Address of Issuing Office : Address of Servicing Branch Office :

Reliance General Insurance Co. Ltd Reliance General Insurance Co. Ltd
Rectifier House, Naigaum Cross Road, 570 Policy Servicing Branch address : Flat No-10-15, 14th Floor, Vijaya
Wadala (W), Mumbai - 400 031, India 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 : 9202952911000011 Policy Certificate No : 1301952911605624
Proposal / Covernote No: P1301952911605624
Date of proposal & declaration : 19/11/2015
Name of the Insured : Shivam Bansal
Address of the Insured : Post Office Ke Samne, Sitaram Bazar, City : Bari, State : Rajasthan, PinCode : 328021,
Telephone No : , Mobile No : 9509690433
, Email ID : bansals30@gmail.com
Period of Insurance : From : 18/11/2015 To : 17/11/2016
Description and situation of the premises containing the property insured :
Address :
Post Office Ke Samne, Sitaram Bazar, City :Bari, State : Rajasthan, PinCode : 328021
Property Insured :
Make and Description Model No. Serial No. Identification No. Year of Mfg. Total Sum
Insured (in Rs.)
HP Notebook 15-ac170TU CND5348G9Y 90078186 2015 22237.00

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 : 111.19
Add: Service Tax (14.00% of Net Premium) : 15.57

Total Premium : 127.00

(Service Tax Registration Number: AABCR6747BST001)
Category-General Insurance Business Service 00440005)
Category-General Insurance Business Service 00440005.
Consolidated Stamp Duty Paid with Receipt No. MH006126164201415E Dated 02 Mar 2015 ** 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 21-Nov-2015
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

Insurance is the subject matter of Solicitation. IRDA of India Registration No. 103
Corporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited.
Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.
Corporate Office: 570, Rectifier House, Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai 400031.
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