THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Two Wheeler Liability Only Policy

UIN Number - IRDAN190RP0002V01200203

Policy Number :72080331210200001950

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
DHARAPURAM (720803), NAME: DHARAPURAM (720803)
M.L. COMPLEX, 1ST FLOOR, 10/11, CHURCH Invictus Insurance Broking Services Pvt Ltd - M.L. COMPLEX, 1ST FLOOR, 10/11, CHURCH
ROAD , DHARAPURAM 638656 , , (BR00000175), ROAD,DHARAPURAM 638656,;04258220320//
TAMIL NADU , 638656. PHONE NUMBER:18002660101 / / CUSTOMER CARE NUMBER: 1800-209-1415
PHONE NUMBER:04258220320 LAND/FAX NUMBER:02261149800/
FAX NUMBER:04258225282 / NA EMAIL:[email protected] /
Email:[email protected]

INSURED DETAILS
Insured Name DHARMARAJ S Customer ID PO89827189 (PAN No :NA)
Insured Address 12-6/102-A V O C STREET VISHWANATHAPURAM Contact Number / / 9361836801
MADURAI TN 625001,,,
MADURAI ,TAMIL NADU, 625001
Email kkhinsurancesolutions@g
mail.com
GSTIN NA

POLICY DETAILS
Period of cover 24/06/2021 12:39:59 PM to 23/06/2022 11:59:59 PM Receipt Number 10000089210600560590 -
24/06/21
Previous Insurer Not available Previous Policy Number .

VEHICLE DETAILS
Registration Number TN-59-AB-8953 Chassis no./Engine Number 06BACF06348/06BACE062
41
Make / Model HERO HONDA/SUPER SPLENDOR Variant: SUPER SPLENDOR (124 CC)
Year of manufacture 2006 Type of body / Type of Fuel Metal/Petrol
Colour M BLACK Cubic capacity(cc) 124cc
/Wattage(kW):
Seating capacity including 2 Name of registration Madurai - North
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
0 0 N/A N/A N/A 0
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 0 Basic TP Premium 752
Calculated OD Premium 0 Calculated TP Premium 752
Total OD Premium 0 Total TP Premium 752
Net Premium in Rs 752
GST in Rs 136
Total Payable in Rs 888
Total Payable in Rs(in words): RUPEES EIGHT HUNDRED EIGHTY-EIGHT ONLY
GSTIN(Issuing Office) 33AAACN4165C4ZV
SAC 997134 (Motor vehicle insurance services)
Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 72080331210200001950Document generated by QR_RENEWAL at 2021/06/24 12:40:10.
Vaideswaran
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2021.06.24
12:40:11 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)

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. 1,00,000
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
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(Rs.) Nominee Relationship
none 0 NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium Rs 752.00
SGST 9 68
CGST 9 68
IGST 0 0

In witness where of this policy has been signed at DHARAPURAM on this 24/06/2021WARRANTED 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 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 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: 24/06/2021

(Mr. GOPINATHAN VENKATACHALAM)

[Branch Manager]

Duly Constituted Attorney(s)

Tax Invoice No : 72080321P0002854

Policy No. : 72080331210200001950Document generated by QR_RENEWAL at 2021/06/24 12:40:10.

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)

IRDA Registration Number: 190

Policy No. : 72080331210200001950Document generated by QR_RENEWAL at 2021/06/24 12:40:10.

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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