THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Liability Policy

Insured's Details Policy Details

Insured's Name: umesha k Policy number: 31030031190200325423
Customer ID: PO74242663 (PAN No :NA) Period of cover: 11/10/2019 12:00:01 AM to 10/10/2020
11:59:59 PM
Insureds Address: kelembiri house, belandoor, puttur tq, d.k.,,, Registration no. KA-21-M-7955
PUTTUR ,KARNATAKA, 574201
Prev. Policy no. ABC123 Make/Model: FORD/FIESTA
Email: [email protected] Receipt no. 31030081190000325015 - 08/10/19
Phone Number : / / 9867131265 Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address N BLOCK,CONNAUGHT CIRCUS (310300), Agent / Corp. Agent /
BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW Broker / Banc
DELHI , , , Assurance / Referral
DELHI , 110001. Code - Name /
POS/IMF/SPECIFIED
PERSON
Phone no NA
Phone no 23723521 Fax no. NA
Fax no. NA / NA Email NA
Email [email protected] Development officer DIRECT BUSINESS - (2D10673292)POLICYBAZAAR
level Name/Code WEBAGRTR (WE00000001)
Claim Contact N BLOCK,CONNAUGHT CIRCUS (310300) Claim Contact Detail BOMBAY LIFE BUILDING, N-34, CONNAUGHT
CIRCUS, NEW DELHI,,;23723521// Ph: 011-
27105783/87/81/90, [email protected]
GSTIN 07AAACN4165C1ZT
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/B Year of manufacture: 2009
Name of the Financier: Chassis no./Engine no.: MAJBXXMRJB9K42229/9K42229
Type of body: Saloon/Diesel Variant: 1.4 SXI TDCI
Automobile Association none Colour: As per RC Book
membership:
Seating capacity including Driver: 5 Cubic capacity ( cc)/Wattage(kW): 1399cc
Cover Note No/Cover Note Issue / Name of registration authority: Puttur
Date:
IDV(In `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
0 0 N/A N/A N/A 0
Schedule of Premium
Own Damage Liability
Basic TP Cover
Compulsory PA cover for Owner Driver
(Sum Insured `0 OPTED OUT)

OD Premium in ` TP Premium in ` 3221

Net Premium in `: 3221
GST in `: 580
Total Payable in `: 3801
Total Payable in `(in words): RUPEES THREE
THOUSAND EIGHT
HUNDRED ONE
ONLY

Limitations as to use Limits of Liability

The policy covers use for any purpose other than: a)Hire or reward b) Limit of the amount the Company's Liability Under Section II 1(i) in
Organized racing, OR c)Speed testing respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
of the amount of the Company's Liability Under Section II 1(ii) in
respect of any one claim or series of claims arising out of one event:
Up to ` 7,50,000
For individual covers (OD) in`: 0

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 31030031190200325423Document generated by Policy Bazaar at 08/10/2019 16:53:10 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2019.10.08
For 16:53:15
redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with
IST
our own grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please
visit our website http://newindia.co.in.

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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: NA
Persons or classes of persons entitled to drive
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 requirement of Rule 3 of the Central Motor Vehicles Rules, 1989.
PA cover for Owner Driver

As per the declaration given,the Insured has opted out of CPA cover under this policy.

PA cover for named persons

Name CSI Opted(`) Nominee Relationship
none 0 NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium ` 3221.00
SGST 0 0
CGST 0 0
IGST 18 580

In witness where of this policy has been signed at N BLOCK,CONNAUGHT CIRCUS on this 08/10/2019
WARRANTED THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED ABINITIO
This policy is subject to the Terms, conditions and exceptions applicable to Package/Liability policy attached/available on the web site
http://newindia.co.in; IMT Endorsement Number(s) printed herewith attached 22.
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 clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY". It is clarified that in case  the declaration regarding
the ncb or other previous policy details made by the insured, is found to be incorrect, all the benefits (including claim) under section-1 of this
policy, will stand forfeited.

I/We hereby certify that the policy to which this Certificate relates as For and on behalf of The New India Assurance Company Limited
well as this Certificate of Insurance are issued in accordance with
the provisions of Chapter X and XI of M.V. Act, 1988.NIA S.T.REGN
No: AAACN4165CST178.

Date of Issue: 08/10/2019

(MS. RASHMI LUCY BARWA)

[SRDivisional Manager]

Duly Constituted Attorney(s)

Tax Invoice No : 31030019P0328732

IRDA Registration Number: 190

Policy No. : 31030031190200325423Document generated by Policy Bazaar at 08/10/2019 16:53:10 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with
our own grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please
visit our website http://newindia.co.in.

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