Automobile Insurance Policy

Insurance Card
AAA Insurance
MemberSelect Insurance Company
1 Auto Club Drive
Dearborn, MI 48126
POLICY NUMBER: AUT035570565
POLICY TERM: Apr 21, 2011 To Oct 21, 2011
0331
PRINCIPAL NAMED INSURED:
IN-0040MI-20110421-11502516-010200000 0: 1/2 1 (IN) YOUR SALES REPRESENTATIVE:
RATNA KUMAR PALERU SHAMIM GUJRAL
22730 CIVIC CENTER DR
APT B4 19058870
SOUTHFIELD MI 48033-7147 PHONE: 1-(248)-488-2520
EMAIL: SQGUJRAL@AAAMICHIGAN.COM

Two Certificates of Insurance are provided for each insured vehicle. The certificates attached below apply to the
described insured vehicle for the policy term shown. Please review the information on the certificates and contact
your Sales Representative listed above if anything is incorrect or you have any questions.

You should detach these certificates and keep them in your vehicle at all times. Failure to produce this proof of
insurance upon the request of a police officer may result in a civil infraction and fine. The Secretary of State
copy may also be presented as proof of insurance with your application for license plates, either by mail or at any
Secretary of State branch office.

For your protection, we do not print your address on the Certificates of Insurance.

WHAT TO DO IN CASE OF AN ACCIDENT

If you are in an accident, the first rule of thumb is to be as calm and polite as possible. Switch on your
emergency flashers to warn other drivers. If you can, move your car off the road. Be sure to call the police if
anyone is hurt or needs medical care. If the police are not able to come to the scene, go directly to the nearest
station to report the accident.

Get all the facts. Exchange names, addresses, driver license numbers and insurance information with the other
driver. Do not admit fault. Record license plate numbers, descriptions and directions of the vehicles involved.
Get the names and addresses of any witnesses. Also make note of the location.

To report your claim, simply call 1-(800)-936-4066.

MICHIGAN CERTIFICATE OF INSURANCE MICHIGAN CERTIFICATE OF INSURANCE

MEMBERSELECT INSURANCE COMPANY MEMBERSELECT INSURANCE COMPANY

POLICY NUMBER TYPE OF INSURANCE POLICY NUMBER TYPE OF INSURANCE

AUT035570565 NO-FAULT AUT035570565 NO-FAULT
EFFECTIVE DATE EXPIRATION DATE EFFECTIVE DATE EXPIRATION DATE
04-21-2011 10-21-2011 04-21-2011 10-21-2011
VEHICLE/VIN VEHICLE/VIN
1999 NISS ALT/GXE/GE - 1N4DL01D4XC120117 1999 NISS ALT/GXE/GE - 1N4DL01D4XC120117
PRINCIPAL NAMED INSURED PRINCIPAL NAMED INSURED
RATNA KUMAR PALERU RATNA KUMAR PALERU
ASSIGNED DRIVER ASSIGNED DRIVER
RATNA KUMAR PALERU RATNA KUMAR PALERU

YOUR TOLL FREE NUMBER TO REPORT A CLAIM IS 1-(800)-936-4066 YOUR TOLL FREE NUMBER TO REPORT A CLAIM IS 1-(800)-936-4066

8600-22323-MI
 __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ _
l THE SECRETARY OF STATE COPY OF THIS FORM MUST BE PRESENTED l THE SECRETARY OF STATE COPY OF THIS FORM MUST BE PRESENTED l
l AS EVIDENCE OF INSURANCE WITH YOUR APPLICATION FOR LICENSE l AS EVIDENCE OF INSURANCE WITH YOUR APPLICATION FOR LICENSE l
l PLATES AT ANY SECRETARY OF STATE BRANCH OFFICE. l PLATES AT ANY SECRETARY OF STATE BRANCH OFFICE. l
l _____________________________________________________________________________________________________________________ l _____________________________________________________________________________________________________________________ l

l The Company Indicated, an authorized Michigan Insurer, certifies as follows: l The Company Indicated, an authorized Michigan Insurer, certifies as follows: l
l 1. If the type of Insurance certified is a "No-Fault Policy," it has issued a policy complying l 1. If the type of Insurance certified is a "No-Fault Policy," it has issued a policy complying l
l with Act 294, P.A. 1972, as amended, for the described motor vehicle(s). l with Act 294, P.A. 1972, as amended, for the described motor vehicle(s). l
l l 2. If the type of Insurance certified is a "Liability Policy," it has issued a policy complying l
2. If the type of Insurance certified is a "Liability Policy," it has issued a policy complying
l with Section 3009 of the 1956 P.A. 218, added by P.A. 1971, No. 210, Eff. Dec 29, l with Section 3009 of the 1956 P.A. 218, added by P.A. 1971, No. 210, Eff. Dec 29, l
l 1971, for the described motor vehicle(s). l 1971, for the described motor vehicle(s). l
l l l
l Note: The issuance of this Certificate does not guarantee that the described policy or l Note: The issuance of this Certificate does not guarantee that the described policy or l
l specific coverages therein will remain in force until the stated expiration date. Further, this l specific coverages therein will remain in force until the stated expiration date. Further, this l
l Certificate is void if the described policy was not renewed by the policyholder thereof. l Certificate is void if the described policy was not renewed by the policyholder thereof. l
_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________
l l l
l PENALTY FOR OPERATION WITHOUT INSURANCE l PENALTY FOR OPERATION WITHOUT INSURANCE l
l l Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle l
Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle
l l registered in this State must have Insurance or other approved security for the payment l
registered in this State must have Insurance or other approved security for the payment
l l of No-Fault benefits on the vehicle at all times. An owner or registrant who drives or l
of No-Fault benefits on the vehicle at all times. An owner or registrant who drives or
l permits a vehicle to be driven upon a public highway without the proper insurance or l permits a vehicle to be driven upon a public highway without the proper insurance or l
l other security is guilty of a misdemeanor. l other security is guilty of a misdemeanor. l
l l l
l A person convicted of such a misdemeanor shall be fined not less than $200.00 nor l A person convicted of such a misdemeanor shall be fined not less than $200.00 nor l
l more than $500.00, imprisoned for not more than 1 year, or both. l more than $500.00, imprisoned for not more than 1 year, or both. l
l l A person who supplies false information to the Secretary of State under this section or l
A person who supplies false information to the Secretary of State under this section or
l who uses an invalid Certificate of Insurance is guilty of a misdemeanor punishable by l who uses an invalid Certificate of Insurance is guilty of a misdemeanor punishable by l
l imprisonment for not more than 1 year, or a fine of not more than $1,000.00, or both. l imprisonment for not more than 1 year, or a fine of not more than $1,000.00, or both. l
l _____________________________________________________________________________________________________________________ l _____________________________________________________________________________________________________________________ l

l l THIS CERTIFICATE MUST BE IN THE POSSESSION OF l

l SECRETARY OF STATE COPY l THE OPERATOR OF THE VEHICLE l
l __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ l __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ l