THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

The New India Assurance Co.Ltd.

DO3,CONNAUGHT PLACE, NEW DELHI (310300)
Tel. No.: 23723521//
Email: [email protected]/[email protected]

Private Car Liability Policy

IRDAN190RP0001V01200203
Policy Number: 31030031230200267857
Vehicle: MARUTI/XL6

Period of Cover
From: 12/01/2024 12:00:01 AM
To: 11/01/2025 11:59:59 PM

Insured Details
SASMITA BEHERA
To: Roxy hotel lane, badambadi, , ,CUTTACK ,ODISHA, 753009

For Insurance Renewals contact

POLICYBAZAAR INSURANCE BROKER PVT LTD
Tel. No.: 18002585970 / /
Email: [email protected] /

For Claims contact our OFFICE

DO3,CONNAUGHT PLACE, NEW DELHI 310300
13/46, IIND FLOOR, SCINDIA HOUSE,KASTURBA GANDHI MARG,,110001
Tel. No.: 23723521
Email: [email protected]

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 31030023P0279666

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Signature Not
Verified
Digitally signed
by DHIRAJ
KUMAR
Date: 2024.01.09
15:30:04 IST
Policy No. : 31030031230200267857Document generated by Policy Bazaar at 09/01/2024 15:29:46 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 1 of 8
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Liability Policy

UIN Number - IRDAN190RP0001V01200203

Policy Number :31030031230200267857

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
DO3,CONNAUGHT PLACE, NEW DELHI NAME: WEB AGGREGATOR NON SUIT CLAIMS HUB (319004)
(310300), Policybazaar Insurance Broker Pvt Ltd - ADDRESS: 13/46, 2nd Floor, SCINDIA HOUSE, K G
13/46, IIND FLOOR, SCINDIA HOUSE , (BR00000972), MARG, CONNAUGHT PLACE, NEW DELHI , , , DELHI ,
KASTURBA GANDHI MARG , , PHONE NUMBER:18002585970 / / 110001.
DELHI , 110001. LAND/FAX NUMBER:/ PHONE NUMBER: 23723521 /
PHONE NUMBER:23723521 EMAIL:[email protected] / MOBILE NUMBER:
FAX NUMBER:NA / NA Email: [email protected]
Email:[email protected]

INSURED DETAILS
Insured Name SASMITA BEHERA Customer ID POB1069612 (PAN No :NA)
Insured Address Roxy hotel lane, badambadi,,, Contact Number / / XXXXXX1355
CUTTACK ,ODISHA, 753009
Email [email protected]
m
GSTIN NA
CHANNEL PARTNER CONTACT DETAILS
Channel Partner Name Email Address(s) Contact Number(s)
Policy Bazaar [email protected] 1800-258-5970

POLICY DETAILS
Period of cover 12/01/2024 12:00:01 AM to 11/01/2025 11:59:59 PM Receipt Number 31030081230000315295 -
09/01/24
Previous Insurer UNIVERSAL SOMPO GENERAL INSURANCE CO. LTD. Previous Policy Number 2367/62308024/00/000

VEHICLE DETAILS
Registration Number OD-02-BQ-0064 Chassis no./Engine Number MA3CNC32SLM238670/K1
5BN9080855
Make / Model MARUTI/XL6 Variant: XL6 ZETA
Year of manufacture 2020 Type of body / Type of Fuel Saloon/PETROL
Colour As per RC Book Cubic capacity(cc) 1462cc
/Wattage(kW):
Seating capacity including 5 Name of registration Bhubaneshwar
Driver authority
Geographical Area / Zone India Name of the Financier
Cover Note No/Cover Note / Automobile Association none
Issue Date: membership
FASTag ID:
INSURED DECLARED VALUE (in Rs)
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 OD Premium 0 Basic TP Premium 3416
(-)Discount over Base TP Premium for Restricting TPPD 100
cover to Rs6000
Calculated OD Premium 0 Calculated TP Premium 3316
Total OD Premium 0 Total TP Premium 3316

Policy No. : 31030031230200267857Document generated by USRPB at 2024/01/09 15:30:04.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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.
Página 1 de 3

Page 2 of 8
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Net Premium in Rs 3,316

GST in Rs 597
Total Payable in Rs 3,913
Total Payable in Rs(in words): RUPEES THREE THOUSAND NINE HUNDRED THIRTEEN ONLY
GSTIN(Issuing Office) 07AAACN4165C1ZT
SAC 997134 (Motor vehicle insurance services)
Limitation as to use:The policy covers use for any purpose other than: a)Hire or reward b)Organized racing, OR c)Speed testing
Limits of Liability:Limit of the amount the Company's Liability Under Section II 1(i) in 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 Rs. 6000
For individual covers (OD) in RS:0 Compulsory excess in Rs:NA
Imposed excess in Rs:0 Voluntary excess in Rs:0
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(Rs.) Nominee Relationship
none 0 NA NA
Premium and GST Details
Rate of Tax Amount in INR
Premium Rs 3,316
SGST 0 0
CGST 0 0
IGST 18 597

In witness where of this policy has been signed at DO3,CONNAUGHT PLACE, NEW DELHI on this 09/01/2024WARRANTED 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 20,22.
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.
Anti Money Laundering Clause: In the event of a claim under the policy exceeding Rs 1lakh or a claim for refund of premium exceeding Rs 1
lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as well
as Company website.

I/We hereby certify that the policy to which this Certificate relates For and on behalf of The New India Assurance Company Limited
as well as this Certificate of Insurance are issued in accordance
with the provisions of Chapter X and XI of M.V. Act, 1988.
Date of Issue: 09/01/2024

(MR. DAYANAND SINGH)

[SRDivisional Manager]
Duly Constituted Attorney(s)

Policy No. : 31030031230200267857Document generated by USRPB at 2024/01/09 15:30:04.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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.
Página 2 de 3

Page 3 of 8
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 31030023P0279666

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 31030031230200267857Document generated by USRPB at 2024/01/09 15:30:04.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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.
Página 3 de 3

Page 4 of 8
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : DO3,CONNAUGHT PLACE, NEW DELHI (310300)
Address : 13/46, IIND FLOOR, SCINDIA HOUSE
KASTURBA GANDHI MARG
,110001
NEW DELHI
Insured Pan Number :
Phone : 23723521
Email : [email protected]
Fax :
Collection Number : 31030081230000315295
Collection Date : 09/01/2024
Business Source Code : BR00000972
PAN No of Payer :

Received with thanks from SASMITA BEHERA.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
31030031230200267857 Bank-310300 3913.00 9100.310300 BA00018819-310300-9100
Total = ` 3913.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
ECS 3913.00 PB84996 N.A. N.A. N.A. 31030023139434149 N.A.
399
Total = ` 3913.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
3316.00 597.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA POLICYBAZAAR INSURANCE BROKER PVT LTD 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 09/01/2024

(MR. DAYANAND
SINGH)
[SRDivisional Manager]

Cashier's Initial Authorized Signatory

Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence. .
2.NIA shall not be liable for any claim arising out of sales made during the period between the due date and date of payment of the
installment if the premium paid has been exhausted by turnover declarations/if there is insufficient premium balance.

Policy No. : 31030031230200267857Document generated by Policy Bazaar at 09/01/2024 15:29:46 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 5 of 8
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 31030023P0279666

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 31030031230200267857Document generated by Policy Bazaar at 09/01/2024 15:29:46 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 6 of 8
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMT.20. REDUCTION IN THE LIMIT OF LIABILITY FOR PROPERTY DAMAGE

It is hereby understood and agreed that notwithstanding anything to the contrary contained in the policy the insurers liability
is limited to ` 6000/- (Rupees six thousand only) for damage to property other than the property belonging to the insured or
held in trust or in custody or control of the insured In consideration of this reduction in the limit of liability a reduction in
premium of ` is hereby made to the insured.

Subject otherwise to the terms conditions limitations and exceptions of the policy.

IMT.22. COMPULSORY DEDUCTIBLE

(Applicable to Private Cars, three wheelers rated as private cars, all motorized two wheelers, taxis, private car type vehicle
plying for public/private hire, private type taxi let out on private hire)

Notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insured shall
bear under Section 1 of the policy in respect of each and every event (including event giving rise to a total loss/constructive
total loss) the first ` 1000 (or any less expenditure which may be incurred) of any expenditure for which provision has been
made under this policy and/or of any expenditure by the insurer in the exercise of his discretion under Condition no 3 of this
policy.

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such
amount shall be repaid by the insured to the insurer forthwith.

For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause
in connection with the vehicle insured in respect of which indemnity is provided under this policy.

Subject otherwise to the terms conditions limitations and exceptions of this Policy.

IMT 22A. VOLUNTARY DEDUCTIBLE (For private cars/motorized two wheelers other than for hire or reward)

It is by declared and agreed that the insured having opted a voluntary deductible of `0 a reduction in premium of ` under
Section 1 of the policy is hereby allowed.

In consideration of the above, it is hereby understood and agreed that the insured shall bear under Section 1 of the policy in
respect of each and every event (including event giving rise to a total loss/constructive total loss) the first `1000 (or any less
expenditure which may be incurred) of any expenditure for which provision has been made under this policy and/or of any
expenditure by the insurer in the exercise of his discretion under Condition no 3 of this policy .

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such
amount shall be repaid by the insured to the insurer forthwith.

For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause
in connection with the vehicle insured in respect of which indemnity is provided under this policy.

Subject otherwise to the terms conditions limitations and exceptions of this Policy.

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 31030023P0279666

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 31030031230200267857Document generated by Policy Bazaar at 09/01/2024 15:29:46 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 7 of 8
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Policy No. : 31030031230200267857Document generated by Policy Bazaar at 09/01/2024 15:29:46 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 8 of 8