THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Vehicle Libiality Policy

Insured's Details Policy Details

Insured's Name: GANGA PRASAD Policy number: 3229033118019876555
Customer ID: PO60606471 (PAN No :NA) Period of cover: 02/11/2018 12:00:01 AM to 01/11/2019
11:59:59 PM
Insureds Address: VILL. DHANOLI. PO Registration no. UP-80-AE-2221
DHANOLI,MALPURA,,
AGRA ,UTTAR PRADESH, 282006
Prev. Policy no. 46230131176300003380 Make/Model: MARUTI WAGONR
Email: Receipt no. 32290381180000001286 - 02/11/18
Phone Number : / / 00 Fax Number : NA / NA

GSTIN/UIN NA / NA
Issuing office New India Contact
Address AGRA (322903), Agent / Corp. Agent /
AGRA , , , Broker / Banc Mr. MAYANK TRIPATHI -
UTTAR PRADESH , 282005. Assurance / Referral
Code - Name / (NIAAJ65678888)
POS/IMF/SPECIFIED
PERSON
Phone no / 00
Phone no 00 Fax no. /
Fax no. NA / NA Email [email protected] /
Email [email protected] Development officer ASHIKO KUMAR - (1D87760)
level Name/Code
Claim Contact AGRA (322903) Claim Contact Detail AGRA,,;00//
GSTIN 09AAACN4165C4ZM
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/C Year of manufacture: 2003
Type of Commercial Vehicles: A - Goods Carrying Sub Type: Other than 3 wheeler - Public Carrier
Name of the Financier: Chassis no./Engine no.: 204132/102510
Type of fuel: Diesel Cubic capacity ( cc): 1061
Type of body: Open Gross Vehicle Weight (GVW): LXI
Seating capacity including Driver: 5 Variant: WAGONR LXI
Automobile Association none Colour: BROWN
membership:
Cover Note No/Cover Note Issue / Name of registration authority: Agra
Date:
Transit From NA Transit To NA Distance Covered NA
IDV(In `) Based on annexure-I
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
00 0 0 0 0 00
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover 2863
Compulsory PA cover for Owner Driver, LL to
paid driver conductor cleaner employed for oprn,
LL to Non-fare Paying Passengers (Not
Employees of the Insured and not Workmen
under WCA)
50
OD Premium in ` TP Premium in ` 2913
Net Premium in `: 2913
GST in `: 524
Total Payable in `: 3437
Total Payable in `(in words): RUPEES THIRTY-
FOUR HUNDRED
THIRTY SEVEN ONLY

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 32290331180100001086 Document generated by AG_YOGE171 at 02/11/2018 21:35:22 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 9875.
Date: 2018.06.08
For 2re1d
:3r5e:s2s
3aIlSo
Tf 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.

Page 1 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Limitations as to use Limits of Liability

The Policy covers use only under a permit within the meaning of the Motor Limit of the amount the Company's Liability Under Section II 1(i) in respect of any
Vehicles Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of one accident: as per the Motor Vehicles Act, 1988. Limit of the amount of the
the Motor Vehicles Act, 1988.The Policy does not cover use FOR a)Organised Company's Liability Under Section II 1(ii) in respect of any one claim or series of
racing b) Pace Making c)Reliability Trials d) Speed Testing claims arising out of one event: Up to ` 7,50,000

For individual covers (OD) in `: 00

Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 1000
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 Insured Name of the Appointee (if Relationship to the
Nominee is a minor) Nominee
Star singh 56 PARENTS NA NA
PA cover for named persons
Name CSI Opted(`) Nominee Relationship
NA NA NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium 2913.00
SGST 9 262
CGST 9 262
IGST 0 524

In witness where of this policy has been signed at Mumbai on this 08/06/2018
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 21,25,40.
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.

I/We hereby certify that the policy to which this Certificate relates as For and on behalf of The New India Assurance Company Limited.
well as this Certificate of Insurance are issued in accordance with
the provisions of Chapter X and XI of M.V. Act, 1988. NIA S.T.REGN
No: AAACN4165CST178.
Date of Issue: 02/11/2018

(Mr. BHAGWAN DAS GUPT)

[Sr Branch Manager]

Duly Constituted Attorney(s)

Tax Invoice No : 3229033101001086

Policy No. : 32290331180100001086 Document generated by AG_YOGE171 at 02/11/2018 21:35:22 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 87655.
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)

IRDA Registration Number: 190

Policy No. : 32290331180100001086 Document generated by AG_YOGE171 at 02/11/2018 21:35:22 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 766777.
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.

Page 3 of 3