पॉलिसी अनुसूची/ Policy Schedule - National Bharat Sookshma Udyam Suraksha

Policy Number: 604200112310000008 व्यवसाय स्त्रोत / Business Source: 604200

विक्रय चैनल विवरण/
Sales Channel Details
कोड/ Code: 9000116765
जारीकर्ता कार्यालय/Issuing Office नाम/ Name: Mr Mulunkunte Padmanabaiah
कार्यालय कोड/ Office Code: 604200 Nagabhushana
कार्यालय पता/ Office Address: BENGALURU Contact Number: 9739675042
DIVISION VI Second Floor, 911, Dasappa
Complex, T Dasarahally,Tumkur Road, सह दलाल कोड / Co Broker Code:
Bengaluru, - 560057.
State Code: 29 , Karnataka
कस्टमर केयर टॉल फ्री नंबर/Customer
GSTIN: 29AAACN9967E1ZZ
Contact Number: 80 28391103
Mobile Number: 0 Care Toll Free Number:
1800 345 0330
ईमेल/
email:customer.support@nic.co.in

ग्राहक आईडी /Customer ID:

ग्राहक का नाम /Customer Name: MR SRINIVASA MURTHY K V पैन /PAN:
9567600550
पता/ Address: ADAKI MARANAHALLI, MAKALI POST, फोन /Phone:
DASANAPURA HOBLI, City: BENGALURU - RURAL - DISTRICT
O, District: BENGALURU - RURAL, State: KARNATAKA, PIN:
562123. ई-मेल /E-Mail:
Cell: 9741061455

पॉलिसी: 12/05/2023 के 18:00 से 11/05/2024 की मध्य रात्रि तक प्रभावी /Policy Effective from 18:00 hours, on 12/05/2023 to
midnight of 11/05/2024
कवर नोट संख्या और तिथि / Cover
प्रीमियम/ Premium ` 25,050.00 लागू नहीं/NA
Note Number and Date
CGST ` 2,255.00
SGST/UTGST ` 2,255.00
IGST ` 0.00 प्रस्ताव संख्या और तिथि/ Proposal 8800230515536794 Dt. 15/05/2023
कम:जीएसटी_टीडीएस /
Number and Date
` 0.00
Less:GST_TDS
पुनर्प्राप्ति योग्य स्टाम्प
रसीद संख्या और तिथि/ Receipt 604200812310000421,604200812310000422
ड्यूटी ` 0.00
Number and Date Dt. 12/05/2023,12/05/2023
/Recoverable Stamp Duty
पिछली पॉलिसी संख्या और समाप्ती
कुल /Total Amount ` 29,560.00 तिथि / लागू नहीं/NA
Previous Policy Number and
Expiry Date
(Rupees Twenty Nine Thousand Five Hundred Sixty Only.)

Occupancy Details: Transporters godowns and Godowns of clearing and

Occupancy Code: forwarding agents.
4005 (Materials stored in Godowns and Silos)

Total Location Sum Insured ` 2,00,00,000.00

LocationAddress:
1)SURVEY NO 5/1 AND 4/1, ADAKI MARANAHALLI, MAKALI POST, DASANAPURA HOBLI,,Bengaluru - Rural - District O,Bengaluru -
Rural,Karnataka,562123.
SL. No Coverage Coverage Description Sum Insured
Basic Cover(Excluding EQ and
ON BUILDING OCCUPIED AS GODOWN ` 2,00,00,000.00
STFI)
1
अधिक/Excess: Compulsory Excess: ` 5,000.00, RUPEES FIVE THOUSAND ONLY.
Additional Information: NA
STFI ON BUILDING OCCUPIED AS GODOWN ` 2,00,00,000.00
2 अधिक/Excess: Compulsory Excess: ` 5,000.00, RUPEES FIVE THOUSAND ONLY.
Additional Information: NA
Earthquake ON BUILDING OCCUPIED AS GODOWN ` 2,00,00,000.00
3 अधिक/Excess: Compulsory Excess: ` 5,000.00, RUPEES FIVE THOUSAND ONLY.
Additional Information: NA
Terrorism ON BUILDING OCCUPIED AS GODOWN ` 2,00,00,000.00
4 अधिक/Excess: 5% of the claim amount for each and every claim subject to Minimum of INR 100,000 and Maximum of INR
25,00,000

Printed on 15/05/2023 by ID: 74981, AID : 74362 Page no: 1

पॉलिसी अनुसूची/ Policy Schedule - National Bharat Sookshma Udyam Suraksha
Policy Number: 604200112310000008 व्यवसाय स्त्रोत / Business Source: 604200
विक्रय चैनल विवरण/
Sales Channel Details
कोड/ Code: 9000116765
जारीकर्ता कार्यालय/Issuing Office नाम/ Name: Mr Mulunkunte Padmanabaiah
कार्यालय कोड/ Office Code: 604200 Nagabhushana
कार्यालय पता/ Office Address: BENGALURU Contact Number: 9739675042
DIVISION VI Second Floor, 911, Dasappa
Complex, T Dasarahally,Tumkur Road, सह दलाल कोड / Co Broker Code:
Bengaluru, - 560057.
State Code: 29 , Karnataka
कस्टमर केयर टॉल फ्री नंबर/Customer
GSTIN: 29AAACN9967E1ZZ
Contact Number: 80 28391103
Mobile Number: 0 Care Toll Free Number:
1800 345 0330
ईमेल/
email:customer.support@nic.co.in
Additional Information: NA

Clauses As per Annexure I

FINANCIER DETAILS
Sr.No Type of Finance Name of Financier Address
1 Hypothecation AXIS BANK LALBAGH, BENGALURU

टिप्पणियां/ Remarks: COVERAGE FOR BUILDING ONLY

SUM INSURED: 2 CRORES
OCCUPIED AS TRANSPORTER'S GODOWN

BUILDING OCCUPANCY: STEW WEST WAREHOUSE & LOGISTICS

जिसकी गवाही में दिन/ माह /वर्ष को उपरोक्त उल्लेखित कार्यालय पते पर अधोहस्ताक्षरी को विधिवत अधिकृत किया जा रहा है उसके हाथ
निर्धारित किए जाएं। यह अनुसूची, संलग्न पॉलिसी, खण्ड, पृष्ठांकन और पॉलिसी शब्दों, जो कंपनी वेबसाईट https://nationalinsurance.nic.co.in
पर उपलब्ध है, को एक अनुबंध के रुप में एक साथ पढ़ा जाए तथा कोई भी शब्द या अभिव्यक्ति जिसके लिए यह विशिष्ट अर्थ पॉलिसी या अनुसूची
के किसी भी हिस्से में संलग्न किया गया हो, एक ही अर्थ वहन करेगा चाहे जहॉ भी उल्लेखित हो। यह आश्वासन दिया जाता है कि प्रीमियम चेक के
अस्वीकृति के मामले में, यह दस्तावेज स्वतः प्राथमिकता निरस्त हो जाएगी । /IN WITNESS WHEREOF, the undersigned being duly authorized
hereunto set his/ her hand at the office address mentioned above, this 15/May/2023.This schedule, the attached policy, the clauses, the
endorsements and policy wordings as available in the website https://nationalinsurance.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'

इंश्योरेन्सइंडियालिमिटेड Ombudsman Details: Office of the Insurance कृते नेशनल इन्श्योरेन्स कंपनी
Ombudsman,Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, स्टांप ड्यलिमिटे
ूटी ड/ For and on behalf of National Insurance
24th Main Road, JP Nagar,1st Phase, Bengaluru - 560 078. Stamp Company Limited
Tel.: 080 - 26652048 / 26652049 Duty:
Email: bima lokp al.benqaluru@cioins.co.in
.
(` 1.00 ) अधिकृत हस्तात्क्षरकर्ता/ Authorized
Signatory

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 TAX INVOICE

Invoice Serial No: 30675F3PE0000008 Invoice Date: 15/05/2023

Details of Supplier:
National Insurance Company Limited.,
BENGALURU DIVISION VI Second Floor, 911, Dasappa Complex, T Dasarahally,Tumkur Road, Bengaluru, - 560057
State : 29 , Karnataka
GSTIN No : 29AAACN9967E1ZZ

Details Of Receiver : MR SRINIVASA MURTHY K V

Address : ADAKI MARANAHALLI, MAKALI POST, DASANAPURA HOBLI
City : BENGALURU - RURAL - DISTRICT O,
District: BENGALURU - RURAL,
State: KARNATAKA,
PIN: 562123.

Place Of Supply State : Karnataka

State Code : 29
GSTIN No : NA

केरला बाढ़
सेवा का सीजीएसटी की राशि/ एसजीएसटी/यूटीजीएसटी/ उपकर/Kerala
आईजीएसटी/IGST
छूट/ टैक्स योग्य/
सैक कोड/ विवरण/ कुल/Total(
CGST SGST/UTGST
Flood Cess
Descripti Discou मूल्य/Taxable
SAC Code `)
on of nt Value(`)
Service राशि/ राशि राशि/ राशि/Amount(
दर/Rate Amount( दर/Rate Amount( दर/Rate Amount( `)
`) `) `)
Other non-
life
insurance 0
997139 services 25,050 0% 25,050 9% 2,255 9% 2,255 0% 0
(excluding
reinsuranc
e services)
TOTAL 25,050 25,050 2,255 2,255 0 0
कुल इनवॉयस मूल्य (अंकों में )Total Invoice Value (In figures) :
` 29,560
कुल इनवॉयस मूल्य (शब्दों में)Total Invoice Value (In words) : रूपए/Rupees
Twenty Nine Thousand Five Hundred Sixty
केवल/Only.
रिवर्स चार्ज के अधीन टैक्स की राशि/ Amount of Tax Subject to Reverse Charge : No

E.&.O.E कृते नेशनल इन्श्योरेन्स कंपनी लिमिटेड/ For

and on behalf of National Insurance Company Limited

अधिकृत हस्तात्क्षरकर्ता/ Authorized Signatory

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