पॉिलसी अनुसूची Policy Schedule - PRIVATE CAR LIABILITY ONLY

पॉिलसी सं या Policy Number:

व यवसाय क Business Source: 361400-G
36140031206701564824
जारीकता काया लय Issuing Office िव य चैनल कोड Sales Channel Code: 2900
काया लय कोड Office Code: 361400
वनाम Name: Policybazaar insurance web aggregator
काया लय का पता Office Address:
Pvt Ltd
National Insurance Company Ltd.
Gurgaon DO-I
SCO No.- 41-42-43.
Sector-31
संपक सं या Contact Number: 18002585970 (Service) ,
Gurgaon-122001
18002585881 (Claims)
GSTIN: 06AAACN9967E2Z6
Contact Number: 0124-2380932,933
Mobile Number:

ाहक का नाम Customer Name: Mr. SANDEEP VERMA ाहक आई.डी Customer ID: पैन PAN:

पता Address: H.No.-33, ANJANI VIHAR COLONY,# SHUKLA NAGAR, GARHA फोन Phone:9424312316
SHUKLA NAGAR, GARHA
Jabalpur,
State: Madhya Pradesh, PIN: 482003. ई-मेल E-Mail: parthverma1992@gmail.com
Cell: 9424312316

Policy Effective from 00:00 hours, on 06-02-2021 00:00 क अधराि तक to midnight of 05-02-2022 Midnight
ीिमयम Premium ₹ 1972 कवर नोट सं. व तारीखCover Note Number and Date NA
CGST ₹0
SGST/UTGST ₹0 ताव सं या व तारीखProposal Number and Date PB109PG005018308 Dt. 05-Feb-2021
IGST ₹ 355
वसूली यो य टांप ड्यूटी
₹ 0.00 रसीद सं या व तारीख Receipt Number and Date PG29065006 Dt. 05/02/2021
Recoverable Stamp Duty
िपछली पॉिलसी सं या व समाि ितिथ Previous Policy Number and ABC123/Cholamandalam
कुल रािश Total Amount ₹ 2,327.00
Expiry Date Dt. 06/08/2020
(Rupees Two Thousand Three Hundred Twenty Seven केवल Only.)

वाहन का िववरण Vehicle Details

वाहन का आई.डी.वी/Vehicle IDV NA पंजी. सं या Regn. Number MP-20-CC-0397
IDV (Trailer / Sidecar) NA इंजन व एम/सी सं.Engine or M/c No. B10S1163147KC2
इले ीकल ए सेसरी Electrical Accessories NA इचेिसस सं याChassis Number MA6MF481P8TL07102
गैर इले ीकल उपकरणNon Electrical
NA पंजीकरण अिध.Regn. Authority JABALPUR
Accessories
फाइवर लास टक Fiber Glass Tank NA भौगोिलक े Geographical Area इंिडया India
सीएनजी/एलपीजी यूिनटCNG/LPG Unit NA बनावट Make CHEVROLET
Total IDV NA मॉडल Model SPARK
अित. टािवंग शु कAddl. Towing Charges NA वे रएंट Variant 1
सी.सी – जी.भी ड यू CC / GVW 995 वाहन क ेणी/Class of Vehicle Private Car
लाइस स िसिटंग/वहन क मता मत Licensed
5 इढ़ाचा का कार/रंग Body Type / Color Other
Seating / Carrying Capacity
िनमा ण वष Year of Mfg. 2008 पंजीकरण ितिथ Regn. Date 24/01/2009
ीिमयम क अनुसूची Schedule of Premium
प व- ित Own Damage ₹ TP Premium Breakup in Rs. ₹
व- ित आवरण (उिचत पूरक ीिमयम के साथ) Own Damage Basic TP Premium 1,972.00
NA
Cover(Incl. of applicable add-ons)
PA to owner driver 0.00
सकुल Total NA
Total 1,972.00
तृतीय प बीमा िववरण Third Party Insurance Details
मोटर वाहन अिधिनयम 1988 के अनुसार आव यक रािश Such amount as is necessary to meet the requirement of the motor
Limit of liability under section II-I(i)
vehicles Act 1988
under section II-I(ii) ₹ 6000.00 (In respect of any one claim or series of claims arising out of one event/occurrence.)
ित यि मूल बीमा रािश CSI per
यि गत दुघटना बीमा िववरण Personal Accident Cover Details
head
वाहन का मािलक चालक Owner driver of the vehicle
NA
Nominee: PARTH VERMA, Dependent Child
ासंिगक अनु छेद,पृ ांकन और वारंटी Clauses, Endorsements and Warranties Applicable:
उपयोग क सीमाएं : Limitations as to Use: Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover
use for hire or reward, tuition, racing, pace making, reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any
trade or business or use for any purpose in connection with Motor Trade.
वाहन चालन के िलए अिधकृत यि या यि वग Persons or Class 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

मु ण क तारीख Printed on 05-02-2021 05:00:25hours आई.डी. ारा by ID : 74096, सहायता AID : पृ सं.Page no: 1

an effective Learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
मह वपूण सूचना Important Notice: यिद वाहन का योग या चालन इस अनुसूची म उ सिलिखत से िभ न होता है तो बीमाधारक को कोई ितपूित नह क जायेगी। मोटर वाहन अिधिनयम,1988 के अनपालन मं◌े
उ लेिखत िकसी िव तृत िनयम के कारण कंपनी ारा िकया गया कोई भी भुगतान बीमाधारक से वसूली यो य होगा। " कुछ िनयम और वसूली के अिधकार के प रहार" के शीषक के तहत कंड को देख। 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 the reason 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 AND RIGHT OF RECOVERY"
उपरो उि लिखत कायालय पते पर िविधवत प से ािधकृत अधोह ता री को सा ी मानकर िदनांक [06-February-2021] को ह ता र िकया जा रहा है। वेबसाइट
www.nationalinsuranceindia.nic.co.in म उपल ध इस अनुसच
ू ी, संल न पॉिलसी, ख ड, पृ ांकन और पॉिलसी श द को एक अनुबध
ं के प म एक साथ पढ़ा जाएगा और
पॉिलसी के िकसी भी िह से या अनुसच
ू ी म संल न कोई भी श द या अिभ यि , जो िवशेष अथ कट करता हो, जहां भी कट हो समान अथ वहन करेगा करेगा । यह वारंटी दी जाती है
िक ीिमयम चेक क अ वीकृित क ि थित मं◌े, यह पॉिलसी आरंभ होने क तारीख से ही वतः िनर त माना जाएगा ।

IN WITNESS WHEREOF, the undersigned being duly authorized hereunto set his/ her hand at the office address mentioned above, this 06-February-2021.This
schedule, the attached policy, the clauses, the endorsements and policy wordings as available in the website www.nationalinsuranceindia.nic.co.in shall be read
together as one contract and any word or expression to which the specific meaning has been attached in any part of this policy or of the schedule shall bear the same
meaning wherever it may appear. It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED
'AB-INITIO'

कृते
ने श नल इ योरे स कंपनी िलिमटेड
For and on behalf of National Insurance
Company Limited

Ombudsman Details: Shri K.M.Chadha Insurance

Ombudsman Office of the Insurance Ombudsman S.C.O. No.101-103 2nd Floor टा प ड्यूटी
Batra Building Sector 17-DCHANDIGARH-160017 Stamp Duty:
Fax:- 0172-2708274 ( ₹ 0.50 )
Email:-Email ombchd@yahoo.co.in,0172-2706468.

क ािधकृत ह ता रकता Authorized

Signatory

मु ण क तारीख Printed on 05-02-2021 05:00:25hours आई.डी. ारा by ID : 74096, सहायता AID : पृ सं.Page no: 2
 Policy Schedule - PRIVATE CAR LIABILITY ONLY
Policy Number: 36140031206701564824 यवसाय ोत Business Source: 361400-G
जारीकता काया लय Issuing Office िव य चैनल कोड Sales Channel Code: 2900
काया लय कोड Office Code: 361400
नाम Name: Policybazaar insurance web aggregator Pvt
काया लय का पता Office Address:
Ltd
National Insurance Company Ltd.
Gurgaon DO-I
SCO No.- 41-42-43.
Sector-31
संपक सं या Contact Number: 18002585970 (Service) ,
Gurgaon-122001
18002585881 (Claims)
GSTIN: 06AAACN9967E2Z6
Contact Number: 0124-2380932,933
Mobile Number:

बीमा माण-प CERTIFICATE OF INSURANCE

के ीय मोटर वाहन िनयम 1989 के फाम 51 Form 51 of the Central Motor Vehicle Rules, 1989

माण-प
36140031206701564824 IXI
Certificate No.:

बीिमत वाहन का िववरण Particulars of vehicle insured

पंजी सं.Reg. Mark, इबनावट, मॉडल
इं. व चे. सं Engine No. & िनमा ण वष Year of डी का कारType of सया ी मता
No. & Place of Make, Model & सी सी C.C ीिमयम Premium()
Chassis No Manufacture Body Seating capacity
Registration Variant
MP-20-CC-0397/ B10S1163147KC2 CHEVROLET,
2008 Other 995 5 1972
JABALPUR MA6MF481P8TL07102 SPARK & 1.

पंजीयन अिधकारी का नाम Name of Registration Authority JABALPUR

Mr. SANDEEP VERMA H.No.-33, ANJANI VIHAR COLONY,# SHUKLA NAGAR,
बीिमत का नाम व पता Name & Address of Insured GARHA SHUKLA NAGAR, GARHA Jabalpur, State: Madhya Pradesh .
Madhya Pradesh,Jabalpur,482003.
भौगोिलक े Geographical Area India
Business or Profession
बीमा के ारंभ होने क भावी ितिथ Effective date of commencement of Insurance for
----- बजे िदनांक-----से म य राि िदनांक --तकFrom 00:00 O' Clock on 06-02-2021 00:00.
the purpose of Act.
बीमासमाि क ितिथ Date of expiry of the insurance Midnight on: 05-02-2022 Midnight

गाड़ी चलाने के अिधकृत यरि या यि य का समुह PERSONS OR CLASS 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
requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

योगाथ स माएं LIMITATIONS AS TO USE

Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover use for hire or reward, tuition, racing,
pace making, reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any trade or business or use for any
purpose in connection with Motor Trade.

मं◌ै/हम एत वारा मािणत करते है िक पॉिलसी िजससे यह माण-प संबंिधत है एवं यह बीमा माण-प मोटर वाहन अिधिनयम, 1988 के अ याय X और XI के ावधान के अनुसार जारी िकये गए हैँ। 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 M.V. Act, 1988.
जारीकता काया लय का पूरा पता Full address of Issuing Office: National Insurance कृते ने श नल इ योरे स क पनी िलिमटेड क पनी िलिमटेड
Company Ltd. Gurgaon DO-I SCO No.- 41-42-43, Sector-31 For and on behalf of National Insurance Company
Gurgaon-122001 Limited

जारी करने क ितिथ Date of issue: 06-02-2021 00:00 िविधवत गिठत अटॉन (ओं) Duly Constituted Attorney(s)

In case of any claim, please contact our nearest office Authorized Signatory