THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Liability Policy

UIN - IRDAN190RP0001V01200203

Insured's Details Policy Details

Insured's Name: SANJAY LAKKEWAR Policy number: 16031031190200000295
Customer ID: Period of cover: 11/02/2020 08:58:45 PM to 10/02/2021
11:59:59 PM
Insureds Address: 02 D K DAIMONF VINEET KUNJ, Registration no. MP-04-CC-8959
KOLAR ROAD

Prev. Policy no. NA Make/Model: CHEVOURLET\MALIBU

Email: Receipt no. 10000089190200157405 - 11/02/20
Phone Number : // Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address MAHAL MICRO OFFICE (160310), Agent / Corp. Agent /
BLOCK NO G 01, MANISH KRITIKA RESIDENCY, OPP Broker / Banc D2c Insurance Broking Pvt
NATRAJ TALKIES, ZENDA CHOWK, MAHAL NAGPUR , , ,
MAHARASHTRA , 440002.
Assurance / Referral
Code - Name / Ltd - (BR00000204)
POS/IMF/SPECIFIED
PERSON
Phone no //
Phone no 9975507424 / 8766533716 Fax no. /
Fax no. NA / NA Email [email protected] /
Email [email protected] Development officer NA
level Name/Code
Claim Contact NAGPUR (160001) Claim Contact Detail DR. AMBEDKAR BHAVAN, M.E.C.L. PREMISES, 4TH
FLOOR, HIGHLAND DRIVE, SEMINARY
HILLS,,NAGPUR- 440006,;07122980462/07122512069/
GSTIN 27AAACN4165C3ZP
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/B Year of manufacture: 1966
Name of the Financier: Chassis no./Engine no.: 1366960/160296
Type of body: SALOON Variant: MALIBU
Automobile Association none Colour: -
membership:
Seating capacity including Driver: 5 Cubic capacity ( cc)/Wattage(kW): 1500
Cover Note No/Cover Note Issue / Name of registration authority: BHOPAL
Date:
IDV(In `)
Vehicl Trailer Non-Elec Acc Electrical Acc Bi-fuel Total
e kit Value
0 0 N/A N/A N/A 0
Schedule of
Premium
Own Liabilit
Damage y
Basic TP Cover
,PA cover for UnNamed Persons, LL cover
for Paid Driver

OD Premium in ` TP Premium in ` 8115

Net Premium in `: 8115
GST in `: 1461
Total Payable in `: 9576
Total Payable in `(in words): RUPEES NINE
THOUSAND FIVE
HUNDRED SEVENTY-
SIX ONLY

Limitations as to Limits of Liability

use
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

Signature Not
Verified

Digitally signed
by Srinivasan Policy No. : 16031031190200000295 Document generated by QR_RENEWAL at 12/02/2020 12:17:00 Hours.
Vaideswaran
Date: 2020.02.12 Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
For 1re2d:1r7e:s2s7aIlSoTf 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.

Page 1 of
 For individual covers (OD) in`: 0
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

Name of Nominee Age of Nominee Relationship with the Name of the Appointee (if Relationship to the
Insured Nominee is a minor) Nominee
none 0 none none none

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 ` 8115.00
SGST 0 0
CGST 0 0
IGST 18 1461

In witness where of this policy has been signed at MAHAL MICRO OFFICE on this 12/02/2020
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 16,22.
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 well as this Certificate of Insurance For and on behalf of The New India Assurance Company
are issued in accordance with the provisions of Limited
Chapter X and XI of M.V. Act, 1988.NIA S.T.REGN No:
AAACN4165CST178.

Date of Issue: 12/02/2020

(Mr. GAJANAN KUMBHARE)

[DIVISIONAL MANAGER]

Duly Constituted Attorney(s)

Tax Invoice No : 16031019P0000492

IRDA Registration Number: 190

Policy No. : 16031031190200000295 Document generated by QR_RENEWAL at 12/02/2020 12:17:00 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.