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Servicing Office Address

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Kolkata Division XV,National Insurance Building1st floor, 8 India Exchange

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Place, Pin : 700001

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GSTIN No: 19AAACN9967E1Z0

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RECEIPT

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Customer Details Collection Details

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Name : AMIT DALUI Agent Code : 9000127027

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Address : RANJOYBAR HOWRAH , WEST BENGAL , Collection Number : 15010081230000012674

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HOWRAH Collection Date : 25/02/2024

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Pin Code : 711401 Bank Account : 9172

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Received with thanks from Sri/Smt AMIT DALUI

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a sum of 5286 (RUPEES FIVE THOUSAND TWO HUNDRED EIGHTY SIX ONLY) by CD
towards Long Term(1yr OD+5yr TP) 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

29
09
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1 15010031236260009294 11 C.D CONTROL A/C 5076 0.00 5286.00 -5286.00

26
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2 15010031236260009294 11 CASH PREMIUM A/C 5083 4480.00 0.00 4480.00
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3 15010031236260009294 11 CGST_WB_Int_Liab 7031 403.00 0.00 403.00

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10

4 15010031236260009294 11 SGST_WB_Int_Liab 7032 403.00 0.00 403.00

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TOTAL : 5286.00 5286.00 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
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policy.
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3.We hereby declare that though our aggregate turnover in any preceding
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/900012702701 02/03/2024 11:18 AM

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
-1-
 Issuing Office Name & Address
KOLKATA DIVISION XV ,NATIONAL INSURANCE BUILDING1ST FLOOR, 8 INDIA
EXCHANGE PLACE, PIN : 700001
Tel: Fax:
GSTIN No: 19AAACN9967E1Z0
RSA Service Provider: M/s ki MOBILITY SOLUTIONS PRIVATE LIMITED
RSA Service Provider Toll Free Number :- 1800 570 1906
For feedback to RSA:- Email: rsa.service@tvs.in
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:15010031236260009294 2W Long Term(1yr OD+5yr TP) from 12:48 Hrs of 25/02/2024 to Midnight of 24/02/2029 IXI
OD Cover Start Date:25/02/2024 OD Cover End Date:24/02/2025
TP Cover Start Date:25/02/2024 TP Cover End Date:24/02/2029
Insured Details
Name : AMIT DALUI
Address : RANJOYBAR HOWRAH , WEST BENGAL , HOWRAH
Pincode : 711401 Telephone : 7865961526 Email : bose_2016@rediffmail.com
PAN No. : GSTIN No. : Aadhar No. :

29
Channel : AMITAVA ADHIKARI Mobile : 9830186414 Email : amitavaadhikari@yahoo.co.in

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Aadhar : PAN : xxxxxx011J Code. : 150100 / 9000127027

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Vehicle Details

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Make & Model Two Wheeler TVS RAIDER TVS RAIDER DISC 125CC

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

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NEW AF9LP1604063 MD625AF9XP1L03824 125 2024 1+1 HOWRAH

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Geographical Area : INDIA.

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FastTag ID : .

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

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Rs.95,400 - - - - Rs.95,400

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OD Premium Breakup in Rs.

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Year Basic Prem. Geo. Area Vol. Exc.(-) Auto. Anti-theft(-) Other(-) Nil Dep. Nil Dep. Plus NCB Prot. Eng. Prot. Invoice Prot. Driving Total(Rounded

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Ext. Assoc(-) Lics. Off)
1 1,598.90 -959.00 229.00 so 879.00
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RSA Protect: 10.00 EMI Protect: Towing Charge: Motor Daily Allowance:
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TP Premium Breakup in Rs.

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Year Basic Prem. Geo. Area Extension PA to owner driver PA to unnamed PAX Discount For Limited TPPD Total(Rounded Off)
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1 770.00 -50.00 720.00

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2 770.00 -50.00 720.00

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3 770.00 -50.00 720.00

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4 770.00 -50.00 720.00

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5 771.00 -50.00 721.00

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OD Total (Rounded Off) 879.00

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TP Total (Rounded Off) 3,601.00

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TOTAL PREMIUM 4,480.00

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GST 806.00
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NET PAYABLE 5,286.00

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Collection Number :15010081230000012674 dated 25-Feb-2024 Subject to IMT Endorsement No. 20,24,25
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Excess : Compulsory: Rs.100 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
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
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
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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 : IRDAN058RP0005V01201819
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Financier : SELF OWNED

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Nominee Name : ARUP DALUI Relation : FATHER Age : 50 Years

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Excess for Nil Depreciation Clause : 5% of claim amount subject to a minimum of Rs.250 and maximum of Rs.1000.
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In consideration of payment of additional premium as indicated in the Schedule it is hereby agreed and understood that indemnification in respect of Partial loss claims shall be done without application of
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Depreciation as mentioned in Section 1. of the policy.

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

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Authorised Signatory
For & On behalf of
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National Insurance Company Limited

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NIC/UBPORTAL/900012702701 02/03/2024 11:18 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