Issuing Office Name & Address
AZAMGARH BRANCH , 434, THANDI SADAK, RAHUL NAGAR, AZAMGARH, UTTAR
PRADESH, PIN : 276001
Tel: 05462 - 247450 (G) , 221597 Fax:
GSTIN No: 09AAACN9967E1Z1
RSA Service Provider: M/s ki MOBILITY SOLUTIONS PRIVATE LIMITED
RSA Service Provider Toll Free Number :- 1800 570 1906
For feedback to RSA:- Email: rsa.service@tvs.in
National Insurance Company Ltd.
Registered & Head Office: 3, MIDDLETON STREET, POST BOX NO. 9229, KOLKATA - 700 071
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989
Policy No: 45210331236760002730 2W 1 Year Liability Only from 15:03 Hrs of 14/07/2023 to Midnight of 13/07/2024 IXI
Insured Details
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Name : Mr MITHILESH RAM
02
Address : SHIVALI NIZAMABADA AZAMGARH , UTTAR PRADESH , AZAMGARH
7/2
Pincode : 276001 Telephone : 7309100266 Email : mithilesh@gmail.com
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PAN No. : GSTIN No. : Aadhar No. : xxxx xxxx 9096
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Channel : RUBI SINGH Mobile : 9838680281 Email : santossinghrto@gmail.com
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Aadhar : PAN : xxxxxx611M Code. : 452103 / 9000156225
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Vehicle Details
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Make & Model Two Wheeler CD DELUXE KICK START DRUM BRAKE CAST WHE
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Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District
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UP-50-R-0357 HA11EA89E29284 MBLHA11EE89E12721 100 2008 1+1 AZAMGARH
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Geographical Area : INDIA.
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FastTag ID : .
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Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV
14
- - - - - -
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OD Premium Breakup in Rs. TP Premium Breakup in Rs.
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Basic OD Premium Basic TP Premium 714.00
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(+) Geographical Area Extension - (+) Geographical Area Extension :24 -
(-) Vol. Excess Discount - (+) WC for Driver -
:03
(-) Auto. Assoc Discount - (+) PA to owner driver YES 295.00
15
(-) Anti-theft Discount - (+) PA to unnamed PAX -
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(-) Other Discount - (-) Discount For Limited TPPD -
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(-) NCB Discount TP Total (Rounded Off) 1,009.00
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(+) Nil Depreciation - OD Total (Rounded Off)
(+) Nil Depreciation Plus - TOTAL PREMIUM 1,009.00
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(+) NCB Protect - GST 182.00
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(+) Engine Protect - NET PAYABLE 1,191.00
(+) Invoice Protect - Collection Number :45210381238000004912 dated 14-Jul-2023
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(+) Loss of Driving Licence -
1
(+) RSA Protect -
30
(+) EMI Protect -
27
(+) Towing Charge -
00
60
OD Total (Rounded Off) Subject to IMT Endorsement No. 24,25
67
Excess : Compulsory: Rs. 0 Imposed: Rs. 0 Voluntary: Rs. 0
23
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 and Reliability Trials (f) Use in connection with Motor Trade
31
Drivers Clause : Any person including Insured Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from holding or obtaining such a
03
licence. Provided also that the person holding an effective Learner's Licence may also drive the vehicle and such a person satisfies the requirements of Rule 3 of Central Motor
Vehicles Rules, 1989.
21
Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
45
Under section 1(ii) Damage to third party property is Upto Rs. 1,00,000 . PA Cover under section 3 for owner-driver is Rs. 15,00,000.
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 reasons of wider terms
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appearing in the certificate in order to comply with the Motor Vehicles Act,1988 is recoverable from the insured .See the clause headed "AVOIDANCE OF CERTAIN TERMS AND
RIGHT OF RECOVERY". For legal interpretation, English version will hold good.
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UIN : IRDAN058P0036V01100001
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Financier : SELF OWNED
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Prev Policy : Not Available
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Nominee Name : SHYAM DEV RAM Relation : FATHER Age : 65 Years
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NOTE : Warranted that in case of dishonour of the premium cheque, this document stands automatically cancelled 'AB-INITIO'.
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Policy stamp to be defaced at the respective policy servicing office.
TP Rate Revision Notice: For all policies having an effective date on or after 1st April 2023, the TP premium is subject to revision as may be notified by the IRDAI.
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The Insured should contact and submit the difference of premium to the policy issuing office on issuance of such notification by IRDAI.
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I/We hereby certify that this Certificate cum Schedule of Insurance is issued in accordance with the provisions of chapter X and chapter XI of Motor Vehicles Act,1988.
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Authorised Signatory
For & On behalf of
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National Insurance Company Limited
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NIC/UBPORTAL/9000156225 14/07/2023 03:03 PM
Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email: customer.support@nic.co.in
