पॉिलसी अनुसूची Policy Schedule - Motor - Two Wheelers - TP LIABILITY ONLY

पॉिलसी सं या Policy Number:

व यवसाय क Business Source: 910631-G
36140031226702080218
िव य चैनल कोड Sales Channel Code: 91063100000001
जारीकता काया लय Issuing Office
काया लय कोड Office Code: 361400 वनाम Name: Policybazaar Insurance Brokers Private
काया लय का पता Office Address: Limited
National Insurance Company Ltd.,
Gurgaon DO-I,SCO No.- 41-42-43., Sector-31,
Gurgaon - 122001.
GSTIN: 06AAACN9967E2Z6 संपक सं या Contact Number: 18002585970
Contact Number: 0124-2380932,933
Mobile Number:

ाहक का नाम Customer Name: Roshan Mahto ाहक आई.डी Customer ID: पैन PAN:
फोन Phone:9467787665
पता Address: 172/2B, Chandra Sekharan Nagar , Tamil Nagar 6th Street,
Opposite Medical College 2nd Gate City: Thanjavur, District:
State: Tamil Nadu, PIN: 613004. ई-मेल E-Mail: auror.roshan@gmail.com
Cell: 9467787665

Policy Effective from 00:00 hours, on 29/04/2022 क अधराि तक to midnight of 28/04/2023

ीिमयम Premium ₹ 702 कवर नोट सं. व तारीखCover Note Number and Date NA
CGST ₹ 0.00
SGST/UTGST ₹ 0.00 ताव सं या व तारीखProposal Number and Date PB16845875430586071 Dt. 28/04/2022
IGST ₹ 126.00
वसूली यो य टांप ड्यूटी
₹ 0.00 रसीद सं या व तारीख Receipt Number and Date PB50724135 Dt. 28/04/2022
Recoverable Stamp Duty
िपछली पॉिलसी सं या व समाि ितिथ Previous Policy Number and Expiry / /
कुल रािश Total Amount ₹ 828
Date Dt. Dt. 23/01/2022
(Rupees Eight Hundred Twenty Eight केवल Only.)

वाहन का िववरण Vehicle Details

वाहन का आई.डी.वी/Vehicle IDV ₹0 पंजी. सं या Regn. Number KA38K5570
IDV (Trailer / Sidecar) NA इंजन व एम/सी सं.Engine or M/c No. JC40E9115587
इले ीकल ए सेसरी Electrical Accessories NA इचेिसस सं याChassis Number ME4JC404M98076239
गैर इले ीकल उपकरणNon Electrical
NA पंजीकरण अिध.Regn. Authority BIDAR
Accessories
फाइवर लास टक Fiber Glass Tank NA भौगोिलक े Geographical Area इंिडया India
सीएनजी/एलपीजी यूिनटCNG/LPG Unit NA बनावट Make HONDA
Total IDV 0 मॉडल Model CBF STUNNER
KICK START DRUM BRAKE ALLOY WHEELS (125
अित. टािवंग शु कAddl. Towing Charges NA वे रएंट Variant
CC)
सी.सी – जी.भी ड यू CC / GVW 125 वाहन क ेणी/Class of Vehicle Motor Cycle
लाइस स िसिटंग/वहन क मता मत Licensed
2 इढ़ाचा का कार/रंग Body Type / Color
Seating / Carrying Capacity
िनमा ण वष Year of Mfg. 2009 पंजीकरण ितिथ Regn. Date 01/12/2009
ीिमयम क अनुसूची Schedule of Premium
प व- ित Own Damage ₹ िविधक दािय व Legal Liability ₹
व- ित आवरण (उिचत पूरक ीिमयम के साथ) Own Damage Legal Liability Cover 702
0
Cover(Incl. of applicable add-ons)
यि गत दुघटना Personal Accident 0
सकुल Total 0
कुल Total 702
पवाहन व- ित बीमा िववरण Vehicle Own Damage Insurance Details
नो लेम बोनस % No Claim Bonus% N/A Loss of Accessories Covered No
िवदेशी दूतावास का नाम Foreign Embassy Name N Nil Depreciation Plus Covered No
कंपलसरी ए सेस Compulsory Excess ₹
इंपो ड ए सेस Imposed Excess ₹ 0.00
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
₹ 0.00
Nominee: Bhakti Singh Thakur
ा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
 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 [29/04/2022] 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 29/04/2022.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-D CHANDIGARH-160017 Stamp Duty:
Fax : 0172-2708274 ( ₹ 0.25 )
Email ombchd@yahoo.co.in,0172-2706468.

क ािधकृत ह ता रकता Authorized

Signatory
 पृ सं.Page no: 2

Motor - Two Wheelers - TP LIABILITY ONLY

Policy Number: 36140031226702080218 यवसाय ोत Business Source: 910631-G
िव य चैनल कोड Sales Channel Code: 91063100000001
जारीकता काया लय Issuing Office
काया लय कोड Office Code: 361400 नाम Name: Policybazaar Insurance Brokers Private
काया लय का पता Office Address: Limited
National Insurance Company Ltd.,
Gurgaon DO-I,SCO No.- 41-42-43., Sector-31,
Gurgaon - 122001.
GSTIN: 06AAACN9967E2Z6 संपक सं या Contact Number: 18002585970
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
36140031226702080218 IYI
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
HONDA, CBF
STUNNER &
KA38K5570 / JC40E9115587 KICK START
2009 Solo 125 2 702
BIDAR ME4JC404M98076239 DRUM BRAKE
ALLOY WHEELS
(125 CC).

पंजीयन अिधकारी का नाम Name of Registration Authority BIDAR

Roshan Mahto,172/2B, Chandra Sekharan Nagar , Tamil Nagar 6th Street,
बीिमत का नाम व पता Name & Address of Insured Opposite Medical College 2nd Gate
,Thanjavur,Tamil Nadu,613004.
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 29/04/2022.
the purpose of Act.
बीमासमाि क ितिथ Date of expiry of the insurance Midnight on:28/04/2023

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
Company Ltd.,
Gurgaon DO-I,SCO No.- 41-42-43., Sector-31, कृते ने श नल इ योरे स क पनी िलिमटेड क पनी िलिमटेड
Gurgaon - 122001. For and on behalf of National Insurance Company
GSTIN: 06AAACN9967E2Z6 Limited
Contact Number: 0124-2380932,933
Mobile Number:

जारी करने क ितिथ Date of issue: 28/04/2022 िविधवत गिठत अटॉन (ओं) Duly Constituted Attorney(s)

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