THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

[B]
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Commercial Vehicle Package Policy

UIN Number - IRDAN190RP0044V01100001

Policy Number :71230131210100003290

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
DIRECT AGENTS BRANCH 712301 (712301), NAME: CHENNAI (710001)
RANI SEETHAI HALL , 3RD FLOOR ,603 ANNA F A Premium Insurance Broking Pvt Ltd. - Macmillan House,2nd Floor, "B" Block 21,Patullos
SALAI, , , (BR00000338), Road,Chennai 600002,,;04423456729//
TAMIL NADU , 600006. PHONE NUMBER: / / 8939933533 PHONE NUMBER: 04423456729 /
PHONE NUMBER:23456809 / 23456810 LAND/FAX NUMBER:/ MOBILE NUMBER:
FAX NUMBER:42698154 / NA EMAIL:[email protected] / Email: [email protected]
Email:[email protected]

INSURED DETAILS
Insured's Name RADHESHYAM JOKHAI SAHANI Customer ID PO91337571 (PAN No :NA)
Insured's Address PLOT NO 56/57 SHOP NO GROUND FLOOR SANJAY Contact Number / / 9042529631
APARTMENT SEC-9 AIROLI
NAVI MUMBAI,,,
AIROLI ,MAHARASHTRA, 400708
Email [email protected]
om
GSTIN NA

POLICY DETAILS
Period of cover 02/09/2021 07:50:16 PM to 01/09/2022 11:59:59 PM Receipt Number 10000089210900029398 -
02/09/21
Previous Insurer CHOLAMANDALAM MS GENERAL INSURANCE CO. LTD. Previous Policy Number 33790274693800000
VEHICLE DETAILS
Geographical Area / Zone: India/B Year of manufacture: 2010
Type of Commercial A - Goods Carrying Sub Type: Other than 3 wheeler -
Vehicles: Public Carrier
Name of the Financier: Chassis no./Engine no.: MC233HRC0AC040357/E48
3CDAC229200
Type of fuel: Diesel Cubic capacity ( cc): 0
Type of body: Open Gross Vehicle Weight 11950
(GVW):
Make/Model: EICHER/11.10 HD (FSD/4 Registration no. MH-43-U-6799
Seating capacity including 3 Variant: 11.10 HD (FSD/43
Driver:
Automobile Association none Colour: AS PER RC
membership:
Cover Note No/Cover / Name of registration Navi Mumbai
Note Issue Date: authority:

INSURED DECLARED VALUE (Rs)

Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
400000 0 0 0 0 400000

SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 2196 Basic TP Premium 26935
(+)Loading for Inclusion of IMT 23 329.4 (+)Compulsory PA Premium for Owner Driver(Sum 275
Insured Rs 1500000)
(+)LL to paid driver conductor cleaner employed for 100
oprn
Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 71230131210100003290Document generated by QR_RENEWAL at 2021/09/02 19:50:18.
Vaideswaran
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2021.09.02
19:50:19 IST 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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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Calculated OD Premium 2526 Calculated TP Premium 27310

Total OD Premium (Rs) 2526 Total TP Premium (Rs) 27310
Net Premium (Rs) 29836
GST (Rs) 3754
Total Payable (Rs) 33590
Total Payable in Rs(in words): RUPEES THIRTY-THREE THOUSAND FIVE HUNDRED NINETY ONLY
GSTIN(Issuing Office) 33AAACN4165C4ZV
SAC 997134 (Motor vehicle insurance services)
Limitation as to use:The Policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage falling
under Sub-section 3 of Section 66 of the Motor Vehicles Act, 1988.The Policy does not cover use FOR a)Organised racing b) Pace Making c)
Reliability Trials d) Speed Testing
Limits of Liability:Limit of the amount the Company's Liability Under Section II 1(i) in respect of any one accident: as per the Motor Vehicles
Act, 1988. Limit of the amount of the Company's Liability Under Section II 1(ii) in respect of any one claim or series of claims arising out of one
event: Up to Rs. 7,50,000
For individual covers (OD) in RS:400000 Compulsory excess in Rs:1000
Imposed excess in Rs:0 Voluntary excess in Rs:0
Persons or classes of persons entitled to drive: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 vehicle and that such a person satisfies the requirement of Rule 3 of the Central Motor Vehicles
Rules, 1989.
PA cover for Owner Driver
Name of Nominee Age of Nominee Relationship with the Name of the Appointee (if Relationship to the
Insured Nominee is a minor) Nominee
NA NA NA NA NA
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
NA NA NA NA
Premium and GST Details
Rate of Tax Amount in INR

Premium Rs2901
SGST 0 0
CGST 0 0
IGST 18 522
Premium Rs26935
SGST 0 0
CGST 0 0
IGST 12 3232

In witness where of this policy has been signed at DIRECT AGENTS BRANCH 712301 on this 02/09/2021
WARRANTED THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED ABINITIO
This policy is subject to the Terms, conditions and exceptions applicable to Package/Liability policy attached/available on the web site
http://newindia.co.in; IMT Endorsement Number(s) printed herewith attached 21,23,40.
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 reason of wider terms appearing in the certificate in order to comply with the Motor Vehicles Act, 1988 is recoverable from the
insured: see clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY". It is clarified that in case the declaration regarding
the ncb or other previous policy details made by the insured, is found to be incorrect, all the benefits (including claim) under section-1 of this
policy, will stand forfeited.
Anti Money Laundering Clause: In the event of a claim under the policy exceeding Rs 1lakh or a claim for refund of premium exceeding Rs 1
lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as
well as Company website.

Policy No. : 71230131210100003290Document generated by QR_RENEWAL at 2021/09/02 19:50:18.

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

I/We hereby certify that the policy to which this Certificate For and on behalf of The New India Assurance Company Limited
relates as well as this Certificate of Insurance are issued in
accordance with the provisions of Chapter X and XI of M.V. Act,
1988.
Date of Issue: 02/09/2021

(Mr. C.K. Sumesh Babu)

[Branch Manager]

Duly Constituted Attorney(s)

Tax Invoice No : 71230121P0006648

IRDA Registration Number: 190

Policy No. : 71230131210100003290Document generated by QR_RENEWAL at 2021/09/02 19:50:18.

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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