THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Package Policy

UIN Number - IRDAN190RP0042V01100001

Policy Number :68030031210100003135

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
GULBARGA DO (680300), NAME: GULBARGA DO (680300)
Dr.Rajshekhar Patil Bldg,10- Invictus Insurance Broking Services Pvt Ltd - Dr.Rajshekhar Patil Bldg,10-
2/7,P.B.No.12,S.B.Temple Road Gulbarga , , (BR00000175), 2/7,P.B.No.12,S.B.Temple Road
, PHONE NUMBER:18002660101 / / Gulbarga,,;08472229668//
KARNATAKA , 585103. LAND/FAX NUMBER:02261149800/ CUSTOMER CARE NUMBER: 1800-209-1415
PHONE NUMBER:08472229668 EMAIL:[email protected] /
FAX NUMBER:NA / NA
Email:[email protected]

INSURED DETAILS
Insured Name VENUGOPAL BHIMRAO HARNOOR Customer ID PO90588258 (PAN No
:ABSPV7648G)
Insured Address KAVI PLOT NO STATION ROAD VIJAPUR,,, Contact Number / / 9854789854
BIJAPUR ,KARNATAKA, 586101
Email insuranceagency2019@gm
ail.com
GSTIN NA

POLICY DETAILS
Period of cover 10/08/2021 12:00:01 AM to 09/08/2022 11:59:59 PM Receipt Number 10000089210800156021 -
06/08/21
Previous Insurer HDFC GENERAL INSURANCE COMPANY LIMITED. Previous Policy Number 2311202916227701000

VEHICLE DETAILS
Registration Number KA-28-P-7945 Chassis no./Engine Number F19046/10610
Make / Model TATA/INDICA eV2 CR4 Variant: LX
Year of manufacture 2018 Type of body / Type of Fuel Hatch-Back/Diesel
Colour MINT WHITE Cubic capacity(cc) 1396cc
/Wattage(kW):
Seating capacity including 5 Name of registration Bijapur
Driver authority
Geographical Area / Zone India Name of the Financier
Cover Note No/Cover Note / Automobile Association none
Issue Date: membership
INSURED DECLARED VALUE (in Rs)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
240000 0 0 0 0 240000

SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 3063 Basic TP Premium 3221
(-)(#)Total NCB Discount(35%) 1072.18 (+)PA premium for Named Persons(4) 100
Calculated OD Premium 1992 Calculated TP Premium 3321
Total OD Premium 1992 Total TP Premium 3321
Net Premium in Rs 5313
GST in Rs 956
Total Payable in Rs 6269
Total Payable in Rs(in words): RUPEES SIX THOUSAND TWO HUNDRED SIXTY-NINE ONLY
GSTIN(Issuing Office) 29AAACN4165C2ZM
Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 68030031210100003135Document generated by QR_RENEWAL at 2021/08/06 16:01:21.
Vaideswaran
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2021.08.06
16:01:21 IST 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.
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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

SAC 997134 (Motor vehicle insurance services)

Limitation as to use: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
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. 7,50,000
For individual covers (OD) in RS:240000 Compulsory excess in Rs:1000
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
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 NA NA
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
NA,NA,NA,NA 200000 BHIMRAO FATHAR
Premium and GST Details
Rate of Tax Amount in INR
Premium Rs 5313.00
SGST 9 478
CGST 9 478
IGST 0 0

In witness where of this policy has been signed at GULBARGA DO on this 06/08/2021WARRANTED 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 15,22,25.
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 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: 06/08/2021

(MR. PRASHANT KUMAR)

[DIVISIONAL MANAGER]
Duly Constituted Attorney(s)

Policy No. : 68030031210100003135Document generated by QR_RENEWAL at 2021/08/06 16:01:21.

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

Tax Invoice No : 68030021P0005517

IRDA Registration Number: 190

Policy No. : 68030031210100003135Document generated by QR_RENEWAL at 2021/08/06 16:01:21.

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

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