THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

[B]
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Standalone Motor Own Damage Policy for Private car

UIN Number - IRDAN190RP0001V01201920

Policy Number :31030031231900032653

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
DO3,CONNAUGHT PLACE, NEW DELHI NAME: Policybazaar Insurance Broker Pvt Ltd - WEB AGGREGATOR NON SUIT CLAIMS HUB (319004)
(310300), (BR00000972) ADDRESS: 13/46, 2nd Floor, SCINDIA HOUSE, K G
13/46, IIND FLOOR, SCINDIA HOUSE , MARG, CONNAUGHT PLACE, NEW DELHI , , , DELHI ,
KASTURBA GANDHI MARG , , PHONE NUMBER:18002585970 / / 110001.
DELHI , 110001. LAND/FAX NUMBER:/ PHONE NUMBER: 1234567890 /
PHONE NUMBER:23723521 EMAIL:[email protected] / MOBILE NUMBER:
FAX NUMBER:NA / NA Email: [email protected]
Email:[email protected]

INSURED DETAILS
Insured Name Sumit kumar Customer ID POA4771502 (PAN No
:BBGPD4713B)
Insured Address Tower- K FLAT NO - 1604, GOLDAN PALM SEC - Contact Number / / XXXXXX4944
168,,NOIDA, GAUTAM BUDDHA NAGAR , UTTAR
PRADESH,,
NOIDA ,UTTAR PRADESH, 201301
Email sidharthdhimanlbs@gmail.
com
GSTIN NA
CHANNEL PARTNER CONTACT DETAILS
Channel Partner Name Email Address(s) Contact Number(s)
Policy Bazaar [email protected] 1800-258-5970

POLICY DETAILS
Period of cover 26/04/2023 06:05:34 PM to 25/04/2024 11:59:59 PM Receipt Number 31030081230000044264 -
26/04/23
Previous Insurer IFFCO TOKIO GENERAL INSURANCE CO. LTD. Previous Policy Number 12345
Related Bundled/Liability 12345 Bundled/Liability Policy 12/12/2021 to 11/12/2024
Policy No.: period:
Bundled/Liability Insurer: IFFCO TOKIO GENERAL INSURANCE CO. LTD.
VEHICLE DETAILS
Registration Number UP-16-DB-1312 Chassis no./Engine Number MAT627129MLN88302/RE
VTRN11NYXKB4458
Make / Model TATA/NEXON Variant: XZ +
Year of manufacture 2021 Type of body / Type of Fuel Saloon/Petrol
Colour as per RC book Cubic capacity(cc) 1198cc
/Wattage(kW):
Seating capacity including 5 Name of registration Gautambuddh Nagar
Driver authority
Geographical Area / Zone India Name of the Financier
Cover Note No/Cover Note / Automobile Association none
Issue Date: membership
FASTag ID:
INSURED DECLARED VALUE (IN Rs)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
627840 0 0 0 0 627840
SCHEDULE OF PREMIUM
Own Damage
Signature Not
Verified
Digitally signed
by JAGATJAYEE Policy No. : 31030031231900032653Document generated by USRPB at 2023/04/26 18:05:45.
PANIGRAHI
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2023.04.26
18:05:46 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)

Basic OD Premium 2404

Calculated OD Premium 2404
Total OD Premium in Rs 2404
Net Premium in Rs 2,404
GST in Rs 433
Total Payable in Rs 2,837
Total Payable in Rs(in words): RUPEES TWO THOUSAND EIGHT HUNDRED THIRTY-SEVEN ONLY
GSTIN(Issuing Office) 07AAACN4165C1ZT
SAC 997134 (Motor vehicle insurance services)
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 f) Reliability Trials g)Any purpose in connection with Motor
Trade
Limits of Liability:Coverage is only for Own Damage of the vehicle and does not cover third party property damage/personal injury/TP death
and any other Legal Liability.
For individual covers (OD) in RS:627840 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.
Premium and GST Details
Rate of Tax Amount in INR
Premium Rs 2,404
SGST 0 0
CGST 0 0
IGST 18 433

In witness where of this policy has been signed at DO3,CONNAUGHT PLACE, NEW DELHI on this 26/04/2023
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 ODWTOTADON/ODWTHADDON policy attached/available on the
web site http://newindia.co.in; IMT Endorsement Number(s) printed herewith attached .
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.
I/We hereby certify that the policy to which this Certificate relates For and on behalf of The New India Assurance Company Limited
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: 26/04/2023

(MR. DAYANAND SINGH)

[SRDivisional Manager]

Duly Constituted Attorney(s)

Policy No. : 31030031231900032653Document generated by USRPB at 2023/04/26 18:05:45.

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)

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 31030023P0028995

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 31030031231900032653Document generated by USRPB at 2023/04/26 18:05:45.

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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