THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Two Wheeler Package Policy

UIN Number - IRDAN190RP0043V01100001

Policy Number :31030031230100055837

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: 1234567890 /
PHONE NUMBER:23723521 EMAIL:[email protected] / MOBILE NUMBER:
FAX NUMBER:NA / NA Email: [email protected]
Email:[email protected]

INSURED DETAILS
Insured Name Ranjeet Katoch Customer ID POA5215655 (PAN No :NA)
Insured Address 107 B, Pocket A-3,,Mayur Vihar Phase-3,,New Delhi, Contact Number / / XXXXXX7514
NEW DELHI ,DELHI, 110096
Email ranjeetkatoch1503@gmail.
com
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 21/05/2023 12:00:01 AM to 20/05/2024 11:59:59 PM Receipt Number 31030081230000092152 -
20/05/23
Previous Insurer THE NEW INDIA ASSURANCE COMPANY LTD. Previous Policy Number 31030031220100061085

VEHICLE DETAILS
Registration Number DL-7S-BD-8130 Chassis no./Engine Number MBLKC13EA9GE00549/KC1
3EA9GE00390
Make / Model HERO HONDA/HUNK Variant: KICK START (150 CC)
Year of manufacture 2009 Type of body / Type of Fuel
Colour As per RC Book Cubic capacity(cc) 150cc
/Wattage(kW):
Seating capacity including 2 Name of registration NEW DELHI
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
14913 0 0 0 0 14913
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 178 Basic TP Premium 714
(-)Calculated NCB Discount(50%) 88.99
Calculated OD Premium 89 Calculated TP Premium 714
Total OD Premium 89 Total TP Premium 714
Net Premium in Rs 803
GST in Rs 144
Total Payable in Rs 947
Total Payable
Signature
Verified
Not in Rs(in words): RUPEES NINE HUNDRED FORTY-SEVEN ONLY
Digitally signedOffice)
GSTIN(Issuing 07AAACN4165C1ZT
by JAGATJAYEE
PANIGRAHI
SACDate: 2023.05.20 997134 (Motor vehicle insurance services)
23:14:43 IST
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
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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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. 1,00,000
For individual covers (OD) in RS:14913 Compulsory excess in Rs:100
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 803
SGST 9 72
CGST 9 72
IGST 0 0

In witness where of this policy has been signed at DO3,CONNAUGHT PLACE, NEW DELHI on this 20/05/2023WARRANTED 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.
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: 20/05/2023

(MR. DAYANAND SINGH)

[SRDivisional Manager]

Duly Constituted Attorney(s)

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 : 31030023P0053495

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

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

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