“Consolidated Stamp Fees paid by Pay Order No. 008816 vide Receipt/Chal lan HOg2572° THe New INDI ASSURANCE CO. LTD, Dt.31/10/2012 and the Stamp (Wholly owned by the Govt. of Inia) this Policy iss.) [—_ POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE Two Wheeler Package Policy [RAV BASANT CHAUDHARY Tnsured’s Detalls Policy number ra0s01s1130 100008309 Pozsaze975 Period of cover: ¥7/02720%8 12:00:01 aN to TeOBROIS ‘ 19.58 Pad Insured Address: INS04 GOKUL GARDEN THAKUR [Registration na. lar-02.an8 5521 COMPLEX KANONRCTE MOA! = [Nake/ttodel BAIANCT 100) —_|Receipt no. 4050181130000012499 - 22/01/16 3520086270 [Fax Numbor: NAINA Policy Details [Geographical Area / Zone: nia Z Near of ei [e008 [Namo of the Financier. Fn ‘chassis, 90. laroceri2i7e [Cunic capacity {eo} [100 % Veta: BAIA CT 100) ‘Seating cepecity includin Colour: OTHER ‘Automobile Association Irone Tee |Name of registration authority: | Mumbai West |Gover Note No/Cover Note issuel/ (Date: pels pe ut __W¥infs 5 Trailer | "WonBiee Acc | electrical Ace Bifuel kit Total Vales #2 -o. | = 0 4 21000 _ i. eet = Sehedite of Bronte ed Liabily z Basic TP Cover Compulsory PA caver er Owner Dever cl 168__ [Te Pramiunin We mm s am st Service Tax in Re , o Total Payabe i RE ame t ras Limitations afte ee its of Labi OSS Seale vet or ny purpose thon. 9 He] ini cine aun Compan’ Laoity Under Seen In Sentat ae: oer Soneargcng fos” (Me om aio he Ve ie voc ol ace matin 3) or [bist te thoun‘ of be Companys sity Uns Secon in Any purse in snmoston wth ot Trade (spoetoany one Gaim oleae eat Ue Sie HN Imposed excor ai e otunary ecess in Rez 0 [Compulsory exeoee in REE 100 ‘of persons entiled to drive Any ereon including the insured proved that a porepn dvng hale an affective Giving Teanee a the Gna ol io acoder ands hor eral rom ning or barn ‘elele and tha uh a bers 0 ‘uch a Ecense, Proved also tha Ihe parson holang an fective Lasers License may ale ive tho es the requrrhort of Rule Softw Cant! Motor Vehicles Ples, 1388 PA cover for Owner Driver lage of omnes FRelatonshipwithie [Namo of te Appoinic (F Relatonahip tothe Insured Nompee isa minor) [Noms = INA NA Ina. ea exe oi a asurnes og 07 Ma Riehl sbD0P. TOL FRE Ne 8 outers your gear ou may spas an on he ating tie. ey an ‘otremmarrane ral mechs you my aso speach Wauane uaa Fo dns toile ests aa sescnen chon sine Once fer enen - 140501, edt waa, thee sifftoar % aR, wie Ze, fer (afar), exe - 401 303. Mirar Branch Office - 140501, Shakti Sadan, Near Post Ofico, Vartak Road, Virer (West), Thane - 401 303. Tel. Dir: 0250-2508243, 8: 2504197, 2602653, Fax : 0250-2507188. (Service Tax No. AAACN 4165CST178) GICG at 11/13 Qty. $0000‘THE NEW INDIA ASSURANCE CO. LTD, (Wholly owned by the Govt. of India) Pa cover for named persons dane [csi opamp Nominee Rotana aoe. 0 rms A ig ce ew india Contact [Ress [RAR BRaNCR - 140003 0509 Gap Raed ; SHARITSADAN sor rLOUR Ne POST Orrce ‘Este eiaee*| Vashishth N. Shukla - kaon an settee Rte MAHARASHTRA, s0t300. Cs Nero. “"* (206490371) ‘Agent _Site_76672 - x (206492832) 7 Pas 7 iereiesesst Phone ns [mene roanzees —e z oxo. [os7166/Na fem i fEmst na. 10501@newdia cin evoopmgntaier| MR SR. TARI-@Deaan507 In witness where of this policy has been ees is 2202014 MBaRRgGeS oat CARE 8 BEN CRSGRe MU CHEGLE. THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED “his oly subj tothe Tams, condone and except opotcan Hi fre cn, WT Endo gba pA hawk a [important notice g The insured i not indent, thevehicle bees oF a ae tis schedae, Ary payment made bythe company ty reason o wice ts appearing inte cries oper to campy nin hw oie Vonisca Mat TGS eee eae ee nse se ase Headed “AVODANCE OF CERTAIN TERIIS AND RIGHTS CF RECOVERY® tis oatkad Retiree een tp Bachagetiai pofeyatachesvatabe on the web ta Iegarcing thera le reo oly deals made by Ee nour, oor obo eae aie bes (hausing cain uncer sections Repeat ‘| Inte ary eaten diab doge atl Wve mevdhisirncs come fetes scone orearc any Ctatues, Eaten on eh ~ = Rainanien permanente, Uni Tercrece aamaaog, Gas A uy Constitutes Atomey(s) ty Ma: 3831 HHO Doan gens by 24 BONO How eet oom a ssa e878 Real ot Mant, TOLL PREE Ne 108 36 4 {errr of your genes any you mny pouch ony oreo orn ea Paey aura ers Raga ae cet fae eran - 140501, eet wea, die sifftes & ue, ade as, free (afkse), eet - 401 303, Mirar Branch Office - 140501, Shakt Sadan, Near Post Ofico, Vartak Road, Vrar (Wes!) Thane ~401 303, Tal, Dir 0250-2508243, 8: 2504187, 2502663, Fax : 0250-2507188. (Service Tax No. AAACN 4165CST173) GICG at 11/13 aay. $0000THE NEW INDIA ASSURANCE Co. LTD, (inolly owned by the Govt. of india & SS COLLECTION RECEIPT cum ADJUSTMENT VOUCHER Issuing oftice Address Phone Ema Fax Collsction Number VIRAR BRANCH - 140501 (140501) SHAK SADAN, 157 FLOOR RRROST OFFICE: VARS on, Vinan ° + 2505249 # ia.149501@inenina on 2507166 1050 811300000 12600 Coleen Date zaovacre Business Source Code 20s4on387 rhe Para fom RAW Sash CoA a The amount reveived/Adiustod is towarce oo ae Poly Na Ne tcinon Ra WG Code ‘8b AE Cade sae [Teeacoge the 100.40501 | ernest aosaoiop ‘Total = Rs, 743.00 , @ 2 , tor Eee ctmen ga ede under ees Mote | Anguot chaeue] “cheauw | ——~brenec Baa — Brewer] Reterence no Sagumer wey" [Pe] age 7. ‘oS Hye | Fda : aloe eneque ra.00 [oseser if 20-H0b a" INDIAN OVERSEAS Baek [rgyowaar | ##080175t00te542 faa I 5. 743.00 —Ubleaton dt ot ns Cas [coum _[Senves Ts pesene FT ato $4 lo.00 “ lo ai ane [Denaitnent code VASHISiTH ni Shula — isi a a For The New india Assurance | ‘Company Limited \ , even Stamp NIA S.T-REGN No: ARACNatescSTi76, Nove r | faere een - 140504, Virar Branch office Tel. Dir. 0250-250824% _ ta ea, tee alfa wa, whee, Rew (afm), als a01 303, 3B opp Sadan, Near Post Ofice, Varak Road, Virar Vest) Thane - 401 303, 9B 2504187, 2502659, Fax: 280-2507166 (Sender ee A aac 4165CST178) se j GIGS at 11/13 aty. 50000 —