THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Commercial Vehicle Package Policy
UIN Number - IRDAN190RP0044V01100001
Insured's Details Policy Details
Insured's Name: BRIJLAL . Policy number: 45040031200100003917
Customer ID: PO80360877 (PAN No :NA) Period of cover: 14/06/2020 12:00:01 AM to 13/06/2021
11:59:59 PM
Insureds Address: S/O HARI LAL R/O KHUSAHUPUR BUX Registration no. UP-62-BT-4245
SADAR JAUNPUR ,,,
JAUNPUR ,UTTAR PRADESH, 222002
Prev. Policy no. 45040031190300002728 Make/Model: MAHINDRA &/BOLERO PIK-UP - EXTRA
STRONG
Email: Receipt no. 10000089200600232641 - 13/06/20
Phone Number : / / 7388002318 Fax Number : NA / NA
Stamp Duty Number 0
GSTIN/UIN NA / NA
Issuing office New India Contact
Address SATNA D.O. (450400), Agent / Corp. Agent /
SATNA DIVISIONAL OFFICE , NEAR PARIJAT HOTEL, REWA Broker / Banc Star Insurance Brokers Ltd -
ROAD, , SATNA , Assurance / Referral
MADHYA PRADESH , 485001. Code - Name / (BR00000243)
POS/IMF/SPECIFIED
PERSON
Phone no / /
Phone no 07672401609 / 07672401608 Fax no. /
Fax no. 07672401610 / NA Email /
Email nia.450400@newindia.co.in Development officer NA
level Name/Code
Claim Contact SATNA D.O. (450400) Claim Contact Detail SATNA DIVISIONAL OFFICE,NEAR PARIJAT HOTEL,
REWA ROAD,,SATNA;07672401609/07672401608/
GSTIN 23AAACN4165C1ZZ
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/C Year of manufacture: 2019
Type of Commercial Vehicles: A - Goods Carrying Sub Type: Other than 3 wheeler - Public Carrier
Name of the Financier: MAHINDRA & MAHINDRA FINANCIAL Chassis no./Engine no.: K1D41846/TBK1D50137
SERVICES LTD
Type of fuel: Diesel Cubic capacity ( cc): 2523
Type of body: Open Gross Vehicle Weight (GVW): 2990
Seating capacity including Driver: 3 Variant: BOL PIK UP FB 1.3T - BS4 - PS
Automobile Association none Colour: WHITE
membership:
Cover Note No/Cover Note Issue / Name of registration authority: Jaunpur
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
576396 0 0 0 0 576396
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Inclusion of IMT 23 Compulsory PA cover for Owner Driver
(Sum Insured `15,00,000)LL to paid driver
conductor cleaner employed for oprn
NCB(20%)
OD Premium in ` 3204 TP Premium in ` 16121
Net Premium in `: 19325
GST in `: 2534
Total Payable in `: 21859
Total Payable in `(in words): RUPEES TWENTY-
ONE THOUSAND
EIGHT HUNDRED
FIFTY-NINE ONLY
Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 45040031200100003917Document generated by MS_STARA10 at 13/06/2020 13:34:19 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2020.06.13
For 13:34:20
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
IST
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 Limit of the amount the Company's Liability Under Section II 1(i) in
Motor Vehicles Act, 1988 or such a carriage falling under Sub-section 3 respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
of Section 66 of the Motor Vehicles Act, 1988.The Policy does not of the amount of the Company's Liability Under Section II 1(ii) in
cover use FOR a)Organised racing b) Pace Making c)Reliability Trials d) respect of any one claim or series of claims arising out of one event:
Speed Testing Up to ` 7,50,000
For individual covers (OD) in `: 576396
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 500
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(`) Nominee Relationship
NA NA NA NA
Premium and GST Details
Rate of Tax Amount in INR
Premium `3579
SGST 0 0
CGST 0 0
IGST 18 644
Premium `15746
SGST 0 0
CGST 0 0
IGST 12 1890
In witness where of this policy has been signed at SATNA D.O. on this 13/06/2020
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 21,23,25,40.
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: AAACN4165CST181.
Date of Issue: 13/06/2020
Policy No. : 45040031200100003917Document generated by MS_STARA10 at 13/06/2020 13:34:19 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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 2 of 3
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
(MR. M. S. RATHORE)
[DIVISIONAL MANAGER]
Duly Constituted Attorney(s)
STAR AUTOMOBILES
BUILDING MUKTIYARGANJ,SATNA,07672406700,SATNA,MADHYA
PRADESH,INDIA
Tax Invoice No : 45040020P0004855
IRDA Registration Number: 190
Policy No. : 45040031200100003917Document generated by MS_STARA10 at 13/06/2020 13:34:19 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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
