NATIONAL INSURANCE CO.

LTD
Policy Issuing Office: Mumbai DAB II, First Floor, Sterling Cinema Building, 65, Murzaban Street, Fort, Mumbai, Maharashtra
Pin code: 400001 (State Code: 27), Phone No: 022-22015290
PAN: AAACN9967E, GSTIN: 27AAACN9967E1Z3 , Insurer's IRDA Registration Number: 58
Email: coverfox.tieup@nic.co.in Website: https://nationalinsuranceindia.nic.co.in
CIN: U10200WB1906GOI001713
TWO WHEELER PACKAGE POLICY CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No 26020131216210010471 Proposal No. & Date CFOX20521957, 24-Jul-2021

Policy Issued On 24-Jul-2021 (12:39:42) Tenure 1 year Period of Insurance 24-Aug-2021(00:00:00) To 23-Aug-2022(Midnight)
Insured Name Mr. Raghavan Venkatraman Previous Policy No. VMBJ013735000100 (Expiry : 23-Aug-2021)
Insured Add No.24/25,Thirumurugan street, Venkatesh nagar,Virugambakkam, Previous Insurer Royal Sundaram Alliance Insurance Company Limited
Chennai, TAMIL NADU(State Code: 33)-600092 Mobile: 9840285082
Email: raghavan520747@gmail.com GSTIN No:

Make Model Sub Model Cubic Capacity Manufacturing

Year Seating capacity
TVS Motor Co TVS Scooty
110 2016 2
Limited 110 Zest
Body Type Registration RTO Invoice Date Fuel Type Chassis No
No.
No 47-49, Kaliamman Koil Street, Sai Nagar,
TN10AX0932 01-Aug-2016 Petrol MD626CG48G2E02358
Virugambakkam, Chennai - 600092
Engine No Vehicle IDV Elec. Accessories Non-Elec. Total IDV
Accessories
CG4EG2292111 24002 0 0 24002
Schedule of Premium (Amount in Rs.)
Own Damage Premium (A) ₹ Liability Premium (B) ₹
Basic Premium Basic Third Party Liability 752.0
Vehicle 64.55 Sub Total(Third Party Liability) 752.0
Non-Elec. Accessories 0 PA Cover For Owner Driver of Rs. 15 Lakh NA
Elec. Accessories (IMT-24) 0 Sub Total(PA Cover) NA
Sub Total (Basic Premium) 64.55 Net Liability Premium (B) 752.0
Add Ons [Nil Depreciation Plus] NA Total Premium (A+B) 784.0
Sub Total-Addition NA IGST (18.00%) 141.0
Deductibles
No Claim Bonus (50%) 32.28 Gross Premium Paid 925.0
Sub Total (Deductibles) Addons: NA
Net Own Damage Premium (A) 32
Note:1.Warning that in case of dishonour of the premium cheque, this document stands automatically cancelled 'ab-initio'
2.Consolidated stamp duty paid to state exchequer
3.The policy is subject to compulsory deductible of Rs.100 (IMT-22)
4.Geographical Area-India
5.The insurance company will display terms & conditions on its website https://nationalinsuranceindia.nic.co.in which can be accessed by you online.
*Subject to IMT Endt. Nos.& Memorandum:22
Nominee Details
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
NA NA NA --N.A- --N.A-
Addon Cover(s): 1. Add-ons- If opted, the benefits and exclusions applicable as per insurance company's rules & regulations.
Limitations as to use: The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage)
(3) Organized racing (4) Pace making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Driver’s Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified
from holding or obtaining such license. Provided also that the person holding an effective learner’s license may also drive the vehicle & that such a person satisfies the
requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Limits of Liability Clause: a. Under Section II-1(i) of the policy-Death of or bodily injury to any person so far as it is necessary to meet the requirements of the Motor
Vehicle Act 1988. b. Under Section II-1 (ii) of the policy-Damage to property other than the property belonging to the insured or held in trust or in the custody of control of
the insured up to the limit specified Rs. 100000. c.TPPD 2 Sum Insured - Rs 100000/-.
Grievance Clause: For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call at (18002007710) or may write
an email at (coverfox.tieup@nic.co.in). In case the insured is not satisfied with the response of the office, insured may contact the Grievance Officer of the Company. In
the event of unsatisfactory response from the Grievance Office, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of
grievance. Details of Insurance Ombudsman offices are available at IRDA website:www.irda.gov.in , or on the website of General Insurance Council: www.gicouncil.in or
on the company website https://nationalinsuranceindia.nic.co.in. The policy wording with detailed terms, conditions and exclusions are available on our website
https://nationalinsuranceindia.nic.co.in.
No Claim Bonus will only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy. No Claim Bonus is subject to no claim on the
previous policy. Benefits under the policy stands forfeited if claim is/was made in previous policy.

Hypothecation Details: NA

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Important Notice: The insured is not indemnified, if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by
reasons of wider terms appearing in the certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the insured. See the clause headed
“AVOIDANCE OF CERTAIN TERMS & RIGHT OF RECOVERY”. For legal interpretation, English version will hold good.
SAC: 997134, Description of Service: Motor Vehicle Insurance Services, Place of Supply: TAMIL NADU (State Code: 33), Invoice Number: CFOX20521957.
Billdesk Transaction No: WSBI0137327641. I/we hereby certify that the policy to which this certificate relates as well as this certificate of insurance are issued in
accordance with the provisions of Chapter X and Chapter XI of Motor Vehicle Act, 1988.
For & On Behalf of NATIONAL INSURANCE CO. LTD

Channel Code :
POSP Name:
Signature
Code:

Broker's Name & Add.: Coverfox Insurance Broking Pvt. Ltd. : Unit B2-601, Boomerang, Chandivali Farm Road, Near Chandivali Studio, Andheri East, Mumbai -
400072
Broker's Code : IRDA/ DB 556/ 13 , Broker Contact No.: 1800 209 9930
For Renewal/Claims assistance - please contact Ins.Co at : 1800 209 9930
Insurance is the subject matter of solicitation

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