Future Secure Two Wheeler Insurance Policy‐ PACKAGE
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE ‐ Form 51 of the Central Motors Vehicles Rules, 1989
Policy Servicing : 801 and 802, 8thFloor,Tower C, Embassy 24X7 Park,L.B.S. Marg, Vikhroli ‐ West,Mumbai,Maharashtra ‐ 400083.
Policy No.
: PBR05410
Insured
: Mr. Md Aslam
Address
: AZAD NAGAR, BHULI NAGAR
,Dhanbad,JHARKHAND,828104
GSTIN Number
:‐
Period of Insurance
: From 00:00 hrs of 28/07/2021
To Midnight of 27/07/2022.
Covernote No
: ‐ Dated: Zone: B
Intermediary Name/Code
: Policybazaar Insurance Brokers Private
Limited / 60084631
Telephone﴾Hom﴿
: 8271253745
Email ID
: Saidmd88@gmail.com
FGI GSTIN Number
: 10AABCF0191R1ZO
INSURED MOTOR VEHICLE DETAILS AND PREMIUM COMPUTATION
Registration No., RTA Location
Make/Model of Vehicle
Engine No.
Chassis No.
JH09W1663 Bokaro
HERO PASSION PRO
HA10ENDHL80949
MBLHA10AWDHL46735
Year of Manufacture
Cubic Capacity
Type of Body
Seating Capacity
Premium
2014
100
BIKE
2
1123
TP Policy Insurer Name :
TP Policy No :
TP Policy Period : To
DRIVERS CLAUSE :‐ Any person including the 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 Learner’s License may also drive the vehicle
and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
LIMITATIONS AS TO USE ‐ As per Motor Vehicle Rules, 1989 :‐ The Policy covers use of the vehicle for any purpose other than: a﴿ Hire or Reward,
b﴿Carriage of goods ﴾other than samples or personal luggage﴿, c﴿ Organized racing, d﴿ Pace making, e﴿ Speed testing, f﴿ Reliability Trials, g﴿ Any purpose in
connection with Motor Trade.
Geographical Area : INDIA
Vehicle being insured has valid Pollution Under Control ﴾PUC﴿ Certificate as on inception date of policy.
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 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 be good.
For full details on coverage, terms, conditions and exclusions, please refer the standard policy wordings attached with this schedule.
Not with standing anything mentioned herein to the contrary it is agreed and declared that the cover under this policy does not extend to those parts
mentioned as damaged /scratched /dented noted in the photographs/inspection report number 49‐FGS‐110718‐794371 dated 10/07/2018
IMPORTANT ‐ 1﴿ All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2﴿ In case of payment by cheque, in the event of dishonor of
cheque for any reason whatsoever, insurance cover provided under this document automatically stands cancelled from the inception irrespective of
whether a seperate communication is sent or not.
LIMITS OF LIABILITY
Under Section II‐I ﴾i﴿ : Death of or bodily injury ‐ Such amount as is
necessary to meet the requirements of Motor Vehicles Act, 1988
Under Section II‐I ﴾ii﴿ : Damage to Third Party Property‐ ₹ 100000 /‐ in
respect of any one claim or series of claims arising out of one event.
Under Section III : PA Owner – Driver as per premium computation table
Compulsory DeductibleUnder Sec I ‐ ₹ 100.00
Hypothecation Agreement with:‐ NIL
SPECIAL CONDITIONS – NIL
ADDITIONAL EXCESS – NIL
The nominee for Compulsory PA to owner driver cover is 01﴿ MD SAID ANSARI , aged :33 Years, Relationship : Son, Nomination % : 100%
Future Generali India Insurance Company Limited, Corp. & Regd. Office: 801 and 802, 8thFloor,Tower C, Embassy 24X7 Park,L.B.S. Marg, Vikhroli ‐
West,Mumbai,Maharashtra ‐ 400083. Care Line:‐ 1800‐220‐233, 1860‐500‐3333, 022‐67837800, Email: fgcare@futuregenerali.in, Website: www.futuregenerali.in.
IRDA Regn.No. 132, CIN ‐ U66030MH2006PLC165287
Policy No : PBR05410
Period Of Insurance : From 00:00 hrs of 28/07/2021 To Midnight of 27/07/2022
INSURED'S DECLARED VALUE
For Vehicle‐₹
For Non Elec
Accessories ‐ ₹
For Side Car‐₹
For Elec Accessories‐ ₹
For Bi‐Fuel Kit
﴾CNG/LPG﴿ ‐ ₹
Total Value‐₹
28441
‐
‐
‐
‐
28441
SCHEDULE OF PREMIUM
PARTICULARS
₹
₹
A‐OWN DAMAGE
Basic Premium on Vehicle
**Less : No Claim Discount 0%
Total Own Damage Premium ﴾A﴿ ﴾rounded off﴿
B‐LIABILITY
Basic Premium including Premium for TPPD
Less : Limit of Liability under sec II‐1﴾ii﴿‐Rs6000
Add : Compulsory PA to Owner‐Driver Rs. 0 lacs
Total Liability Premium ﴾B﴿
Total Annual Premium ﴾A+B﴿
Total Premium for the Policy Period
Goods and Service Tax
Total Premium ﴾rounded off﴿
Class of Vehicle: Two Wheelers
200
0
200
752
0.00
0
752
952
952
171
1123
Subject to Endorsement Nos. 15,22
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 chapter XI of M .V. Act, 1988.
For FUTURE GENERALI INDIA INSURANCE CO. LTD.
Receipt No :
Date of Issue : 26/07/2021
Place of Issuance : Mumbai*
*Address as mentioned below
﴾ Authorized Signatory ﴿
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali India
Insurance Company Limited on 26/07/2021
For registration of your Motor Claims SMS MOTORCLAIM to 9222211100 ﴾Standard SMS charges applicable﴿
The stamp duty of Rs. 0.50/‐ paid by Letter Of Authorisation No. CSD/94/2020/1693, Dated 27‐08‐2020. Mudrank ‐ 2017/C.R.97/M‐1,dated
09/01/2018
Product UIN : IRDAN132P0002V01201718
Future Generali India Insurance Company Limited, Corp. & Regd. Office: 801 and 802, 8thFloor,Tower C, Embassy 24X7 Park,L.B.S. Marg, Vikhroli ‐
West,Mumbai,Maharashtra ‐ 400083. Care Line:‐ 1800‐220‐233, 1860‐500‐3333, 022‐67837800, Email: fgcare@futuregenerali.in, Website: www.futuregenerali.in.
IRDA Regn.No. 132, CIN ‐ U66030MH2006PLC165287