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 :31030031210200188754

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
N BLOCK,CONNAUGHT CIRCUS (310300), NAME: N BLOCK,CONNAUGHT CIRCUS (310300)
BOMBAY LIFE BUILDING, N-34, CONNAUGHT Policybazaar Insurance Broker Pvt Ltd - OR
CIRCUS, NEW DELHI , , , (BR00000972), CUSTOMER CARE NUMBER: 1800-209-1415
DELHI , 110001. PHONE NUMBER:18002585970 / /
PHONE NUMBER:23723521 LAND/FAX NUMBER:/
FAX NUMBER:NA / NA EMAIL:[email protected] /
Email:[email protected]

INSURED DETAILS
Insured Name Saravanakumar Customer ID PO92192199 (PAN No :NA)
Insured Address 139 pillaiyar koil Street,,, Contact Number / / XXXXXX8184
SUNDARAPANDIAM ,TAMIL NADU, 626126
Email [email protected]
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 14/10/2021 12:00:01 AM to 13/10/2022 11:59:59 PM Receipt Number 31030081210000189095 -
11/10/21
Previous Insurer Others. Previous Policy Number

VEHICLE DETAILS
Registration Number TN-67-AY-2161 Chassis no./Engine Number ME4JC366C98229258/JC36
E9360418
Make / Model HONDA SCOO/CB SHINE Variant: CB SHINE KICK-DRUM-
SPOKE
Year of manufacture 2009 Type of body / Type of Fuel
Colour As per RC Book Cubic capacity(cc) 125cc
/Wattage(kW):
Seating capacity including 2 Name of registration Virudhunagar
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 135
Total Payable in Rs 887
Total Payable in Rs(in words): RUPEES EIGHT HUNDRED EIGHTY-SEVEN ONLY
Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 31030031210200188754Document generated by USRPB at 2021/10/11 14:11:27.
Vaideswaran
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2021.10.11
14:11:27 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)

GSTIN(Issuing Office) 07AAACN4165C1ZT

SAC 997134 (Motor vehicle insurance services)
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:1000 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 752.00
SGST 0 0
CGST 0 0
IGST 18 135

In witness where of this policy has been signed at N BLOCK,CONNAUGHT CIRCUS on this 11/10/2021WARRANTED 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.
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: 11/10/2021

(MS. RASHMI LUCY BARWA)

[SRDivisional Manager]

Duly Constituted Attorney(s)

Tax Invoice No : 31030021P0202323

Policy No. : 31030031210200188754Document generated by USRPB at 2021/10/11 14:11:27.

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. : 31030031210200188754Document generated by USRPB at 2021/10/11 14:11:27.

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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