____

Mifd4i 3T^T
PolicyPolicy Schedule
Number: - Motor - Private Car- Package Only
200502312110002710
jnfFFRi Issuing Office ^Office Code: 200502 Business Source: 200502
office Address: KARIMGANJ BRANCH Second
Floor. Mayabastralaya Building, Station Road. _____ Sales Channel Coae:
Karimganj. Assam,-788710.
9000169407
State Code: 18 , Assam
Name: Mr Shushobhon Chuudhury
^r^^r^GSTIN: 18AAACN9967E1Z2 ^^/Contact
Number »TIWH ^/Mobile Number: 0 Customer
ContactCare Toll
Number: Free Number
9435076454

1800 345 0330 email:

customer.support@nic.co.in

^Customer Name. MR NUR HUSAIN LASKAR Customer ID: 9561910411 PAN: Phone:
^Address: S/D/W OF AINUL HAQUE LASKAR C/O. NEW
MOTOR CENTRE. NAGATILLA PO- LINK ROAD
PS- SILCHAR, JTWCity: SILCHAR - DISTRICT (rarar/District:
CACHAR ^/State: ASSAM,to PIN: 788006 ^r/Cell: 9686020754 E -Mail: na@gmail.com

Policy Effective from 00:00 hoars, on D2/62/2022 O a«o to miamght of 01/02/2023

Premium anta Cover Note Number and Date NA
?
__
A Ji< ； ^/CGST 5,614.00 ?
__ 505.00
_____ ? 505.00
?0.00 TOTB < HT^aProposal Number and Date 8800220201298576 Dt. 01/02/2022
GR? ^TWKerala Flood
Cess ^0.00
__ 0.00
Less:GST_TDS
’tp’j ’znr ^^Recoverable ?0.00 200502812110003999 Dt. 01/02/2022
A Receipt Number and Date «-if’*»
Stamp Duty Total Previous Policy Number and Expiry
? 6,624.00 NA
Amount Date
(F^/Rupees Six Thousand Six Hundred Twenty Four Only.)
___________ Vehicle Details
__ 320000.00 Regn. Number AS-11-P-5944
3{Tt.^t.4t/Vehicle IDV IDV NA 4 Engine or M/c No. ^iwChassis F8DN5975369
____Trailer) Number
NA MA3EUA61S00C19076
Accessories
Electrical NA ____ 3iW.Regn. Authority Cachar
Accessories
NA Geographical Area
Fiber Glass Tank sfen India
NA
Tfh^^fr^^zCNG'LPG Unit 3,200.00 «niMd Make MARUTI SUZUKI ALTO 800 (2012-
Model Variant 2019) 128006
sifit elf^Jl ^F^Addl. Towing NA
LXI (2012-2019)
Charges
__ 796 ^fl/Ciass of Vehicle Private Car
GVW / Kilo
Watt 5 _____ SALOON/White
_________ Body Type /
_______
Color
OTrfT
Licensed 2018 #T HTfe Date of 13/07/2018
Seating I Purchase
Hypothecation Carrying
MMFS LTD
Capacity
AH^IOwn
^4 Damage Schedule of Premium
_ Year of Mfg._____ (?) • Legal Liability
_ 2,422.00
_ ano^T/Legal Liability Cover
_ NA
350.00
_
No o- Workmen for Opt and Maint.(Upto 6+1 Driver)1-per NA
O 2.842.00
w ’^j^T/Personal Accident
n 5,614.00
D ^/Total
a
m
a
g
e __
Cover(inclusi No Claim Bonus% Vehicle Own Damage Insurance Details 0
ve of acd
ons Package Insurance Details
__wherever ______
opted for) __ 1988 fdi* 3<FP^; nf^T Such amount as is necessary to meet the
^nf^t I (i)^c^H Limit of requirement of the motor vehicles ACT 1986
Total
liability under section -l(i) 750000 (In respect ๙ any one claim or series of claims arising out o' one event/occurrence.)
3^^ I (ii) uncer section
Clauses, Endorsements and Warranties Applicable: IMT 28

sTHTm4Wnr/Limitations 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)Organizea racing. d)Pace
making, e)Speed testing, f)Reliability Trials. g)Use in connection with Motor Trade.

JST ^i/Persons or Class of Persons entitled to drive:Any person inducing the insureo. Provicec 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. Proviced alsc t the perso olding an
effective Learner's license may also crive the vehicle and that SLCh a person satisfies the requirements of Rule 3 of the Central Mo|6r Vehib^

on 01/02/2022 by ID : 76379, AID

^NALlHSURANCECO.im
 Motor - Private Car- Package Only «w Policy
Number: 200502312110002710 Issuing Office
^Office Code: 200502 JFrafjra JST Office fTR Business Source: 200502
Address: KARIMGANJ BRANCH Second Floor. Sa/es Channel Codu: 9000169407
Mayabastralaya Building,Station Road,
Name: Mr Shushobhon Choudhury
Karimganj, Assam, • 788710.
^/State Code: 18, Assam ^^iV.-vGSTIN: ___ 7TW Contact Number: 9435076454
18AAACN9967E1Z2 dw/Confacf Number /Mobile
Number: 0 Customer Care Toll Free Number:
1800 345 0330 email:
customer.support@nic.co.in

portant Notice: The insured is not indemnified if the vehide is used or driven otherwise than in accordance with this schedule. Any payment made by the company
by the reason of wider terms 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”

3Ttflftdlertt «st THeft 02 February 2022 $1 httDS:"nationalinsurance:nic.co.in n

SF4 ^1, >5i^i «HH ^4ii i «IK^I ^1141 3nr*i HT^3 ^d: HHT I

IN WITNESS WHEREOF, the undersigned being duly authorized hereunto set his/ her hand at the office address mentioned above, this 02 February 2022.This schedule, the
attached policy, the clauses, the endorsements and policy wordings as available in the website httDS:"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'
Ombudsman Details:

Shri Kiriti. B. Saha, Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor. Nr
Stamp For and on behalf of National Insurance
Panbazar over bridge. S.S. Road. Guwahati - 781001 (ASSAM). Tel.: 0361 • 26322041
Duty: Company Limited
2602205, Email: bimalokpal.guwahati@ecoi.co.in.
(? 0.50 )

Authorized Signatory

•^ingi TR-^i^-Branch^Ma

^NATIONAL INSURANCE CO. LTD.

/K3-^23! ：］ Sr3HCh

Printed on 01/02/2022 wiAsmby ID : 76379, ’TKTOHTAID 4.Page no: 2

 Motor • Private Car- Package Only ctfttî4r HW
Policy Number: 200502312110002710 Issuing
Office sroku -^Office Code: 200502 ’snri^ra ÎCT Business Source: 200502
w Office Address: KARIMGANJ BRANCH Sales Channel Coda: 9000169407
Second Floor, Mayabastralaya Building.Station
Name: Mr Shushobhon Choudhury
Road, Karimganj. Assam,-788710.
»tw Contact Number: 9435076454
nzw w/State Code: 18,Assam ^ttv^GSTIN:
18AAACN9967E1Z2 iM; ^PivContact Number
*îl“<ışrt HW /Mobile Number: 0 Customer Care Toll Free Number:
1800 345 0330 email:
customer.support@nic.co.in

wvT.tnCERTIFICA
TE OF
INSURANCE
Certificate No.: 989^^51 Form 51 of the IXI
Central Motor Vehicle
Rules, 1989
Wr «i Particulars of vehicle insured
5. -.Engine 200502312110002710
• Tt.Reg. ÎT^RType of Body îlt^C.C ’înft OTXT Seating Premium(
Year of capacity
Mark. No. & No.& Chassis No Variant Manufacture
Place of
MARUTI
Registration
SUZUKI, ALTO
F8DN5975369 796
AS-11-P- 800 & LXI 2018
MA3EUA61S00C1 SALOON 5 ? 5.614.00
5944/ Cachar (2012-2019).
9076

«T Name of Registration Authority

MR NUR HUSSAIN LASKAR, S/D/W OF AINUL HUSSAIN LASKAR
C/0- NEW MOTOR CENTRE. NAGATILLA
Name & Address of Insured P/O- LINK ROAD
P/S- SILCHAR, CACHAR • DISTRICT
CACHAR .ASSAM, 788006.
Geographical Area India
/Business or Profession
pH Effective date of commencement of Insurance for BUSINESS
the purpose of Act.
Date of expiry of the insurance ^f^ns^TOTrf^tt^EwFrom 00:00 O’ Clock on 02/02/2022. ^/Midnight on:

01/02/2023

DRIVER’S CLAUSE:PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE ’ft k «HU 'TO UNi41 _ H^IT 3^ cHJ; m URUI
^7^ fiRTT ftl ’ll PK >4^ ’Un
UHlJl rtişgrl HT Mrtl <TW <^ttl KjfxS 1989 l*lMH 3 i^TI /
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 vehide and that such a person satisfies the requirements of Rule 3 of the
Central Motor Vehicles Rules, 1989.

LIMITATIONS AS TO USE
3frr aw sft’ww w i MIT^ RTZT zzrairni 5? ’T^r MT winr m in wr VTTT W
f^prfraHT (^T UT 3TRHT) wcVn ssr ^i/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, ^Reliability Trials, g)Use in connection with Motor
Trade.

“Rin xfR? 1988 WTO X XI sn4ti3^HR Sint »ni l/We hereby certify that the
Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of
Chapter X and Chapter XI of M.V. Act. 1988.
wJUrd «raTHc w Full address of Issuing Office: KARIMGANJ BRANCH Second Floor,
For and on behalf of National Insurance Company Limited
Mayabastralaya Building,Station Road, Karimganj, Assam,-788710
Date of issue:0l/02/2022

VITW!Ka- fi'-.Branch

arfrar Printed on 01/02/2022 by ID : 76379. AID : ^B’t.Page no: 3