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NEAR GANRAJ RIKSHAW STAND PLOT NO 04
SAFALYA BUNGLOW
WAIDWADI PROGRESSIVE MODEL CO
My Policy Claim Status
OPERATIVE SOCIETY HADAPSAR
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PUNE CITY
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MAHARASHTRA India - 411013
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9326 ******
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Carrying 4W > 6 & 3W > 17 ) Package Policy -
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Schedule , with Policy
Number 170122523400000284 is now live to Customer Information Sheet ( CIS )
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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 13
---PAGE END--- ar
Digitally y signed by Reliance reliancegeneral.co.in
GENERAL
eliny
RELIANCE General Insurance
Smart
INSURANCE Company Limited 022 4890 3009
Date : 2025.02.04 15:36:33
74004 22200
IST
Insence
Ce
Pan
miteo
eneral
Commercial ( Passengers Carrying 4W > 6 & 3W > 17 ) Policy - Schedule
Important
the
of this certificate of policy is subject realization by the of premium cheque paid by the Insured .
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e cum to company
2 ) as provided in GR 27 ( g ) of Erstwhile Indian Motor Tariff ( i.e. Sale of Vehicle ) , No NCB will be allowed when a policy is not renewed within 90 days of
Nurance
its expiry .
Policy Number : 170122523400000284 Proposal / Covernote No : R290125117503
Insured Name : M / S SUDEEP LOGISTICS PVT LTD Period of Insurance : From 00:00 Hrs on 03 - Mar - 2025 to Midnight of
02 - Mar - 2026
Communication Address & Place of Supply : NEAR GANRAJ RIKSHAW Policy Issuing Branch : A Block , Heritage House , Ground floor , 6 Ramabai
STAND PLOT NO 04 SAFALYA BUNGLOW WAIDWADI PROGRESSIVE MODEL Ambedkar Road ,, PUNE , MAHARASHTRA , 411001 .
CO OPERATIVE SOCIETY HADAPSAR PUNE CITY , PUNE , MAHARASHTRA ,
India , 411013 .
Mobile No : 9326 * ****** Tax Invoice No. & Date : R290125117503 & 04 Feb 2025 03:36
Email - ID NA GSTIN / UIN & Place of Supply : 27AATCS2867F1ZS and MAHARASHTRA
Insured Vehicle Details
Registration No. MH12VF0922 Mfg . Month & Year JAN - 2023
a
Make / Model & Variant EICHER 2075 G SRL CWC BSVI CC / HP / Watt 3000
Engine No./ Chassis No. E446CDPA055344 / MC2FCHRTOPA519608 LCC Including Driver 33
Linke
Type of Body NA Total Premium 44479
RTO Location MAHARASHTRA - Pune Total IDV 2,160,000.00
Manufacturer fully build in Yes Hypothecation / Lease Au Small Finance Bank Ltd
Vehicle Category Bus Vehicle Usage Type Contract Carriage
Company
Vehicle Usage Sub Type School Bus
Insured Declared Value ( IDV )
Chassis IDV 0.00 Non Electrical Accessories 0.00
Body IDV 0.00 CNG / LPG Kit 0.00
Vehicle IDV 2,160,000.00 Trailer / Side Car 0.00
Electrical / Electronic Accessories 0.00 Total IDV 2,160,000.00
Premium Summary
Own Damage - Section I Amount ( ) Liability - Section II Amount ( )
Basic OD 1,810.98 Basic Liability ( TPPD 1 ) 36,032.00
Covers for Lamps Tyres / Tubes Mudguards / Bonet / Side Total Basic Liability Premium 36,032.00
parts etc ( IMT - 23 ) 271.65 PA Benefits - Section III
Total Basic Own Damage Premium 2,082.63 Legal Liability to paid driver and / or Conductor and / or
Less cleaner 100.00
Deduct 25 % for NCB -520.66 TOTAL LIABILITY PREMIUM 36,132.00
Sub Total of Deductions -520.66 TOTAL PACKAGE PREMIUM ( Sec I + II + III ) 37,694.00
CGST ( @ 9.00 % ) 3392.00
SGST ( @ 9.00 % ) 3392.00
TOTAL OWN DAMAGE PREMIUM 1,562.00
TOTAL PREMIUM PAYABLE ( ) 44,479.00
Subject to I.M.T.Endt . Nos . & Memorandum printed / herein / attached hereto . IMT 40,23,21,7
GSTIN : 27AABCB1ZG
Lee
Infant
HSN 997134 , Description of services : MOST Insurance Service
will
" As per the regulations , the amount not be refunded if the policy / endorsement is cancelled after 31st October of the next financial year "
.
Of
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Consolidated Stamp duty Paid vide Lot of Authorisation " NO LOA / ENF - 1 / CSD / 05 / 2025 / ( Validity Dt . 27/01/2025 to Dt . 12/2026 ) / 424 Date 24-01-2025 " at
General Stamp Office , Mumbai . ** Applicable for the State of Jammu & Kashmir .
SAMADHAN
23P68356 / R 9326689009 sujitlolage@gmail.com ***** 907 E
RA
Intermediary Customer Name diary Contact No. Intermediary E - mail ID POS UID Aadhaar No. / PAN No.
wellnce
The Sheet ( CIS ) for this product is available on our website
Lim
InsuC
https://www.reliancegeneral.co.in/insurance/about-us/downloads.aspx
Relianc
urance
Relianc
General
Company
Limited
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th beroi Commerz International Business Park Oberoi Garden City Off
, , ,
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 .
Corporate Identification No. U66603MH2000PLC128300 UIN IRDAN103RP001202 100001. Trade logo displayed above belongs Anil i Ambani
Dhirard
: to
.
Ventures Private Limited and used by Reliance General Insurance Company Limited under License . RGI / MCOM / CO / PCV / PS / Ver . 1.3 / 310118
Page 2 of 13
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---PAGE END--- Stian
GENERAL reliancegeneral.co.in
reliany
RELIANCE Smart
INSURANCE
General
022 4890 3009
Limited
74004 22200
Insce
eliance
pany
rance
Limits of liability for section III CSI Under Section II ( 1 ) ( i ) of the Policy - Death of or bodily injury to any
eneral
: r owner driver under 0 ( a )
so far as it is necessary to meet the requirements of the Motor Vehicle Act , 1988. ( b ) Under Section II ( 1 ) ( ii ) of
the Policy - Damage to property other than property belonging to the insured or held in trust or in the custody of control of
the insured up to the limits specified- ( TPPD 1 Sum Insured - 7,50,000 / - , TPPD 2 Sum Insured- 6,000 / - ) .
ellane
as to use The policy covers the use only under a permit within the meaning of Motor Vehicle Act , 1988 or such a carriage falling
under sub - section ( 3 ) of Sec 66 of the Motor Vehicle Act , 1988. The Policy covers use for any purpose other than : ( a )
Rnce
Organized racing ( b ) Pace making ( c ) Speed testing ( d ) Reliability trials . ( e ) Use whilst drawing a trailer except the
towing ( other than for reward ) of any one sabled mechanically propelled ve vehicle .
Persons / Classes of Any person including insured :
:
entitled to drive : Provided that a person driving holds a driving license at the time of the accident and is not disqualified from holding
or obtaining such a license . Provided that the person holding a valid learner's license may drive the vehicle when not used
for the transport of goods at the time of the accident and that a person satisfies the requirements of Rule 3 of the
GenInsurance
3
Central Motor Vehicles Rules , 1989 .
Deductible under Section - I : ( i ) Compulsory deductible 1000 / - ( ii ) Additional y deductible 00 / ( iii ) Voluntar deductible 0 / -
-
Relianc
* No Claim Bonus is subject to no claim on the previous policy . Benefits under the policy stands forfeited if claim is / was made in previous policy .
" It is hereby declared and agreed that any damages losses occurred & any Liability having been incurred , prior to the commencement of cover under
this policy are excluded from e scope of this policy . "
% of Discount on Own Damage Premium
Period of Insurance % of NCB on OD Premium
The Preceding Year 20 %
Preceding Two Consecutive Years 25 %
Preceding Three Consecutive Years 35 %
Preceding Four Consecutive Years 45 %
Preceding Five Consecutive Years 50 %
Compulsory PA cover for owner driver :
Insured is not eligible for the Compulsory PA cover for owner ac in this policy as the same has not been opted for the reasons allowed as per motor tariff and / or basis
insured's declaration given below :
an
personal
" we hereby declare that I / we hold t insurance policy covering death and permanent ( total & partial ) and / or compulsory personal
effective
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 by payment of additional premium as applicable The of insurance y shall commence from
the date of receipt of such additional premium .
wo
.
" It is hereby declared and agreed that all pre - existing damages to the vehicle having occured prior to the of cover from the scope of the
policy
are
applicable
policy "
Relianc
Sprouted ' is on Bass D Premium excluding Add on with detailed terms , conditions and exclusions are available on
-
wherever
our website www.reliancegeneral.co.in
Statutory Provisions :
" As per Section 146 of the Motor Vehicle Act , 1988 it is to have your vehicle insured against third party risk . "
As Section 196 of the Motor Vehicle Act 1988 driving an uninsured vehicle is punishable with fine or Rs . 2000 imprisonment up to 3 for the first
per
,
and
offence and fine of Rs . 4000 and / or imprisonment up to 3 months for the second offence . "
I / We hereby that the Policy to which the certificate relates as well as this certificate of insurance are in accordance with the of Chapter X and
certif
Chapter XI of M.V. Act , 1988 .
Note : In the event of dishonor of cheque , this policy document automatically stands cancelled from irrespective of whether a separate communication is sent
2
or not .
Piano
move
Safeguard your transaction by paying your premium via cross cheque / DD in favour of Reliance General Insurance Co. Ltd.
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 this
Policy has been signed at Mumbai on policy tax invoice date in lieu of Proposal / Covernote No. as mentioned in the policy .
This document shall be treated as a Tax Invoice as per Rule 46 of the Central Goods and Services Tax Rules 2017 .
Updating Registration Number of vehicles within 15 days of policy inception is MANDATORY as per IRDA . Kindly provide the same to your Agent / Our Call
centre / Policy i issuing Branch ( Applicable for policies booked without Registration No of vehicles ) .
S
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IMPORT 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 hold good .
In case of a renewal , the benefits provided under the policy and / or terms and conditions of the policy including premium rate may be subject to change .
As per National Highways of India kindly ensure to affixed FASTag on your vehicle
Authority ,
.
Rel
Gener
Limited
Insuranny
Comp
Relianc
General
Reliance
surance
surance
Company
Limited
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th IRDAN103RP0012001 Oberoi Commerz International Business Park Oberoi ( City Off
, , , ,
uan
Mumbai logo
den
Western Express Highway Goregaon ( East ) - 400 063 .
, ,
Trade
.
Corporate identification No. U66603MH2000PLC128300 UIN : displayed above belongs to Anil Dhir i Ambani
. ,
Ventures Private Limited and used by Rallance General Insurance Company Limitled under License . RGIMCOM.CO/PCV/PS/Ver . 1.3.310118
Page 3 of 13
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---PAGE END--- t
any
GENERAL
tian
RELIANCE
INSURANCE reliancegeneral.co.in
relio
General
022 4890 3009
Insence
Limited
74004 22200
pany
eliance
Grievance
For resolution of any query or
grievance
urance
, Insured may contact the respective
write an branch office of the Company or
email at rgicl.services@relianceada.com may call at 02248903009 or may
. In case the insured is not satisfied
Nodal Grievance with the response of the office
Officer of the Company at rgicl.grievances@relianceada.com , insured may contact the
Grievance . In the event of unsatisfactory
Officer , insured may email to Head response from the Nodal
Grievance Officer at rgicl.headgrievances@relianceada.com
response from the Head Grievance . In the event of unsatisfactory
Officer , he / she may , subject to vested
grievance jurisdiction , approach the Insurance
Relianceneral
. Details of the offices of the Insurance Ombudsman for the redressal of
Ombudsman are available at IRDAI
www.reliancegeneral.co.in website www.irda.gov.in or
or on www.gbic.co.in. on company website
The insured may also contact
territorial the following office of the Insurance
jurisdiction the branch or office of Ombudsman within whose
the Company is located .
of the Insurance Ombudsman
3rd Floor Jeevan Seva
acknowlence , , Annexe S. V. Road Santacruz
26106960 Fax : 022 -26106052 , ( Mumbai - 400 054. Tel 287
, .: 022 -2
Email : bimalokpal.mumbai@cioins.co.in . 26106552 /
Note : Kindly
the receipt of this In case
you find any variations against
your proposal or in
the policy , contact
C us immediately .
them
neral
Fast
The
Relianc
policy does not cover liability
for death , bodily injury or
as excluded under Section
empany
Vide GSR no 164 ( f ) dated ( 2 ) ( ii ) and ( iii ) : b and C of Motor
25.02.2022 w . e . f 01.4.2022 Vehicles Act 1988 ( Inserted
)
In the unfortunate event
of a claim , please
P.
call quoting your Policy No. on 248903009 (
0224
In the absence Communication and register your claim
of any fr from you within immediately within 7days from the date
a period of 15 days of receipt of loss .
of this letter , we will consider that
proposal . he issued
policy is in order and
as per your
Special Conditions ACERemark
: as ACE of Rs.25000 Additional
Compulsory Excess of Rs.5000.0 RGIC
ORB .
Lindom
Policy has been issued with
reference to vehicle inspection
report , reference lead no . &
viewed on company's special conditions.The
website by the lead no report remarks can be
.
Renc
Reliance
Genea
For Reliance General
Insurance Co. Ltd.
Co
Insured
Limite1eneral
A
Reliance
General
Authorised Signatory
Company
Insurance
Reliance
Relianc
General
Insurance
Company
Limited
Reliance
General
Company
Insurance
Limited
Reliance
Relianc
General
Insurance
Limited
Company
Reliance
General
Company
Insurance
Limited
Reliance
Relianc
General
Insurance
Limited
Reliance
General
Company
Limited
Company
Reliance
Relianc
urance
* Reliance General
Insurance Company Limited
Limited
. IRDAI Registration
Company
Registered No. 103
& Corporate Office : Reliance An ISO 9001 : 2015 Certified
General Insurance Company Company
Limited , 6th 128300. Oberoi Commerz Internatione logo
Western Express Highway , Goregaon ( East ) , Mumbai - 400 IRDAN103RP0012 UN , , ational , Oberoi Garden City
Insurance
063 . . O
Business ,
The Trade
Sun. N IRDAN103RP
01.
:
Ventures
Park
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General
Private Limited and used by Reliance General Insurance d above belongs to Anil Dhirub Ambani
Company Limited under License . RGI / MCOM / CO / PCV
/ PS / Ver . 1.310118
Page 4 of 13
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---PAGE END--- any
Stian
GENERAL reliancegeneral.co.in
relio
RELIANCE Smart
INSURANCE
General
022 4890 3009
Limited
74004 22200
Insce
Reliance
Risk Assumption Letter
General
Limited
Insurance
Company
Dear M / S SUDEEP LOGISTICS PVT LTD
ral
Thank you for choosing Reliance General Insurance .
Please find enclosed policy no .: 170122523400000284 which has been issued based on the details declared by the applicant .
Relianc
Insured Vehicle Details
Registration No. MH12VF0922 Mfg . Month & Year JAN - 2023
company
Make / Model & Variant EICHER 2075 G SRL CWC BSVI CC / HP / Watt 3000
Engine No./Chassis No. E446CDPA055344 / MC2FCHRTOPA519608 LCC Including 33
Reliant
Type of Body NA Total Premium 44479
Limited
RTO Location MAHARASHTRA - Pune IDV 2160000
Manufacturer fully build in Yes Hypothecation / Lease Au Small Finance Bank
Insured's Declared Value ( IDV )
Chassis IDV 0.00 Non Electrical Accessories 0.00
Coany
Body IDV 0.00 CNG LPG Kit 0.00
Lim
Vehicle IDV 2160000 Trailer / Side Car 0.00
Electrical / Electronic Accessories 0.00 Total IDV 2,160,000.00
any
ted
Previous Policy Details
Previous Year Policy No. Period of Insurance Previous Policy - Claim Status
3062751701 From : 03/03/2024 To : 02/03/2025 midnight Yes No
YOU HAVE OPTED FOR THE FOLLOWING COVERS
Relianc
Vehicle
Generalerance
Standard Own Damage + Third Party
Comp
Cover
Electrical / electronic accessories
Non - electrical accessories
Bi - fuel kits comprising systems
Add - on Covers
Reliance
urance
Nil Deprecia Cover
No for depreciation on vehicle parts other than tyres and tubes with respect of approved partial loss claims .
Provides cover for towing charges over and above the standard guideline as per the cover by customer ( Sum
Insured 0.0 / - ) .
Additional L Limit of TPPD Indemnify the Insured for an additional TPPD amount opted for damage to property other than property belonging to the
Relianc
accidented
Insured or held in trust or in custody of Insured .
Emergency Hotel Provide allowance towards the Hotel accommodation vehicle met with a V stolen 200 kms away from the location
Accomodation provided in policy copy .
Whed
NCB Retention No - Claim Bonus % is retained even after a claim , would have become 0 % without this cover .
Total Cover Provides cover for registration charges , road tax and insurance premium ( Total Cover Sum Insured -
EMI Protect Pays for car EMIs for the time period during which the vehicle is in one of our network garages for repair .
Benefit Provides allowance as per plan opted , if vehicle is in garage for more than minimum days & for initial eligible own damage
claim . , and in case of theft where vehicle is not found for more than 90 days
owance Benefit Plus Provides allowance as per plan opted , if vehicle is in garage for more than minimum days & for own damage claim . , and
eligit
I case of theft where vehicle is not found for more than 90 days
Ranc
Protector Covers repair or replacement expenses arising out of accidental loss or damage to tyre & tubes
14b
Rim Protector Covers repair or replacement expenses arising out of accidental loss or damage to Rims
is
Personal belongings Covers loss of al of insured or his f while such items are in at the time loss or damage to the
vehicle
belongings
Key Protect Cover Provides I cost of keys in the event keys are lost . It also covers cost of locks if the vehicle is broken
into
Assistance cover Provides or support in various emergency situation to the insured and Insured Vehicle due to or breakdown
Tools and Equipment Cover It will provide an allowance of specified amount for loss or damage to the tools and equipments at the time of event
Voluntary Deductible The insured shall be given reduction in premium if insured opts for specified amount of voluntary deductible and will bear the
specified expense at the time of event
No Claim Discount retension
Relianc
It will maintain the current applicable NCB at the time of renewal of the policy
Insurance
Compone
Li
Insuran
Reliance
General
Limited
Insurance
Company
Relianc
General
Reliance
urance
Company
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Limited
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Oberoi Commerz , Business Park Cen Off
and
, City
,
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 . na
viruterden
Trade
ESTATE above belongs to Anil Ambani
logonal
Vertures Private Limited and used by Reliance General Insurance Company Limited under License . RGIMICOMICO.PCV / PS / Ver 138310118
Page 5 of 13
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---PAGE END--- RELIANCE
discrepancies Please INSURANCE GENERAL
and changes take
claims a
as / rectification moment
( Note- per , please neral Ins Live ace
.
on your Smart
subsistence the Warranted to
date proposal . In let us carefully
of the know
of commencement that . Non absence check
the Policy the insured disclosure of immediately your
. any policy Limited
Further communication . pany
Reliance Gener of named and You details
the /
, Policy or can
the herein misrepresentation write mentioned
Company and / owner from to
undertakes us
reserves of you at rgicl.services@relianceada.com above
the within
vehicle of and General
to claims eliance
Compart the a in
Reliance General Insurance right renew period the
holds in policy
to and the of
take a previous 15
appropriate maintain valid days schedule
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valid receipt or Kindly reliancegeneral.co.in
action and Under period of call confirm rance any
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case lead , 48903009 022
of PUC ( PUC to we the
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or applicable rejection
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General Insurance Co Authorised Insurance . ) . ) the applicable Relianc
Reliance
Company Limited
Reliance General Insurance ,
Co.
Signatory Ltd.
Limited Relianc
Insurance Company
Reliance General
Company Limited
Reliance General Insurance
Registered Reliance
Corporate Western General
Ventures Express &
Private Identification Corporate Insurance Company Limited Relianc
Highway General Insurance
Limited Reliance
Office surance Company
Limited , Company
and No. Goregaon : Reliance
used U66603MH2000PLC128300 by Reliance ( East ) , General Limited . Relianc
Mumbai Company Limited
General Insurance Limited Reliance General Insurance
-
400 Company
Insurance . UIN 063 IRDAI
.
Company : IRDAN103RP0012V02100001 Limited Registration
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6th Company Limited
Limited Floor No. General Insurance
, 103
under Oberoi
License . Trade Commerz
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RGI logo ,
/ MCOM displayed International Company Limited Relianc
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PCV ISO
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/ Ver Park :
. 1.3 to , Oberoi 2015
/ 310118 Anil Certified
Dhirubhai Garden Relianc
Ambani City Company
,
Off
Page
6
of
13
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---PAGE END--- any
Stian
GENERAL reliancegeneral.co.in elia
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 .
nyited
In case of any policy details revet within 15 days from the policy start date on 0248905009 ( Paid or visit any of ou
of our branches .
ellane
Kindly refer to the Key Feature Document and Policy Wording at www.reliancegeneral.co.in to understand your policy better and learn more about the policy coverages ,
add - on 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 manufacture / registration no./location/address
Documents required : Letter for change , policy copy and registration certificate copy along with additional Premium cheque if a
,
2. Changes in electrical and non electrical accessories / CNG / LPG kit
Documents : Letter for addition policy copy invoice copy of accessories endorsed gistration > certificate copy ( for CNG / LPG kit ) and cheque for additional
Chequired premium . , , ,
Rend
3. s in financier details ( Hypothecation / Lease / Hire purchase )
Documents required : Letter for change , policy copy , endorsed registration certificate copy and no objection certificate from financier ( not mandatory for deletion , if
registration certificate copy is endorsed ) .
How to register a Claim - Cashless
F ά
No
茴
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
OU
C B =
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
Ca
123 Claim form duly filled and signed stamp in case of company registered vehicles )
Registration
copy
Raim
Suanccompany
Relianc
Driving License of the driver the time of loss
General
Reli
4 . Policy copy
Company
Limited
5 . Vehicle fitness certificate
Cat
6 . Vehicle route permit
7 . Vehicle carriage permit
8 . Road tax copy
Reliance
ompany
9 . Load Challan ( if applicable )
Limited
Insurance
Note : 1. As soon as a claim occurs , please immediately to our call centre 022 48903009 ( Paid ) . Delay in intimation would result in the violation of policy
ac
So
condition
2. Any additional document , if will be informed .
Relianc
ited
Gener
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
Re
An ISO 9001 : 2015 Certified Company
Limit
* Reliance General Insurance Company Limited . IRDAI Registration No. 103
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Trade Oberoi Commerz International Business Park Oberoi ( City Off
and
, , ,
Dhiren
.
Western Express Highway , Goregaon ( East ) , Mumbai - - 400 063 . IRDAN103RP001201
Corporate identification No. U66603MH2000PLC128300 UIN : logo displayed above belongs to Anil Ambani
.
Ventures Private Limited and used by Rallance General Insurance Company Limitled under License . RGIMCOM.CO/PCV/PS/Ver . 1.3.310118
Page 7 of 13
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---PAGE END--- any
Stian
GENERAL reliancegeneral.co.in
relio
RELIANCE Smart
INSURANCE
General
022 4890 3009
Insence
Limited
74004 22200
POS
Reliance
Proposal for Vehicles Package I
Forneral
Commercial
Insurance
Limited
( Other Motor Trade Risks Policy )
erpany
made / details stated below are the minimum requirement to be furnished by a proposer .
Relianc
quer
General
The Insurer may seek any other as desired for under for underwriting purpose )
men
.
icmation
* ( Applicable to all classes of with suitable amendments in ' Limitations as to Use ' )
Company
for
PCV GCV
Me
For Office Use Only
Policy Number 1701225000284 Date
Goal
Lind
Savvion Reference No. Inspection Lead No.
ang
ny
Intermediary Details ( To be filled in BLOCK LETTERS )
Intermediary Name SAMADHAN RANSHUR Code 23P68356
Ge
Branch Name Code 1701
Limit
Sales Manager Name Anikesh Kailas Kolhapure Code 71016662
* POS PAN No. ***** *** 907 E * POS UID Aadhaar No.
liance
any
any
Details ( To be filled in BLOCK LETTE
1 . This Proposal is for A new Policy Renewal of Policy Others ( Please specify )
22 Proposer's Full Name Mrs. SUDEEP LOGISTICS PVT LTD
where vehicle
Relianc
Address Address for Communication is normally and Used
NEAR GANRAJ RIKSHAW STAND PLOT NO 04
Reser
Coated
Flat / Building / Door / Block No. SAFALYA BUNGLOW WAIDWADI
Road / Street / Sector PROGRESSIVE MODEL CO OPERATIVE
SOCIETY APSAR
Nearest
mana
Reliance
Area
Limited
Insurance
CITY
411013
Relianc
MAHARASHTRA
General
Country India
Restore
Company
Phone Mobile
Limited
Insurancom
Emergency Contact No. Blood Group
#Email Fax
ranc
Reliance
3 . Period of 03/03/2025 To
4. Source of Funds Business Salary Agricultural Income Savings
,
5 . Monthly Income Upto 20,000 50,001 to 1,00,000 1,00,001 and above
6 . Aadhaar No. No. **** 907 E
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8 . Fast Tag ID
Gw
Rosure
nite
copyelianurancmpany
Comimited
9 . Are you an existing General
Yes No
Insurance Customer
If Yes , please the Policy No .:
eliance
rance
pany
#The Policy all related documents shall be sent to the email ID provided above . If you wish to receive copy and related documents in physical form to
%
the aforesaid communication address , please drop us an email at rgicl.services@relianceada.com
Lited
Details of the Vehicle
Number
Reno
Lited
10. Registration MH12VF0922 of Registration 22/03/2023
12. Registering Authority & Loca MAHARASHTRA
Comp
,
13. Year & Month of Manufacture JAN - 2023 14. Cubic Capacity 3000
15. Engine Number E446CDPA055344
16. Chassis Number MC2FCHRTOPA519608
Reliance
17. Make of Vehicle EICHER
Limited
18. Type of Body / Model NA / 2075
19. Gross Vehicle Weight ( GVW ) / Cubic Capacity ( C.C. )
Comp
20 . type ( Applicable only if W 7500 kgs ) Hazardous Non - Hazardous Goods
+
Relianc
21. Is the Vehicle made in India ? ☠No
Insurance
Limited
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Oberoi % Commerz , International Business Park , Oberoi City Off
,
any
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 . IRDAN103RP001201 logo
buran
IRDAN103RP00120
Trade
displayed yarden
Identification No. 166603 MH2000PLC128300 I UIN Dhirubhai
eral
Caprate : above belongs to Anil Ambani
.
: .
Ventures Private Limited and used by Reliance General Insurance Company Limited under License . / PCV / PS / Ver 1.3 / 310118
CO
.
Page 8 of 13
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Stian
GENERAL reliancegeneral.co.in
relio
RELIANCE Smart
INSURANCE
General
022 4890 3009
74004 22200
Limited
Insence
Reliance
Max . Licensed carrying
assen
22 . 22 capacity ( No. of in case of Passenger carrying vehicles
Limited
Insurance
23 . Vehicle Category
Vehicle usage type ( Applicable if bus ) : Contract Carriage Carriage
Ceneral
sub type ( Applicable if Contract Carriage ) : School Bus Employee pickup Bus Others
e usage
Relianc
24. Seating capacity ( Including 33
Genel
mite
Comp
Details of the Vehicle Type and Use
25 . a . Whether the ehicle is driven by Non conventional source of power ? Yes No If yes Bi Fuel CNG Electric
-
Insured's Declared Value Non electrical Electronic accessories Value of CNG / I Total Value ( )
-
IDV ) of vehicle Chasis Fuel
Lin
( accessories fitted to the fitted to the vehicle ( ) ( )
0.00
Vanc
b . Do you have a valid PUC ? Yes No
Ge
mite
( Note Warranted that the insured named herein / owner of the vehicle holds a valid Pollution Under Control ( PUC ) 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 subsistence of the Policy . Further , the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate . )
26 . Details of ( a ) Age of Owner
Intercom
No
Limi
( b ) Does the driver suffer from defective or hearing or any physical infirmity . Yes
If give
Please
any
eral
elianc
Ra
( c ) Has the driver ever been involved for causing any accident or loss ? Yes ☠No
If " Yes " please give details as under including the pending prosecution , if any : -
Reliance
( d ) D.O.B.
Senece
Limited
Insurance
27 . Covers ( Subject to availability and eligibility )
Easy Monthly Instalment Protection Cover : ( RGI - MO - A00-00-17 - V01-14-15 )
Relianc
If Yes , please choose any one option ;
General
Relle
Company
Plan I - 1 EMI , EMI Amount :
Limi
Plan II - 2 EMIs , EMI Amount :
Plan 3 EMIS , EMI Amount :
Limit
Reliance
mited
( b ) Additional Towing Charges
%
Insurance
Depreciation Cover :
Total Cover No
Relianc
( e ) Voluntary rance
General
Release
Company
Company
Voluntary
amount opted
Limited
:
( f ) Emergency Hotel Accommodation ì€
Reliance
imited
( g ) limit of TPPD %
Insurance
Company
Additional amount opted :
Personal Belongings ì€
Relianc
General
Benefit Amount :
Relancerance
surce
Company
Limited
( i ) Daily Allowance Benefit No
Per day amount opted :
Days opted :
Reliance
Insurance
1imited
( j ) Allowance Benefit Plus
Company
Per day allowance amount
Coverage Days opted :
Relianc
General
Relian
Company
Limited
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Commerz International Business Park Oberoi Garden City Off
, , ,
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 .
Corporate Identification No. U66603MH2000PLC128300 UIN 100001. Trade logo displayed above belongs to Anil Dhirubh Ambani
IRDAN103RP0012eroi
. :
Ventures Private Limited and used by Reliance General Insurance Company Limited under License . RGI / M / COM / CO / PCV / PS / Ver . 1.3 : 310118
Page 9 of 13
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Stian
GENERAL reliancegeneral.co.in
relio
RELIANCE Smart
INSURANCE
General
022 4890 3009
Limited
74004 22200
Insence
Reliance
( k ) and Equipment Cover
Limited
Insurance
Company
( 1 ) Any other Details
ce
anceneral
ellane
Is the vehicle fitted with any I device approved by the ARAI ? Yes
General
Company
If Yes , please attach of Installation in the vehicle , issued by Automobile Association of India .
the
29 . 29 Are you a member of Association of India ? If Yes , please submit membership copy . Yes No ì€
Vale
is used for Driving Tuitions ? Yes No ì€ì€
Whether
333
Rell
Whether use f Vehicle is limited to Own Premi No
KKK
Li
Whether commercial vehicle is also used for Private purposes ( excluding use for hire or reward ) ? No
Insurance
Yes
is fitted with Fibre Glass Tank ? Yes No
the Vehicle
llanc
If so , is the the duty Vehicle element belongs included to in Embassy the IDV ? / Consulate of a for of / challenged Yes %
General
For
Company
use
Blind
35 . Whether the Vehicle is F No
Handic
Yes
design
36 . Date of purchase of the Vehicle by the Proposer 22 / Mar / 2023
any
37 . Whether the Vehicle at the time of purchase was New Second Hand
urance
Relian
Risk Inclusions
38 . Do wish to restrict the above limits to the statutory TPPD Liability limit of 6000 / - only ? Yes No
O you wish to cover legal to ?
ellane
my
( a ) Driver / Conductor / Cleaner ( No. of persons ) Yes
General
Re
( b ) Other employees ( No. of Persons ) Yes No
Company
( c ) Non - fare paying ( No. of ) Yes
Limited
inclusenger persons No
39 . Do wish to personal Accident ( P.A. ) for paid drivers , cleaners conductors ? No
you e
Co.
If Yes , give name and Capital Sum Insured opted for . The maximum CSI available per person is 1 Lakh in the case of Motorised wheelers and 2
sance
મà«
lakhs for other classes of vehicles .
Low
Accident Cover for Owner Please give details of nomination
al
40 .
Name of the Appointee ( if
Name of the Nominee Age of Nominee Address
Roland
Nominee is Minor )
પો
( Note : 1. Personal Accident cover for owner driver is compulsory for Sum Insured 15,00,000 / - for Two Wheeler , Private Car , GCV , PCV and Misc - D
2. Compulsory PA cover for owner driver cannot be granted where a is owned by a company , a partnership firm or a similar body corporate or
Recortance
owner - driver does not hold effective driving license )
Do to include Personal Accident cover Named Persons ? Yes
Lim
41 . No
Insuliny
you
Name of the Appointee
Name CSI Name of Nominee Age of Nominee Relationship Address
( If is Minor )
RentMany
CLim
42 . Extension of Geographical Area
Whether extension of Geographical Area to the Countries required ?
1 .
Reliance
2 .
Limited
Insurance
Nepal
Relianc
General
5. Pakistan
Company
Limited
Insurance
6. Sri Lanka
el
ance
Details of Hire Purchase / Hypothecation / Lease
43 Please state if the vehicle is under Hire Purchase Lease ✓ Hypothecation Agreement
.
If so , give name and address of parties .
44 . Full Name Au Small Finance Bank Ltd
45. Address
Relianc
ancerny
oneralnce
Note
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Oberoi Commerz , International Business Park , Oberoi Garden City , Off
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 . logo
IRDAN103RP001201
Trade
Corporate identification No. U66603MH2000PLC128300 UIN 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
Company
Page 10 of 13
ex
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Stian
GENERAL reliancegeneral.co.in
relio
RELIANCE Smart
INSURANCE
General
022 4890 3009
Limited
74004 22200
Insence
20
rance
pany
neral
The Insured's Declared Value ( IDV ) of the vehicle will be deemed to be the ' SUM INSURED ' for the purpose of tariff and it will be fixed at commencement of
Meliance
each policy period for each insured vehicle .
The IDV of the vehicle is to be fixed on the basis of manufacturers ' listed selling price of the brand & model as the vehicle proposed for urance at the commencement
of insurance / renewal , and adjusted for depreciation as per policy wordings .
Details of Previous Insurance
46 . Full Name of previous insurer KOTAK MAHINDRA GENERAL INSURANCE COMPANY LIMITED
47 . Address
Expire
48 . Policy Number 3062751701 Previous Policy 02/03/2025
49. Type of Cover ☠Package Policy Liability only others ( to be describe )
onellan
50 . NO CLAIM allowed under previous policy ( % ) 20
માં
51 . Claims taken in previous policy Yes No
If yes , No. of Claims Claims
Are you entitled to No Claim Yes
wellane
Gerlinceited
If yes , please submit / attached proof thereof
પા
Payment Details
☠Cheque / DD Cheque / DD No.
anmited
Cheque / DD Date Cash Others
Proposer's Bank Details
53 . Name of the Bank Account Holder
54 . Bank Account No .: 55 . Current
56 . of the Bank
Relianc
57 . Branch
GencoCompany
Comonymited
58 . MICR Code ( 9 digit MICR code number of the bank and branch appearing on the cheque issued by the bank )
59 . IFSC Code ( 11 character code appearing on your cheque leaf )
shan
I understand that any refund due on the payment / any payment / to be directly credited to my aforesaid Bank Account . *
* As per IRDAI , its mandetory that all payments to the insured are only through electronic mode .
Curance
Limited
Insince
Comited
Relianc
General
Reliance
Company
Insurance
Limited
Reliance
General
Limited
Insurance
Company
Relianc
General
Reliance
Company
Limited
Insurance
Reliance
Limited
General
Insurance
Company
Relianc
General
Reliance
Company
Limited
Insurance
Reliance
General
Insurance
Limited
Company
Relianc
General
Reliance
surance
Company
Limited
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Oberoi Commerz , Business Trade for of
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 .
logo
to Anil Dhirubhai Ambani
02100001
above belongs
Ventures Private Limited and used by Reliance General Insurance Company Limited under License . RGV / MCOM / CO / PCV / PS / Ver . 1.3 / 310118
Page 11 of 13
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GENERAL reliancegeneral.co.in
relio
RELIANCE Smart
INSURANCE
General
022 4890 3009
Insence
Limited
74004 22200
bany
Reliance
GENERAL DECLARATION :
DECeral
I understand that as per the new AML / CFT Guidelines issued Reliance General Insurance Co. Ltd will be verifying my details pertaining to KYC and PAN provided at
Vrance
ano
the time of proposal .
I further do hereby agree and consent that in the case of the event of a mismatch of information by me in the proposal form , identification 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 given 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 ) ?
S
No
Li
f yes , e mention the position held
Avanc
Is any of your close relation or a PEP ? Yes No
If yes , please mention the name and relation and the position
cetera
by such close relative / family member .
thoman
I hereby declare that in future if me , any of my close s or any of my family mem r attains a position of PEP I shall confirm the same to Reliance General
Insurance Co. Ltd as a mandate . I understand that this is a crucial information under the PMLA Rules and AML / CFT Guidelines and shall confirm that the answers
given by me is true . In case the company comes to know that this is a misrepresentation and concealment of then the policy shall put on hold for
e
scrutiny by the company and I shall be responsible for the same .
Note :
" Politically Exposed Persons " ( PEPs ) individuals who have been entrusted with prominent public functions in foreign count e.g. , Heads of
Revanc
are are or a
States / Governments , senior politicians , senior government / judicial / military officers , senior executives of state - owned corporations , important political party officials cale ,
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 / We hereby declare that 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
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 . âš« I have read and understood the brochure , prospectus , sales literature & Policy wordings and confirm to
abide by the same . • I / We declare that the rate of NCB stated above by me / us is correct and that no claim 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 respect of section I of the policy will stand forfeited . âš« 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 .
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
: . th
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
con
proposal form and have fully explained to and Wei understood the Onificance s of the proposed contract
ected melus .
been
Refully
This proposal form completed by
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
anc
Name
Date : 04 Feb 2025 03:36 04 Feb 2025 03:36
Limited
Signaturanymited
Signature Signature of Proposer & Company Seal
pany
Relianceneral
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
an
any kind of risk relating to lives or property in India any rebate of the whole or part of the commission payable or any rebate of the premium shown on the
policy
,
nor shall any person taking out or renewing or continuing a accept any rebate , except rebate as may be allowed in accordance with the published
prospectuses or tables of the insurer .
Reneral
Reliance General Insurance Company Limited . IRDAI Registration No. 103 An ISO 9001 : 2015 Certified Company
Registered & Corporate Office : Reliance General Insurance Company Limited , 6th Trade Oberoi Commerz International Business Park Oberoi Garden City Off
, , ,
,
Western Express Highway , Goregaon ( East ) , Mumbai - 400 063 . IRDAN103RP0012 .
01
Caporate Identification No. U66603MH2000PLC128300 UIN : logo displayed above belongs to Anil L Ambani
.
Ventures Private Limited and used by Reliance General Insurance Company Limited under License . RGI / MCOM / CO / PCV / PS / Ver . 1.3 / 310118
Page 12 of 13
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2 . INSURANCE GENERAL
I confirm Supporting Any
Place Name the person mal insce Live
( In Date case of IRDAI above Confirmation default Smart
* Mandatory of Agent signature
The Direct in
Vide policy / Broker tobe of complying
Relianc0164 GSR does details Business of the Agent
to nsura registered / with pany Limited
not be , Name Broker
( cover filled the
f ) â˜
dated liability & Signature Mr. owner / SM provisions
25.02.2022 for ☠of / CSO of
death of Mrs. the this
CSO vehicle section
w ,
Reliance General Insurance . e bodily parimite / SM proposed Reliance General
.
f shall
01.4.2022 injury to be be
or taken for liable
) damage ) insurance for
a
as excluded penalty
Reliance General Insurance Company Limited under Reliance Section Generance which may extend reliancegeneral.co.in 022 any
150 to ten 74004 4890
( 2 lakh
)
( ii 3009
) rupees 22200
Reliance General Insurance Company Limited and Signature Compa mited Stian
Reliance General urat
( iii
) .
:
b
and of
C of IRDAI
the Agent
Motor
/
General Insurance Company % Vehicles nite Broker
Reliance General Insurance Company Limited Reliance Relac
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 surance Company Limited Reliance General Insurance Company Limited Relianc
Limited Office Company
,
and No. Goregaon : Reliance
used U66603MH2000PLC128300 by Reliance ( East ) , General Limited .
Mumbai Insurance
General Limited Reliance General Insurance Company Limited Relianc
-
400
Insurance . UIN 063 Company IRDAI
.
: Registration
Company IRDAN103RP0012V02100001 Limited , 6th
Limited Floor No. General Insurance Company Limited Relianc
, 103
under Oberoi
License . Trade Commerz
.
RGI logo , International
/ MCOM
displayed 8 Company Limited Relianc
/ CO
/ above Business An
PCV ISO
/ PS belongs
/ Park 9001
Ver
: 2015
. ,
1.3 to Oberoi
/ 310118 Anil Certified
Dhirubhai Garden Relianc
Ambani City Company
,
Off
Page
13
of
13
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