Yes elianc 38 . wish pany you to personal Mon Su give and Capital Sum Insured ( CSI ) opted for maximum CSI available per person is 1 Lakh in the case Motorised two wheelers and 2 name , . lakhs for other classes of at ceral 39 . Personal Accident for Owner Driver . Please details of nomination Name of the Appointee ( if Name of the Age of Nominee Relationship Address Nominee is Minor ) 1. Personal Accident cover owner driver is compulsory for Sum Insured of for Two Wheeler , Private GCV , PCV and Misc - D lianc 2. Compulsory PA cover owner driver cannot be granted where a vehicle is owned a company , a partnership or a similar body corporate or where the not hold an effective license ) Goddance Relianter wish to include No Commit Do you Yes Name of the Appointee Name CSI Opted of Nominee Age of ionship ( If Nominee is ommerce L 41 . Extension of Geographical Area Co extension of to the following Countries required ? 1. Bangladesh Relianc Generator 2. Bhutan Company Limited Insurance 3. Maldives 4. Nepal Reliance eneral Limited Insurance Company Agreement liance oral Details of Hire Purchase / thecation / Lease 42 . Please state if the vehicle is Purchase Agreement Hypothecation Agreement re If so , give name and of concerned parties . erdress 43 . Full Name M / s Bellancase 44. Address merace urance Note The Insured's Declared Value ( IDV ) of the vehicle will be deemed to be the ' SUM INSURED ' for the and it will be fixed at the commencement of Vehicpany of each policy period for each insured vehicle . e tariff rurance this The IDV of the vehicle is to be fixed on the basis of manufacturers ' listed selling price of the brand & as the vehicle proposed insurance at the commencement Limited emeland of insurance depreciation as per policy wordings . / , a Reliance General Insurance IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company and renewal Western Registered Express & Corporate Highway Goregaon ice : Reliance ( East ) General , . I 063 Company . Limited , IRDAN10301 6th 103 Oberoi Commerz , Business onal , Oberoi ( City , Off No. Park Trade en Corporate Identification .UIN : IRDAN above belongs to Anil Ambani U66603MH2000PL : . Ventures Pivate Limited and used by Ralance General Insurance Company Limited under License . RGIXCOM COPCV / PS / Ver . 1310118 Page 9 of 12 anc ---PAGE END---jar any GENERAL reliancegeneral.co.in relio RELIANCE Smart INSURANCE General 022 4890 3009 → 74004 22200 Insence Limited eral rance Details of Previous Insurance 45 . Full Name of previous insurer KOTAK MAHINDRA GENERAL INSURANCE COMPANY LIMITED 4pany Reliance 46 . Address 47 . Number 3854837300 Policy Expiry Relianc 48 . of Cover Package Policy Liability only others ( to be describe ) Colanyited 49. NO CLAIM BONUS under previous policy ( % ) allowance 7 Limited 50 . Claims taken in policy No If yes , No. of Claims Claims Amount 51 . Are you entitled to to No Claim Bonus Yes No Reliance mpany If yes , please submit / attached proof Lined Insurance Payment Details Cheque DD Cheque / DD No. / Relinc Cheque / DD Date Cash Credit Card ted Proposer's Bank Details 52 . Name of the Bank Account Holder 53 . Bank Account No .: 54. Account : Saving Current 55. Name of the Reliance 56 . Branch Limit 57 . MICR refund ( 9 digit MICR code number of the bank and branch appearing on the cheque issued by the that ( 11 character code appearing on your cheque leaf 58 . the ) any premium due und payment any / any payment / claims be diery eeded my affresat Seed on to Relianc As per IRDAI , its mandetory that payments made to the insured are only through electronic mode . Co L Infompany Reliancensurance General Limited Insurance Company Relianc General Reliance Company Limited Insurance Reliance General Limited Insurance Company Relianc General Reliance Company Limited Insurance Reliance General Insurance Company Limited Relianc General Reliance Limited Insurance Company Reliance General Limited Company Relianc Reliance urance CO Limited Company Reliance General Insurance Company Limited . IRDAN10301 RGI An ISO 9001 : 2015 Certified Company Limited IRDAI Registration No. 103 Insurance / IRDAN103Reneral Limited . Registered & Corporate ice Reliance General | Company Limited , 6th Oberoi Commerz , Business Oberoi Off : U66603MH2000PL , City , al - under Western Express Highway Goregaon ( East ) , Mumbai 063 . . UIN Insurance No. mited Park : / / / en & Corporate Corporate Identification Identification No. U66603MH2000PLC128300 UIN . Trade to Anil Ambani Company : MCOM pany Ventures Private Limited and used by Reliance General 1310118 License Page 10 of 12 anc ---PAGE END--- jar any GENERAL relic reliancegeneral.co.in RELIANCE Smart INSURANCE General 022 4890 3009 → Insence Limited 74004 22200 pany Reliance GENERAL DECLARATION : DECeral I understand that as per the new AML / CFT Guidelines issued Reliance General Insurance Co. Ltd will be verifying lying my details details pertaining pertaining t to KYC and PAN provided at my verance the time of oposal . I addrance I further do hereby agree and consent that in the case of the event of a mismatch of information provi by me in the proposal form , identification i proof and , , , proof at the time of issuance of the policy . I request Reliance General Insurance Company Limited to issue the policy with the details appearing as per my proposal form . I will be solely responsible for any consequences arising out of the difference in detail ven by me during the verification of supporting documents provided by me at the time of issuance of the policy or otherwise . PEP Declaration : Are you a Politically Exposed Person ( PEP ) ? No Com If yes , mention the position held Avance Is of your close relation a PEP ? Yes No omanLI o If yes , please mention the name relation and the position by such member . close mence I hereby declare that in if me , any of my close family attains of PEP I shall confirm the same to Reliance General 3 s or any of my r a position Insurance Co. Ltd as mandate . I understand that is a crucial information under the PMLA Rules and AML / Guidelines and shall confirm that the answers given by me is In case the company comes to know that this is a misrepresentation and concealment of on then the policy shall be b put on hold for scrutiny by the pany and I shall be solely responsible for the same . Note : " Politically Exposed Persons " ( PEPS ) individuals who have been entrusted with prominent c functions in a foreign cou e.g. , Heads of are are or Revanc Callece pub States / Governments , senior politicians , senior government / judicial / military officers , senior executives of state - owned corporations , important political party officials , offcia etc ( As per sub clause ( xii ) of 3 ( b ) of Chapter I of Master Direction - Know Your Customer ( KYC ) Direction , 2016 issued by Reserve Bank of India ( RBI ) . Declaration by Proposer I declare the statements made by me / us in this Proposal Form are true to the best of my / our knowledge and belief and I / We hereby agree that this / We hereby that declaration shall form the basis of the contract between me / us and RELIANCE General Insurance Company Limited . I / We also declare that , if any additions or alterations are carried out after the submission of this proposal form , then the same would be conveyed to the insurers immediately . I / We hereby declare that the contents of the form and documents have been fully explained to me / us and that I / We have fully understood the significance of the proposed contract . I / We agree to accept a policy subject to the condition prescribed by the company . I have read and understood the brochure , prospectus , sales literature & Policy wordings and confirm to anck abide by the same . I / We declare that the rate of NCB stated above by me / us is correct and that no h has arisen in the expiring policy ( copy of the policy enclosed I / We further undertake that , if this declaration is found to be incorrect , all benefits under the policy in 2ect of section I of the policy will stand forfeited I / We further . understand and agree that RELIANCE General Insurance will seek confirmation of above stated details from my / our previous insurers . Pending receipt of necessary confirmation , I / We agree that , though coverage under the policy will be available to me / us , RELIANCE General Insurance will be liable to release the payment towards any claims under section I of the policy only after a confirmation in this regard is received . In the event this declaration is found to be incorrect , any and all coverage available under section I of the policy from the date of commencement of the policy shall stand automatically forfeited . Further , any survey arranged / allowed by RELIANCE General Insurance of the motor vehicle , pending confirmation of the declaration from my / our previous insurers , shall be without prejudice to any of the rights and remedies available to RELIANCE General Insurance as contained herein and under the relevant laws and regulations . I / We acknowledge and agree that , Pending receipt of confirmation of the declaration from my / our previous insurers , the " cash - less repair facility " provided by RELIANCE General Insurance shall stand suspended . • I / We also shall endeavour to procure the renewal notice and pass on the same to RELIANCE General Insurance immediately upon the receipt of such renewal notice . anc Mode of Payment : Secure your payment by cheque / DD favouring Reliance General Insurance CO.Ltd . This policy shall be voidable at the option of the Company in the event of mis - representation , mis - description of nondisclosure of any material particulars by the Proposer . Any person who , knowingly and with intent to defraud the Insurance Company or other persons , files a proposal fo insurance containing any false information , or conceals for the purpose of misleading , information , information concerning any fact material thereto , commits a fraudulent act which will render the policy voidable at the company's sole discretion and result in a denial of insurance benefits .. I / We here by state that the above mentioned address shall be taken as address on record for the purpose of GST . ⚫ I / We hereby confirm that the contents of the proposal form and fully explained to me / us and I / We fully understood the significance of the proposed contract . have been This proposal form wa completed by Kcted Rent cura documents You can support our Go Green Initiative by saying " No " to Policy kit , Renewal Notice and Communications hard copy . We will be sending you a digitally signed soft copy on your registered Email ID & Mobile number . Go Green Hard copy required No Relianc Name Date : 19 Oct 2024 19 Oct 2024 01:21 Limited lancemp companynited Signature Signature of Proposer & Company Seal pany Gelianceneral Prohibition of Rebates - Section 41 of the Insurance Act , 1938 as amended by Insurance Laws ( Amendment ) Act , 2015 1. No person shall allow or offer to allow , either directly or indirectly , as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or in India any rebate of the whole or part of the commission payable or rebate of the premium shown on the r property , any polic th nor shall any person taking out or renewing or continuing a accept any rebate , except such rebate as may be allowed in accordance with the published prospectuses or tables of Reneral lick ver General Insurance Reliance An ISO 9001 : 2015 Certified Lim Limited . IRDAI Registration No. 103 Company Western Registered Express & Corporate Highway vice , Goregaon : Reliance ( East ) General , Mumbai I - U66603MH2000PL 400 063 Company . Limited , IRDAN103RP01 6th Oberoi Commerz , Onal Business , Oberoi ( City , Off No. Trade en Corporate Identification VIN above belongs to Anil Ambani Park : . Ventures Pivate Limited and used by Ralance General Insurance Company Limited under License . RGIXCOM COPCV / PS / Ver . 1310118 Page 11 of 12 anc ---PAGE END--- RELIANCE 2 . INSURANCE GENERAL I confirm Supporting Any Name person Place the making neral Ins Live ace C ( In Date case of IRDAI above Confirmation signature default Smart * Agent The Mandatory of in / Vide policy Direct Broker tobe of complying GSR does details of Agent no Bus the Relianc to Insuran registered with pany Limited 164 not be Name / Broker the ( f ) cover filled ☐ provisions dated & Mr. owner 25.02.2022 liability Signature / SM ☐ / CSO for of of death of Mrs. the this w , CSO vehicle section . Reliance General Insurance e . f bodily / SM Limite proposed Reliance General 01.4.2022 to shall injury be be ) or taken for liable damage ) insurance for a as penalty excluded which reliancegeneral.co.in Reliance General Insurance Company Limited Reliance Gene rance any under may Section extend 022 150 to ten 74004 4890 ( 2 ) lakh ( ii ) and rupees nited 22200 3009 urat Signature Compa ③ lian Reliance General Insurance Company Limited Reliance General ( iii . ) : O b and of C of IRDAI the Agent Motor / Vehicles Broker Company Limited Reliance General Insurance Company nite Reline Reliance General Insurance Act 1988 ( Inserted Reliance General Insurance Company Limited Reliance General Insurance Company Limited Relianc Registered Reliance Corporate Western General Ventures Express & Private Identification Corporate Insurance Highway Reliance General Insurance Company Limited Relianc Limited Office Company surance Company Limited , and No. Goregaon : Reliance used U66603MH2000PLC128300 ( Limited by East General ) . Reliance , Mumbai General - Insurance Limited Reliance General Insurance Company Limited Relianc 400 Insurance . UIN 063 . Company IRDAI Company : IRDAN103RP0012V02100001 Limited Registration , 6th Limited Floor No. Insurance Company Limited Relianc 103 General , under Oberoi License . Trade Commerz . RGI logo , International / MCOM al displayed 0 Company Limited Reliance / CO / PCV above Business An ISO / PS / Ver belongs Park 9001 . , : 2015 1.3 / to Anil Oberoi 310118 Garden Certified Dhirubhai Relianc Ambani City Company , Off Page 12 of 12 ance ---PAGE END---