THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

The New India Assurance Co.Ltd.

TUTICORIN D.O. (730700)
Tel. No.: 04612300571//4612321528
Email: [email protected]/

Two Wheeler Package Policy

IRDAN190RP0043V01100001
Policy Number: 73070031230100002030
Vehicle: HONDA SCOO/ACTIVA

Period of Cover
From: 26/07/2023 12:00:01 AM
To: 25/07/2024 11:59:59 PM

Insured Details
JAGADEESWARAN RAVI MR.
To: 109-5-11-C, POLEPETTAI WEST,,MELUR THOOTHUKUDI,THOOTHUDAI.,MELUR
THOOTHUKUDI ,TAMIL NADU, 628002

For Insurance Renewals contact

PITCHAIAH S
Tel. No.: 04612321528 / / 9843118940
Email: [email protected] /

For Claims contact our OFFICE

TUTICORIN D.O. 730700
41 B, FIRST FLOOR,VICTORIA STREET,TUTICORIN-628001,,,628001
Tel. No.: 04612300571
Email: [email protected]

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 : 73070023E0003386

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Signature Not
Verified
Digitally signed
by JAGATJAYEE
PANIGRAHI
Date: 2023.07.21
15:04:10 IST
Policy No. : 73070031230100002030Document generated by 32380 at 21/07/2023 15:04:02 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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 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 :73070031230100002030

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
TUTICORIN D.O. (730700), NAME: DIRECT BUSINESS - (2D6484409) Tirunelveli Non Suit Claim Hub (739005)
41 B, FIRST FLOOR,VICTORIA Mr. Pitchaiah S - (NIAAG00000985), ADDRESS: 84 A, Tirvandrum Road, Ist Floor,
STREET,TUTICORIN-628001 , , , PHONE NUMBER:04612321528 / / 9843118940 Palayamkottai,Tirunelveli - 627002 , , , TAMIL NADU
TAMIL NADU , 628001. LAND/FAX NUMBER:/ , 627002.
PHONE NUMBER:04612300571 / 4612321528 EMAIL:[email protected] / PHONE NUMBER: 04622573102 / 04622573107
FAX NUMBER:NA / NA MOBILE NUMBER:
Email:[email protected] Email: [email protected]

INSURED DETAILS
Insured Name JAGADEESWARAN RAVI MR. Customer ID PO51925486 (PAN No :NA)
Insured Address 109-5-11-C, POLEPETTAI WEST,,MELUR Contact Number / / XXXXXX5583
THOOTHUKUDI,THOOTHUDAI.,
MELUR THOOTHUKUDI ,TAMIL NADU, 628002
Email rhs.jagadeeswaran@gmail.
com
GSTIN NA

POLICY DETAILS
Period of cover 26/07/2023 12:00:01 AM to 25/07/2024 11:59:59 PM Receipt Number 73070081230000001839 -
21/07/23
Previous Insurer THE NEW INDIA ASSURANCE COMPANY LTD. Previous Policy Number 73070031220100001611

VEHICLE DETAILS
Registration Number TN-69-BF-4389 Chassis no./Engine Number ME4JF493FG8220948/JF49
E81257198
Make / Model HONDA SCOO/ACTIVA Variant: HONDA ACTIVA
Year of manufacture 2016 Type of body / Type of Fuel Metal/Petrol
Colour RED Cubic capacity(cc) 125cc
/Wattage(kW):
Seating capacity including 2 Name of registration Thoothukudi
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
21875 0 0 0 0 21875
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 327 Basic TP Premium 714
(-)Calculated NCB Discount(50%) 163.63 (+)Compulsory PA Premium for Owner Driver(Sum 275
Insured Rs 1500000)
Calculated OD Premium 164 Calculated TP Premium 989
Total OD Premium 164 Total TP Premium 989
Net Premium in Rs 1,153
GST in Rs 208
Total Payable in Rs 1,361
Total Payable in Rs(in words): RUPEES ONE THOUSAND THREE HUNDRED SIXTY-ONE ONLY
GSTIN(Issuing Office) 33AAACN4165C4ZV
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
Página 1 de 2

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

event: Up to Rs. 1,00,000

For individual covers (OD) in RS:21875 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
Name of Nominee Age of Nominee Relationship with the Name of the Appointee (if Relationship to the
Insured Nominee is a minor) Nominee
NA NA NA NA NA
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 1,153
SGST 9 104
CGST 9 104
IGST 0 0

In witness where of this policy has been signed at TUTICORIN D.O. on this 21/07/2023WARRANTED 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: 21/07/2023

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 : 73070023E0003386

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

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

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : TUTICORIN D.O. (730700)
Address : 41 B, FIRST FLOOR,VICTORIA STREET,TUTICORIN-628001

,628001
THOOTHUKUDI
Insured Pan Number :
Phone : 04612300571
Email : [email protected]
Fax :
Collection Number : 73070081230000001839
Collection Date : 21/07/2023
Business Source Code : 2D6484409
PAN No of Payer :

Received with thanks from JAGADEESWARAN RAVI MR..

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
73070031230100002030 Bank-730700 1361.00 9100.730700 BA00013455-721400-9100
Total = ` 1361.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
RTGS 1361.00 7953702 21-JUL-23 UNION BANK OF INDIA TUTICORIN 7307002310007643 N.A.
5
Total = ` 1361.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
1153.00 208.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NIAAG00000985 PITCHAIAH S 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 21/07/2023

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.

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 : 73070023E0003386

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 73070031230100002030Document generated by 32380 at 21/07/2023 15:04:02 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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

Policy No. : 73070031230100002030Document generated by 32380 at 21/07/2023 15:04:02 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.

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 : 73070023E0003386

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 73070031230100002030Document generated by 32380 at 21/07/2023 15:04:02 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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