Fabian

BANGALORE

19/05/2014

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupee

IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in

Place :

Date :

For and on behalf ofThe Oriental Insurance Company Limited

Authorised Signatory

B N PrasadGeneral Manager

In case of any query regarding the Policy please call TollFree No. 1800 11 8485 and 011 33208485.

This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.

Page 1 of 3

1 Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does notcover use for hire or reward, tuition, racing, pace making, reliability trial, speed testing, carriage of goods(other thansamples or personal luggage) in connection with any trade or business or use for any purpose in connection withMotor Trade

KA 03 HN 5239 F4862009931 -CAEC8137025

2012 OTHERS 1 + 1 125SUZUKI INDIA-SUZUKI ACCESSUZ 125

421504/31/2015/1519Policy No 421504/31/2014/1629Prev Policy No :

-

#A1, ARMY INSTITUTE OF HOTELMANAGEMENT, SURVEYNO.19,NAGARESHWARANAGENAHALLI,KOTHANURPOST,BANGALORE-560077

BANGALORE KARNATAKA 560077

CBO17, NO12, BELLARY ROAD,HEBBAL, NEXT TO CANARA BANK

BANGALORE KARNATAKA 560024

FROM 00:00 ON 28/05/2014 TO MIDNIGHT OF 27/05/2015

9731722084 / /[email protected]

080-23544118/ 23434131 / /[email protected]

1,081 134 .5 1,215

MOTORISED-TWO WHEELERS PACKAGE POLICY - ZONE A

CC 9121001592 - 19/05/2014

INDIA

FABIAN GOMES CBO -17 HEBBAL

55414408 421504

Bangalore East

Cover Note No :

Insured's Code :

Insured's Name :

Address :

Tel /Fax /Email : Tel /Fax /Email :

Address :

Cover Note Dt :

Issue Office Code :

Issue Office Name :

Agent/Broker Details

////Tel /Fax /Email :Period of Insurance :

Collection No & Dt :

Gross Premium : Service Tax : Stamp Duty : Total :

Geographical Area : Area Extension :

Particulars of Insured Vehicle:

RegistrationMark & Place

Engine No. &Chassis No. Make - Model

Year OfManufacture

Type Of Body Seating Capacity(including Driver)

CubicCapacity

Any person including the insured,Provided that a person driving holds an effective driving license at the time of the accidentand is not disqualified from holding or obtaining such a license.,Provided also that the person holding an effective Learner'slicense may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor VehiclesRules, 1989.

Limitations as to use:

The Policy covers use only under a permit within the meaning of the Motor Vehicles Act 1988 or such a carriage falling underSub-section 3 of Section 66 of the Motor Vehicles Act 1988.

Driver :

MOTOR INSURANCE CERTIFICATE CUM POLICY SCHEDULE

Agent/Broker :

NA0000002739 DIRECT

Address :

Dev.Off.Code :

Digitally signed byPRASAD BRAHMADEONARAYANDate: 2014.05.1915:16:08 IST

Signature Not Verified

BANGALORE

19/05/2014



Place :

Date :






Page 2 of 3

100000

For the Vehicle For the Side CarNon Electrical

AccessoriesElectrical

Accessories Value of LPG/CNG Total Value

44,242 0 0 0 0 44,242

421504/31/2015/1519

Subject to IMT Endorsement Printed herein/attached to : IMT-22

Hypothecation Agreement with: -

(Details of IMT Endorsements and GR also available on internet TAC website www.tac.org.in)

B. LIABILITYA. OWN DAMAGE

BASIC TP COVER

BASIC TP TOTAL

ADD :PA FOR OWNER DRIVER-GR36A

TP TOTAL

TOTAL PREMIUM

ADD :SERVICE TAX

STAMP DUTY

TOTAL AMOUNT

464.00

464.00

50.00

514.00

1,081.00

134.00

0.50

1,215.00

BASIC OD COVER

MOTOR OD BASIC - NEW

BASIC OD TOTAL

OD TOTAL

LESS :NO CLAIM BONUS-GR27

MOTOR TOTAL OD

755.65

755.65

755.65

756.00

188.91

567.00

* NCB discount - 25 %

100000

COMPULSORY DEDUCTIBLE Rs.100

Limit of Liability:

Under Section II-I(1) in respect of any one accident: as per Motor Vehicles Act, 1988.

Under Section II-I(ii) in respect of any one claim or series of claims arising out of one event is Rs.

P.A. Cover under Section III for Registered Owner Cum Driver (CSI) : Rs.

Insured's Declared Value

SCHEDULE OF PREMIUM

Deductibles under Section-I :

The insurance under this policy is subject to conditions, clauses, warranties, exclusions, IMTs and OICendorsements mentioned herein above which are available on Company's website: www.orientalinsurance.org.in oron demand from the policy issuing office

In the event of a claim under the policy exceeding Rs.1lac or a claim for refund of premium exceeding Rs1lac,the insured willcomply with the provisions of the AML policy of the Company.The AML policy is available in all our operating Offices as wellas company's website.

Attached to and forming part of policy number

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policyshall be void abinitio (from inception).

Claim for theft of vehicle not payable if theft not reported to Company within 48 hours of its occurrence.

Claim is not admissible if Driving Licence is found fake or is not valid whether or not in the knowledge of the insured.

Hire Purchase/Lessor Agreement with: -

Page 3 of 3

BANGALORE

19/05/2014



Place :

Date :






421504/31/2015/1519

IMPORTANT NOTICEThe Insured is not Indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any paymentmade by the Company by reason of wider terms appearing in the Certificate in order to comply with the MVAct, 1988 isrecoverable from the Insured. See the Clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY".

[email protected] By :

Attached to and forming part of policy number

I/We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued inaccordance with the provision of Chapter X and Chapter XI of Motor Vehicles Act, 1988.

In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/theirhands at BANGALORE on 19-MAY-14

For and on behalf of

The Oriental Insurance Company Limited



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