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Issuing Office Name & Address

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Mumbai Direct Agents Branch II,First Floor, Sterling Cinema Building, 65,

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Murzaban Street, Fort, Mumbai, Pin : 400001 ,Telephone No: 18003450330

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Email ID: phonepe.tieup@nic.co.in

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GSTIN No: 27AAACN9967E1Z3

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RECEIPT

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Customer Details Collection Details

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Name : DEEPESH KAFLAY Agent Code : 91067500000001
Mobile No : 9832051303 Collection Number : 26020181225000430530

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Email : kaflayd@hotmail.com Collection Date : 19/02/2023

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Bank Account : 9100

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Received with thanks from Sri/Smt DEEPESH KAFLAY
a sum of 2471 (RUPEES ) by ONLINE

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towards 1 Year Liability Only Policy as per details given hereunder

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Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount

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No. Year Number (General Ledger) Received

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1 26020131226730430561 11 CASH PREMIUM A/C 5083 2094.00 0.00 2094.00

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2 26020131226730430561 11 IGST_KA_Int_Liab 7345 377.00 0.00 377.00

56
30 TOTAL : 2471.00 0.00 2471.00
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Particulars : ONLINE
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For National Insurance Company Ltd.,

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1.Please quote collection no. and date in all correspondeces

01

2.The stamp has been defaced and retained at the office against the issued
02

policy.
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Authorised Signatory
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NIC/PHONEPE/91067500000001 19/02/2023 08:56 A.M.

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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 Issuing Office Name & Address
MUMBAI DIRECT AGENTS BRANCH II ,FIRST FLOOR, STERLING CINEMA
BUILDING, 65, MURZABAN STREET, FORT, MUMBAI, PIN : 400001
Telephone No: 18003450330 Email ID: phonepe.tieup@nic.co.in
GSTIN No: 27AAACN9967E1Z3

National Insurance Company Ltd.

Registered & Head Office: 3, MIDDLETON STREET, POST BOX NO. 9229, KOLKATA - 700 071
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Policy No: 26020131226730430561 1 Year Liability Only from 00:00 Hrs of 20/02/2023 to Midnight of 19/02/2024 IXI
Insured Details
Name : DEEPESH KAFLAY

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Mobile No : 9832051303 Email : kaflayd@hotmail.com

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PAN No. : GSTIN No. :

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Channel : PHONEPE INSURANCE BROKING SERVICES PRIVATE LIMITED Tele. No: 080-68727888 Email : support@phonepe.com

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Aadhar : PAN : xxxxxx058K Code. : 260201 / 91067500000001

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Vehicle Details

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Make & Model Private Car MARUTI SUZUKI OMNI E 8 STR

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Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District

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WB-60-F-2267 31966 59256 MPV 796 2011 1+7 NORTH DINAJPUR

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Geographical Area : INDIA.

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Registration Date : 12/01/2011

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Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV

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- - - - - -

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OD Premium Breakup in Rs. TP Premium Breakup in Rs.

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Basic OD Premium Basic TP Premium 2,094.00

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(+) Electrical Access. Premium - (+) WC for Driver -

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(+) Bi-fuel kit Loading - (+) Wider Legal Liability to employees :00 -
(+) Geographical Area Extension - (+) Geographical Area Extension -
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(-) Vol. Excess Discount - (+) PA to owner driver -

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(-) Auto. Assoc Discount - (+) PA to unnamed PAX -

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(-) Anti-theft Discount - (-) Discount For Limited TPPD -

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(-) Other Discount - (+) Bi-fuel kit Loading -

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(-) NCB Discount TP Total (Rounded Off) 2,094.00

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(+) Nil Depreciation - OD Total (Rounded Off)

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(+) Nil Depreciation Plus - TOTAL PREMIUM 2,094.00

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(+) NCB Protect - GST 377.00

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(+) Engine Protect - NET PAYABLE 2,471.00

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(+) Invoice Protect - Collection Number :26020181225000430530 dated 19-Feb-2023

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(+) Consumables Protect - Subject to IMT Endorsement No. 16,22A,29

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(+) Lock-Key Protect

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OD Total (Rounded Off)

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Excess : Compulsory: Rs. 0 Imposed: Rs. 0 Voluntary: Rs. 0

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Limitation 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
67

Trade
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Drivers Clause : 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
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Motor Vehicles Rules, 1989.

01

Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
Under section 1(ii) Damage to third party property is Upto Rs. 7,50,000 .
02

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 the reason of wider terms
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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" 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
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claim on the previous policy. Benefits under the policy stands forfeited if claim is/was made in previous policy. For legal interpretation, the English version will hold good.
FINANCIER NAME :
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Prev Policy : HDFC Ergo General Insurance Company Ltd (Pol No: 2319101161709400000 Expiry Date: 29/01/2023)
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Nominee Name : Relation : Age :

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Disclaimer Note : It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'.
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In the event of misrepresentation, fraud or non-disclosure of material fact, the Company reserves the right to cancel the Policy. The policy is issued based on the information provided by you, which is available
with the company. In case of discrepancy/non recording of relevant information in the policy, the insured is requested to bring the same to the notice of the company within 15 days. This Policy is to be read in
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conjunction with the Policy wordings available on the website https://nationalinsurance.nic.co.in of the Company. On renewal, the benefits provided under the policy and/or terms and conditions of the policy
including premium rate may be subject to change.
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I/We hereby certify that this Certificate cum Schedule of Insurance is issued in accordance with the provisions of chapter X and chapter XI of Motor Vehicles Act,1988.
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Authorised Signatory
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For & On behalf of

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National Insurance Company Limited

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NIC/PHONEPE/91067500000001 19/02/2023 08:56 A.M.

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email: customer.support@nic.co.in