पॉिलसी अनुसूची Policy Schedule - Motor - 1 year OD only

पॉिलसी सं या Policy Number:

व यवसाय क Business Source: 361400-G
36140031206801610571
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. Jeet Narayan Singh ाहक आई.डी Customer ID: पैन PAN:

पता Address: G-308, silverline Appartment, Naer BBD Colledge of Management, फोन Phone:7351009030
Chinhat, Lucknow
Lucknow,
State: Uttar Pradesh, PIN: 226028. ई-मेल E-Mail: jeetmaterial@gmail.com
Cell: 7351009030

Policy Effective from 00:00 hours, on 20-03-2021 00:00 क अधराि तक to midnight of 19-03-2022 Midnight
ीिमयम Premium ₹ 3680 कवर नोट सं. व तारीखCover Note Number and Date NA
CGST ₹0
SGST/UTGST ₹0 ताव सं या व तारीखProposal Number and Date PB2326PG005217785 Dt. 04-Mar-2021
IGST ₹ 662
वसूली यो य टांप ड्यूटी
₹ 0.00 रसीद सं या व तारीख Receipt Number and Date PB30280731 Dt. 04/03/2021
Recoverable Stamp Duty
िपछली पॉिलसी सं या व समाि ितिथ Previous Policy Number and TMA27651
कुल रािश Total Amount ₹ 4,342.00
Expiry Date Dt. 19/03/2021
(Rupees Four Thousand Three Hundred Fourty Two केवल Only.)

वाहन का िववरण Vehicle Details

वाहन का आई.डी.वी/Vehicle IDV ₹ 374,400.00 पंजी. सं या Regn. Number UP-32-LL-7548
IDV (Trailer / Sidecar) NA इंजन व एम/सी सं.Engine or M/c No. REVTRN08BZXK17274
इले ीकल ए सेसरी Electrical Accessories 0 इचेिसस सं याChassis Number MAT626203LKB08195
गैर इले ीकल उपकरणNon Electrical
0 पंजीकरण अिध.Regn. Authority LUCKNOW
Accessories
फाइवर लास टक Fiber Glass Tank NA भौगोिलक े Geographical Area इंिडया India
सीएनजी/एलपीजी यूिनटCNG/LPG Unit 0.00 बनावट Make TATA
Total IDV 374,400.00 मॉडल Model TIAGO
अित. टािवंग शु कAddl. Towing Charges NA वे रएंट Variant REVOTRON XE
सी.सी – जी.भी ड यू CC / GVW 1199 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. 2020 पंजीकरण ितिथ Regn. Date 01/03/2020
ीिमयम क अनुसूची Schedule of Premium
OD Premium Breakup in Rs. ₹
Basic OD Premium 11,947.10
NCB Discount (20%) 358.41
Nil Depreciation Plus 2,246.40
Insurer Discount 10,155.04
Total 3,680.05
Ref Policy
Policy No: TMA27651 OD Expiry Date: 19-03-2022 Midnight
TP Start Date: 20/03/2020 TP Expiry Date: 19/03/2023
Insurer: FGIIC
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 04-03-2021 01:26:12hours 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 [20-March-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 20-March-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 04-03-2021 01:26:12hours आई.डी. ारा by ID : 74096, सहायता AID : पृ सं.Page no: 2
 Motor - 1 year OD only
Policy Number: 36140031206801610571 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
36140031206801610571 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
UP-32-LL-7548/ REVTRN08BZXK17274 TATA, TIAGO &
2020 Other 1199 5 3680
LUCKNOW MAT626203LKB08195 REVOTRON XE.

पंजीयन अिधकारी का नाम Name of Registration Authority LUCKNOW

Mr. Jeet Narayan Singh G-308, silverline Appartment, Naer BBD Colledge of
बीिमत का नाम व पता Name & Address of Insured Management, Chinhat, Lucknow Lucknow, State: Uttar Pradesh .
Uttar Pradesh,Lucknow,226028.
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 20-03-2021 00:00.
the purpose of Act.
बीमासमाि क ितिथ Date of expiry of the insurance Midnight on: 19-03-2022 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: 20-03-2021 00:00 िविधवत गिठत अटॉन (ओं) Duly Constituted Attorney(s)

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