Address of Issuing Office :

Address of Servicing Branch Office :

Reliance General Insurance Co. Ltd

Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway ,
Santacruz (East), Mumbai - 400 055.

Reliance General Insurance Co. Ltd

Policy Servicing Branch address : Flat No-10-15, 14th Floor, Vijaya
Building, 17, Barakhamba Road , Connaught Place, New Delhi - 110001
Delhi Delhi 110001, India
Branch Contact No. 011-39975617

Burglary and Housebreaking Insurance Policy

Master Policy No :

9202962911000036

Proposal / Covernote No:

P1301962911632114

1301962911632114

Policy Certificate No :

Date of proposal & declaration : 03/12/2016

Name of the Insured :

Pawan Kumar

Address of the Insured :

House-F-22, Roop Enclave, Bhatola, Sector-82, City : Faridabad, State : Haryana, PinCode : 121004,
Telephone No : , Mobile No : 9810525910
, Email ID : vishu6802@gmail.com

Period of Insurance :

From : 23/11/2016 To : 22/11/2017

Description and situation of the premises containing the property insured :

Address :
House-F-22, Roop Enclave, Bhatola, Sector-82, City :Faridabad, State : Haryana, PinCode : 121004

Property Insured :
Make and Description

Model No.

HP Pavilion Notebook 15au111TX

Serial No.

Identification No.

Year of Mfg.

Total Sum
Insured (in Rs.)

5CD6310WK7

90317234

2016

56990.00

Extensions :
The policy covers THEFT as an extension.

Special Conditions :
1) Laptop as checked-in baggage or under contract of afrieghtment is excluded.
2) Any theft/ burglary from any premises while laptop is not in custody or control of the insured is excluded. Premises would include any mode of travel.
Premium Details

Amount (Rs.)

Net Premium :

284.95

Add: Service Tax (14.00% of Net Premium) :

39.89

Swachh Bharat Cess (0.50% of Net Premium) :

1.42

Krishi Kalyan Cess (0.50% of Net Premium) :

1.42

Total Premium :

328.00

(Service Tax Registration Number: AABCR6747BST001)

Category-General Insurance Business Service 00440005)
Consolidated Stamp Duty Paid with Receipt No. MH004071849201617E Dated 07 Sep 2016 ** Not Applicable for the State of Jammu & Kashmir

Note : In the event of dishonor of cheque, this policy document automatically stands cancelled from inception, irrespective of
whether a separate communication is sent or not.
In witness whereof this policy has been signed at Corporate Group - Delhi on 14-Dec-2016
For any assistance with claims, please contact us on 1800 3009 (toll free) or email us at services.rgicl@relianceada.com.

For Reliance General Insurance Company Limited

Duly Constituted Attorney(s)

Agent Code/Name :

Direct/Direct

IRDAI Registration No. 103

Corporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited.
Registered Office: H Block, 1st Floor, Dhirubhai Ambani Knowledge City, Navi Mumbai 400710.
Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055.
"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General
Insurance Company Limited under License

An ISO 9001:2008 Certified Company

PAN No. AABCR6747B