THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

The New India Assurance Co.Ltd.

N BLOCK,CONNAUGHT CIRCUS (310300)
Tel. No.: 23723521//
Email: [email protected]/[email protected]

Two Wheeler Package Policy

IRDAN190RP0043V01100001
Policy Number: 31030031190100594875
Vehicle: HONDA SCOO/ACTIVA 3G

Period of Cover
From: 05/03/2020 12:00:01 AM
To: 04/03/2021 11:59:59 PM

Insured Details
Sudha Rani Nayak
To: AT-WARD NO-09, POST-KHARIAR,RO AD, PS-JONK, ,KHARIAR ROAD ,ODISHA, 766104

For Insurance Renewals contact

Tel. No.: NA
Email: NA

For Claims contact our OFFICE

N BLOCK,CONNAUGHT CIRCUS 310300
BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW DELHI,,,110001
Tel. No.: 23723521
Email: [email protected]

Tax Invoice No : 31030019P0606046

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2020.03.01
18:53:58 IST
Policy No. : 31030031190100594875Document generated by Policy Bazaar at 01/03/2020 18:53:53 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 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

[B]
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Two Wheeler Package Policy

UIN Number - IRDAN190RP0043V01100001

Insured's Details Policy Details

Insured's Name: Sudha Rani Nayak Policy number: 31030031190100594875
Customer ID: PO78409116 (PAN No :NA) Period of cover: 05/03/2020 12:00:01 AM to 04/03/2021
11:59:59 PM
Insureds Address: AT-WARD NO-09, POST-KHARIAR,RO AD, Registration no. OD-26-A-2598
PS-JONK,,
KHARIAR ROAD ,ODISHA, 766104
Prev. Policy no. Make/Model: HONDA SCOO/ACTIVA 3G
Email: [email protected] Receipt no. 31030081190000598055 - 01/03/20
Phone Number : / / 8658254649 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/Designated
Person for MISP
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/Web WEBAGRTR (WE00000001)
Aggregator
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: 2015
Name of the Financier: Chassis no./Engine no.: ME4JF504GF8186703/JF50E82186176
Type of fuel: Petrol Cubic capacity ( cc)/Wattage(kW): 110cc
Type of body: Variant: ACTIVA 3G
Seating capacity including Driver: 2 Colour: As per RC Book
Automobile Association none Name of registration authority: Nuapada
membership:
Cover Note No/Cover Note Issue /
Date:
IDV (in `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
16433.6 0 0 0 0 16433.6

Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Compulsory PA cover for Owner Driver
(Sum Insured `0 OPTED OUT)

OD Premium in ` 69 TP Premium in ` 752

Net Premium in `: 821
GST in `: 148
Total Payable in `: 969
Total Payable in `(in words): RUPEES NINE
HUNDRED SIXTY-
NINE ONLY
Limitations as to use Limits of Liability

Policy No. : 31030031190100594875Document generated by Policy Bazaar at 01/03/2020 18:53:53 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.

Page 2 of 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

The Policy covers use of the vehicle for any purpose other than: a)Hire Limit of the amount the Company's Liability Under Section II 1(i) in
or Reward b)Carriage of goods (other than samples or personal respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
luggage) c)Organized racing d)Pace making e)Speed testing f) of the amount of the Company's Liability Under Section II 1(ii) in
Reliability Trials g)Any purpose in connection with Motor Trade respect of any one claim or series of claims arising out of one event:
Up to ` 1,00,000
For individual covers (OD) in`: 16433.6
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 100
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 ` 821.00
SGST 0 0
CGST 0 0
IGST 18 148

In witness where of this policy has been signed at Mumbai on this 01/03/2020
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 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: 01/03/2020

(MS. RASHMI LUCY BARWA)

[SRDivisional Manager]

Duly Constituted Attorney(s)

Tax Invoice No : 31030019P0606046

IRDA Registration Number: 190

Policy No. : 31030031190100594875Document generated by Policy Bazaar at 01/03/2020 18:53:53 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.

Page 3 of 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Policy No. : 31030031190100594875Document generated by Policy Bazaar at 01/03/2020 18:53:53 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.

Page 4 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : N BLOCK,CONNAUGHT CIRCUS (310300)
Address : BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW DELHI

,110001
NEW DELHI
Phone : 23723521
Email : [email protected]
Fax :
Collection Number : 31030081190000598055
Collection Date : 01/03/2020
Business Source Code : 2D10673292
PAN No of Payer :

Received with thanks from Sudha Rani Nayak .

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
31030031190100594875 Bank-310300 969.00 9100.310300 BA00018819-310300-9100
Total = ` 969.00

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 969.00 PG1704 N.A. N.A. N.A. 31030019301784360 N.A.
8739
Total = ` 969.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
821.00 148.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA NA 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 01/03/2020

(MS. RASHMI LUCY

BARWA)
[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.

Tax Invoice No : 31030019P0606046

IRDA Registration Number: 190

Policy No. : 31030031190100594875Document generated by Policy Bazaar at 01/03/2020 18:53:53 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 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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 ` 100 (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.

Tax Invoice No : 31030019P0606046

IRDA Registration Number: 190

Policy No. : 31030031190100594875Document generated by Policy Bazaar at 01/03/2020 18:53:53 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 6