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Servicing Office Address

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Aizawl Division,Aizawl Divisional Office, RZ Lalbuaia and Chawithangi Annexe

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Building, Zodin Square, Aizawl, Mizoram, 796001

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GSTIN No: 15AAACN9967E1Z8

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RECEIPT

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Customer Details Collection Details

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Name : Mr DANIEL LALRAMNGHETA Agent Code : 9800006954
Address : KEIFANG , MIZORAM , Collection Number : 20350081238000021289

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Pin Code : 796261 Collection Date : 15/02/2024

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Bank Account : 9173

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Received with thanks from Sri/Smt Mr DANIEL LALRAMNGHETA

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a sum of 1552 (RUPEES ONE THOUSAND FIVE HUNDRED FIFTY TWO ONLY) by CD
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
No. Year Number (General Ledger) Received

71
41
12
1 20350031236760012417 11 C.D CONTROL A/C 5076 0.00 1552.00 -1552.00

00
76
2 20350031236760012417 11 36 CASH PREMIUM A/C 5083 1316.00 0.00 1316.00

3 20350031236760012417 11 CGST_MZ_Int_Liab 7364 118.00 0.00 118.00

12
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4 20350031236760012417 11 SGST_MZ_Int_Liab 7365 118.00 0.00 118.00

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TOTAL : 1552.00 1552.00 0.00

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Particulars : CD
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For National Insurance Company Ltd.,

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

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2.The stamp has been defaced and retained at the office against the issued
policy.
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3.We hereby declare that though our aggregate turnover in any preceding
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financial year from 2017-18 onwards is more than the aggregate turnover
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notified under sub-rule (4) of rule 48, we are not required to prepare an invoice
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in terms of the provisions of the said sub-rule.

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Authorised Signatory
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NIC/UBPORTAL/9800006954 15/02/2024 08:53 AM

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
-1-
 Issuing Office Name & Address
AIZAWL DIVISION , AIZAWL DIVISIONAL OFFICE, RZ LALBUAIA AND CHAWITHANGI
ANNEXE BUILDING, ZODIN SQUARE, AIZAWL, MIZORAM, 796001
Tel: Fax:
GSTIN No: 15AAACN9967E1Z8

National Insurance Company Ltd.

Registered & Head Office: PREMISES NO.18-0374, PLOT NO. CBD-81, NEW TOWN, KOLKATA-700156
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989 as amended from time to time
Policy No: 20350031236760012417 2W 1 Year Liability Only from 08:53 Hrs of 15/02/2024 to Midnight of 14/02/2025 IXI
Insured Details
Name : Mr DANIEL LALRAMNGHETA
Address : KEIFANG , MIZORAM ,
Pincode : 796261 Telephone : 9862225099 Email : hssenglishmz@gmail.com

5
02
PAN No. : GSTIN No. : Aadhar No. :

2/2
Channel : ALEX LALDUHAWMA Mobile : 8794351125 Email : alex.khawlhring@gmail.com

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Aadhar : PAN : xxxxxx599A Code. : 203500 / 9800006954

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Vehicle Details

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Make & Model Two Wheeler Hero Karizma Zmr

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

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MZ-01-G-0695 MC38EBAGL01427 MBLMC38ECAGL01481 223 2011 1+1 AIZAWL

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Geographical Area : INDIA.

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FastTag ID : 0.

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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 1,366.00

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(+) Geographical Area Extension - (+) Geographical Area Extension Ho -
(-) Vol. Excess Discount - (+) WC for Driver -
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(-) Auto. Assoc Discount - (+) PA to owner driver -

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(-) Anti-theft Discount - (+) PA to unnamed PAX -

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(-) Other Discount - (-) Discount For Limited TPPD YES -50.00
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(-) NCB Discount TP Total (Rounded Off) 1,316.00

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

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(+) Nil Depreciation Plus - TOTAL PREMIUM 1,316.00

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(+) NCB Protect - GST 236.00

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(+) Engine Protect - NET PAYABLE 1,552.00

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(+) Invoice Protect - Collection Number :20350081238000021289 dated 15-Feb-2024

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OD Total (Rounded Off) Subject to IMT Endorsement No. 20,24,25

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

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Limitation as to use : The Policy covers use of the Vehicle for any purpose other than (a) Hire or Reward (b) Carriage of Goods(other than samples or personal luggage) (c) Organized racing (d) Pace
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making (e) Speed Testing and Reliability Trials (f) Use in connection with Motor Trade
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Drivers Clause : Any person including Insured Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from holding or obtaining such a
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licence. Provided also that the person holding an effective Learner's Licence may also drive the vehicle and such a person satisfies the requirements of Rule 3 of Central Motor
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Vehicles Rules, 1989 as amended from time to time.

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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. 6,000 .
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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 reasons of wider terms
appearing in the certificate in order to comply with the Motor Vehicles Act,1988 is recoverable from the insured .See the clause headed "AVOIDANCE OF CERTAIN TERMS AND
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RIGHT OF RECOVERY". For legal interpretation, English version will hold good.
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UIN : IRDAN058P0036V01100001
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Financier : SELF OWNED

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Prev Policy : National Insurance Company Limited (Pol No: 20350031226760004076 Expiry Date: 18/12/2023)
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Nominee Name : Relation : Age :

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NOTE : Warranted that in case of dishonour of the premium cheque, this document stands automatically cancelled 'AB-INITIO'.
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Policy stamp to be defaced at the respective policy servicing office.

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TP Rate Revision Notice: For all policies having an effective date on or after 1st April 2023, the TP premium is subject to revision as may be notified by the IRDAI.
The Insured should contact and submit the difference of premium to the policy issuing office on issuance of such notification by IRDAI.
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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Policy Details
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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/UBPORTAL/9800006954 15/02/2024 08:53 AM

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