Date: 17/01/2012

Policy No.:
Mr.ILIYAZ MD

0151670316

S/O. MUJUNUSA, H.NO. 18-3-17, CHINNA BAZAR, GUNTUR 522001, ANDHRA PRADESH

Work Phone :

Client Id:
Dear

5003211891

Mr.ILIYAZ MD

It is my pleasure to welcome you to the Tata AIG family.

Your Policy No. is 0151670316. The insurance coverage that you have opted for is Auto Secure Commercial Vehicle Package Policy. The details of your coverages and the other guidelines regarding your policy can be had from the policy document that is enclosed with this. Please do file these documents for future reference. I am sure that you will benefit from the best that we have to offer. You are offered security and convenience by us through a host of benefits under the policy that you have opted, security in the feeling that your assets are protected and convenience in accessing us as your insurer. The most striking feature of this accessibility being the 24 - hour help line for all our policy holders. Please do call us at this number in case you require any clarifications or services.

It is our promise to be there for you in your time of need.

We shall work on providing you with many more benefits that will stand by our commitment to provide you with nothing but the best.
We thank you for choosing us for your requirements and promise you a pleasant experience called insurance.

Sincerely yours,

*Conditions apply.

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale Tata AIG General Insurance Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Email: customersupport@tata-aig.com Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780

Branch: MUMBAI
DE: srimanap

ORIGINAL

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TIME STAMP: 10:07:17/01/12

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RECEIPT

Receipt No.: W002014977

Receipt Date: 29/12/2011

Received with thanks from

Retainer - S.Srimanarayana (ID:5003209053)

(Insured: Mr. RAMEZA MOHAMMAD (ID:5003209053))

a sum of Rs. 97,427.00 ( Rupees Ninety Seven Thousand Four Hundred Twenty Seven and Paise 00 Only )
vide Cheque no. 272528 dated 01/12/2011 drawn on ANDHRA BANK,vijayawada branch towards
Sr. No. 1
Policy No. 0151670316

Total Premium (Rs.) Utilised from Receipt (Rs.) 3,936.00 3,936.00

Excess: 0.00

Note:
1. This is a computer generated receipt and does not require a signature. 2. Upon issuance of this Receipt, all previously issued temporary receipts, if any, related to this Policy shall be considered null and void. 3. Amount received by cheque shall be subject to realisation 4. Any amount received in excess of the premium is being/shall be refunded by the Company Service Tax Registration No : Insurance/Tata/Mumbai-I/1542/2001-02. dated 23/02/2011 , for applicable cases Revenue ( consolidated ) Stamp duty duly paid vide Challan No. 47593

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale. Tata AIG General Insurance Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Website: www.tataaiginsurance.in 24x7 Tollfree Helpline : 1800 266 7780 Email: customersupport@tata-aig.com

RP01

Branch: MUMBAI
DE: srimanap

ORIGINAL

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TIME STAMP:05/01/2012

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Certificate of Insurance and Policy Schedule Form 51 of the Central Motor Vehicle Rules, 1989

Agent/Broker Producer Name- Direct Agent/Broker License Code - NA

Certificate & Policy No.

Agent/Broker Contact No- 1800119966

Policy Type

0151670316 00

Auto Secure Commercial Vehicle Package Policy

Effective time and date of commencement of Insurance From 14:00 Hours on 20/12/2011
Date of Expiry
INDIA

Passenger Carrying Vehicle

Premium (incl.S.Tax)

Midnight on 19/12/2012
GUNTUR

Place of Registration

Rs. 3,936.00 Insured's Business/Profession Self-employed Geographical Area

Name and address of the Insured

ILIYAZ MD Name: Address : S/O. MUJUNUSA, H.NO. 18-3-17 CHINNA BAZAR
GUNTUR 522001 ANDHRA PRADESH

Under Hire Purchase/Hypothecation/Lease with

KANAKA DURGA LEASING AND FINANCE LTD

Registration No.

Make & Model

PIAGGIO APE

Body Type
MOTORIZED RICKSHAW

Mfg. Year

Public / Gross VehicleWeight Private

Cubic Capacity

Engine No.

Chassis No.

AP07TB4362

2010

725.0

395

42556

49680
Total Insured Declared Value (Rs.)

IDV of vehicle(Rs.)

IDV of Trailer(Rs.)

Bi-Fuel/CNG/LPG Kit(Rs.)

IDV of non-built-in Accessories(Rs.) Electrical Non-Electrical

Max. Licensed Capacity Incl Driver, Cleaner

1,07,500.00
SCHEDULE OF PREMIUM
Premium on Vehicle and non electrical accessories
Less : 20.00% for NCB

4
1,354.50
Basic

1,07,500.00
2,360.00

270.90
1,084.00

Add: Compulsory PA Cover for Owner-Driver Rs.2,00,000

100.00

A. TOTAL OWN DAMAGE PREMIUM (rounded off)

Add:Liability to persons employed Loading-Unloading (Endt. IMT 39)

B. TOTAL LIABILITY PREMIUM
COMPREHENSIVE PREMIUM(A+B)

25.00
2,485.00 3,568.60 3,568.60

NET PREMIUM

Add : 10.30% Service Tax

TOTAL PREMIUM

367.57
3,936.00

0.00

Drivers Clause : Persons or classes of persons entitled to drive : Any person including insured: Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an effective learners license may also drive the vehicle when not used for the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules 1989.

Limitations as to use:

Use in connection with the insured's business The Policy does not cover:1) Use for racing, pace making, reliability trial or speed testing.

2) Use for the carriage of passengers for hire or reward.

3) Use whilst drawing a greater number of trailers in all then is permitted by law.

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale. Tata AIG General Insurance Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Website: www.tataaiginsurance.in 24x7 Tollfree Helpline :1800 266 7780 Email: customersupport@tata-aig.com

Branch: MUMBAI
DE: srimanap

ORIGINAL TIME STAMP: 10:07:17/01/12

Page 3 of 4 FU: srivij4f

Drivers Clause : Persons or classes of persons entitled to drive : Any person including insured: Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an effective learners license may also drive the vehicle when not used for the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules 1989.

Limitations as to use:

1) The policy covers use only under a permit within the meaning of the Motor Vehicles Act 1988 or such a carriage falling under sub-section (3) of Section 66 of the Motor Vehicles Act, 1988.
2) The policy does not cover use for a)Organised racing, b) Pace Making,c) Reliability Trials d) Speed Testing, e) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle.

Limits of Liability: Under Section II-1 (i) of the policy (Death of or bodily injury) : Such amount as is necessary to meet the requirements of the Vehicles Act, 1988. Under Section II-1 (ii) of the policy (Damage to Third Party Property ) : Rs. 7,50,000.00/P.A. Cover for Owner - Driver under Section III: CSI : Rs. 2,00,000.00/Nominee for P.A. Cover : Age: Yrs Relationship :

Subject to Indian Motor Tariff Endorsement No(s):

21,07,39

Deductible under Section - I

Compulsory Deductible Voluntary Deductible Imposed Excess

.

: Rs. 500.00/: Rs. /: Rs. /-

I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X and XI of Motor Vehicles Act, 1988.In witness whereof this Policy has been signed at MUMBAI on 17/01/2012.

For Tata AIG General Insurance Company Ltd.

Receipt(s): W002014977 Service Tax Registration No : Insurance/Tata/Mumbai-I/1542/2001-02.

The stamp duty of Rs. 0.50 /-(Rupees zero and Paise 50 Only) paid in cash or demand draft or by pay order, vide Receipt/Challan no 47593 dated the 23/02/2011.

IN CASE OF AN ACCIDENT TO YOUR VEHICLE PLEASE INTIMATE US IMMEDIATELY FOR SPOT SURVEY FAILING WHICH CLAIM COULD BE PREJUDICED.
IMPORTANT NOTICE The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment made by the Company by reason of wider terms appearing in the Certificate in order to comply with the Motor Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or expression to which a specific meaning has been attached in any part of this Policy or of the Schedule shall bear the same meaning wherever it may appear. Any amendments/modifications/ alterations made on this system generated policy document is not valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued, would be valid and effective, only after written request is made to the Company and Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to be issued by the Company.

Insurance is the subject matter of the solicitation.For more details on risk factors,terms and conditions,please read sales brochure carefully before concluding a sale. Tata AIG General Insurance Co. Ltd. Regd Office: Peninsula Corporate Park, Piramal Tower, 9th Floor, Ganpatrao Kadam Marg, Lower Parel, Mumbai 400013. Website: www.tataaiginsurance.in 24x7 Tollfree Helpline :1800 266 7780 Email: customersupport@tata-aig.com

Branch: MUMBAI
DE: srimanap

ORIGINAL TIME STAMP: 10:07:17/01/12

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