THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

MIP4-Horse/Pony/Mule/Donkey Sukshma Bima INSURANCE

(UIN: NIA-OT-P13-90-V01-12-13)

Insured Name : UTTARAKHAND GRAMIN BANK MUNSIYARI, A/C RAMESH SINGH TOLIYA,
Insured's Details Issuing Office Details
Customer ID : PO88990367 Office Code : ALMORA BRANCH (340302)
Address : S/O MR. KALYAN SINGH Address : ALMORA BRANCH
VILLAGE DHAPA
P.O. TALLA DUMMAR MUNSIYARI ,246473
PITHORAGARH ,UTTARAKHAND,
262554
Phone No : Phone No : 05962230381
E-mail/Fax : / E-mail/Fax : nia.340302@newindia.co.in /
PAN No : S.Tax Regn. No : AAACN4165CST178
GSTIN/UIN : NA / NA GSTIN : 05AAACN4165C4ZU
: SAC : 997139 (Other non-life insurance
services excl RI)

Policy Details
Policy Number : 34030247214600000005 Business Source Code
Period of Insurance : From:29/04/2021 11:29:24 AM To: Dev.Off level./Broker/Corp. : K.K. TIWARI - (DE9771266)
28/04/2024 11:59:59 PM Agent/Web
Aggregator/CPSC User
Date of Proposal : 29-Apr-21 Agent/Bancassurance/Spe :
cified Person
Prev. Policy no. : Phone No : NA / NA
Client Type : Non-Corporate E-mail/Fax : / /
Financier(s) Details
Sl. No. Name of the Financiers
1 UTTARAKHAND GRAMIN BANK MUNSIYARI

Premium GST Total(RS) Total Rupees (In Words) Receipt No. & Date
9285 0 9285 RUPEES NINE THOUSAND TWO 34030281210000000296 - 29/04/21
HUNDRED EIGHTY-FIVE ONLY
POLICY SCHEDULE
Type of Policy : Scheme
Name of the Organisation : Other Subsidized Scheme
Details of the Horse/Pony/Mule/Donkey
Sr. No. Origin Type of Purpose of Identification/ Breed Sex Colour Age in Sum Excess Name of
Risk (HD) Use Tag No. Years & Insured (%) Owner/Benefi
Months ciary
1 Cross Mule DROUGHT 102267 / 0 NA Female UPGRD 4 Years 50000 0 AS ABOVE
Breed 22271 BR 0
OWN Months
2 Cross Mule DRAUGHT 102267 / 0 NA Female UPGRD 4 Years 50000 0 AS ABOVE
Breed 22260 LI 0
GHT Months
BROW
N
3 Cross Mule DROUGHT 102267 / NA Female UPGRD 5 Years 50000 0 AS ABOVE
Breed 022282 BR 0
OWN Months

SI.No Permanent Total Disability(PTD)

1 NO
2 NO
3 NO

SI.No. Name of the Veterinary Doctor Registration No. & Address

1 Mr. BABLI DEVI - - (VE00000005) VILL & POST NAHARI P.S KUNDALI DISTT.SONIPAT (HR), GURGAON,
HARYANA, 122001, PH: , Email: , Fax:

Signature Not
Verified
Policy No. : 34030247214600000005Document generated by 26624 at 29/04/2021 11:38:32 Hours.
Digitally signed
by Srinivasan Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Vaideswaran Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
Date: 2021.04.29
For redressal
11:38:33 IST of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own
grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website
http://newindia.co.in.

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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Specific Conditions: NA
1) Death due to Diseases contracted prior to and within 15 days of commencement of risk is not payable.
2) Tag should be surrendered at the time of claim, otherwise it will be treated as no claim. In the event of death of Horse/Pony/Mule/Donkey
covered under the policy, claim/s shall not be entertained unless the ear tag/s are surrendered to the Company.In the event of loss of ear tag/s,
it is the responsibility of the insured to give immediate notice to the Company and get the Horse/Pony/Mule/Donkey retagged.
Subject to MIP4-HorsDonkPoN Sukshma Bima Insurance Clause as attached hereto.

NOTE: WARRANTED THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY
CANCELLED 'AB-INITIO'.
Premium and GST Details
Rate of Tax Amount in INR
Premium `9285
SGST 0 0
CGST 0 0
IGST 0 0

In witness whereof the undersigned being duly authorised by the Insurers and on behalf of the Insurers has (have) hereunder
set his (their) hand(s) on this 29th day of April,2021.

For and on behalf of

The New India Assurance Company
Limited

Duly Constituted Attorney(s)

Mudrank_____________Dt.___________consolidated Stamp Fees Paid by Pay Order Number_______________vide receipt
number___________dt.__________.

Stamp Duty under the Policy is `1/-.

Tax Invoice No : 34030221P0000311

IRDA Registration Number: 190

Policy No. : 34030247214600000005Document generated by 26624 at 29/04/2021 11:38:32 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own
grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website
http://newindia.co.in.

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