THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Two Wheeler Package Policy

Insured's Details Policy Details

Insured's Name: MR. AJAY SIDHAR S/O SH. DILAWAR SINGH Policy number: 36080131170100002873
Customer ID: PO56544890 (PAN No :NA) Period of cover: 20/01/2018 12:00:01 AM to 19/01/2019
11:59:59 PM
Insureds Address: VILL. NANGLAN PO. ROR MAZARA ,DISTT Registration no. PB-07-AR-5880
HOSHIARPUR,,
GARH SHANKAR ,PUNJAB, 144527
Prev. Policy no. PROPOSAL Make/Model: ROYAL ENFI/BULLET
Email: Receipt no. 36080181170000003599 - 15/01/18
Phone Number : / / Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address NAWANSHEHAR BRANCH (360801), Agent / Corp. Agent /
ABOVE UCO BANK, JALANDHAR-NAWANSHAHAR MAIN Broker / Banc Mr. Charanjiv Lal -
ROAD , , ,
PUNJAB , 144514.
Assurance / Referral
Code - Name /
(NIAAG00086864)
POS/IMF
Phone no / / 9417129042
Phone no 01823222421 / 01823227498 Fax no. /
Fax no. 01823227498 / NA Email charanjeetchanni23@gmail.com /
Email nia.360801@newindia.co.in Development officer DIRECT BUSINESS - (1D6341252)
level Name/Code
Claim Contact NAWANSHEHAR BRANCH (360801) Claim Contact Detail ABOVE UCO BANK, JALANDHAR-NAWANSHAHAR
MAIN ROAD,,;01823222421/01823227498/
GSTIN 03AAACN4165C1Z1
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/B Year of manufacture: 2014
Name of the Financier: Chassis no./Engine no.: 91295/91295
Type of fuel: Petrol Cubic capacity ( cc): 350
Type of body: Metal Variant: STD UCE
Seating capacity including Driver: 2 Colour: BLACK
Automobile Association none Name of registration authority: Hoshiarpur
membership:
Cover Note No/Cover Note Issue /
Date:
IDV (in `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
60000 0 0 0 0 60000
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Compulsory PA cover for Owner Driver

OD Premium in ` 528 TP Premium in ` 937

Net Premium in `: 1465
GST in `: 264
Total Payable in `: 1729
Total Payable in `(in words): RUPEES ONE
THOUSAND SEVEN
HUNDRED TWENTY-
NINE ONLY
Limitations as to use Limits of Liability
The Policy covers use of the vehicle for any purpose other than: a)Hire Limit of the amount the Company's Liability Under Section II 1(i) in
or Reward b)Carriage of goods (other than samples or personal respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
luggage) c)Organized racing d)Pace making e)Speed testing f) of the amount of the Company's Liability Under Section II 1(ii) in
Reliability Trials g)Any purpose in connection with Motor Trade respect of any one claim or series of claims arising out of one event:
Up to ` 1,00,000
For individual covers (OD) in`: 60000
Imposed excess in `: 0

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 36080131170100002873Document generated by 35563 at 15/01/2018 14:50:59 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2018.01.15
For 14:50:59
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
IST
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.

Page 1 of 2
 THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

Voluntary excess in `: 0
Compulsory excess in `: 100
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
MR. DILAWAR SINGH 50 NA NA NA
PA cover for named persons
Name CSI Opted(`) Nominee Relationship
none 0 NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium ` 1465.00
SGST 9 132
CGST 9 132
IGST 0 0

In witness where of this policy has been signed at Mumbai on this 15/01/2018
WARRANTED 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.
I/We hereby certify that the policy to which this Certificate relates as For and on behalf of The New India Assurance Company Limited
well as this Certificate of Insurance are issued in accordance with
the provisions of Chapter X and XI of M.V. Act, 1988.NIA S.T.REGN
No: AAACN4165CST178.
Date of Issue: 15/01/2018

Duly Constituted Attorney(s)

Tax Invoice No : 3608013100002873

IRDA Registration Number: 190

Policy No. : 36080131170100002873Document generated by 35563 at 15/01/2018 14:50:59 Hours.

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