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Servicing Office Address
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Bundi Business Office,Toup Circle, By Pass Road, 12, National Highway,
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Bundi,Rajasthan Bundi
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GSTIN No: 08AAACN9967E1Z3
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RECEIPT
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Customer Details Collection Details
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Name : Mr . BRAHMANAND MEENA S/O RAMNATH Agent Code : 9000161496
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Address : D-22 VIVEKAND PURAM MATUNDA ROAD Collection Number : 37080181230000010080
BUNDI , RAJASTHAN , BUNDI Collection Date : 30/03/2024
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Pin Code : 323001 Bank Account : 9174
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Received with thanks from Sri/Smt Mr . BRAHMANAND MEENA S/O RAMNATH
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a sum of 1420 (RUPEES ONE THOUSAND FOUR HUNDRED TWENTY ONLY) by CD
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towards 1 Year Package Policy Policy as per details given hereunder
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Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount
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No. Year Number (General Ledger) Received
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1 37080131236260006671 11 C.D CONTROL A/C 5076 0.00 1420.00 -1420.00
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0
2 37080131236260006671 11 CASH PREMIUM A/C 5083 1204.00 0.00 1204.00
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3 37080131236260006671 11 CGST_RJ_Int_Liab 7379 108.00 0.00 108.00
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4 37080131236260006671 11 SGST_RJ_Int_Liab 7380 108.00 0.00 108.00
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TOTAL : 1420.00 1420.00 0.00
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Particulars : CD
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For National Insurance Company Ltd.,
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1.Please quote collection no. and date in all correspondeces
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2.The stamp has been defaced and retained at the office against the issued
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policy.
3.We hereby declare that though our aggregate turnover in any preceding
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financial year from 2017-18 onwards is more than the aggregate turnover
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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.
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Authorised Signatory
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NIC/UBPORTAL/9000161496 17/07/2024 12:14 PM
Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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Issuing Office Name & Address
BUNDI BUSINESS OFFICE , TOUP CIRCLE, BY PASS ROAD, 12, NATIONAL
HIGHWAY, BUNDI,RAJASTHAN BUNDI
Tel: 0747 2445407 (G) Fax:
GSTIN No: 08AAACN9967E1Z3
National Insurance Company Ltd.
Registered & Head Office: PREMISES NO.18-0374, PLOT NO. CBD-81, NEW TOWN, KOLKATA-700156
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989 as amended from time to time
Policy No: 37080131236260006671 2W 1 Year Package Policy from 00:00 Hrs of 31/03/2024 to Midnight of 30/03/2025 IXI
Insured Details
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Name : Mr . BRAHMANAND MEENA S/O RAMNATH
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Address : D-22 VIVEKAND PURAM MATUNDA ROAD BUNDI , RAJASTHAN , BUNDI
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Pincode : 323001 Telephone : 9414393454 Email : nirdeshbuliwal.bundi@gmail.com
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PAN No. : xxxxxx044H GSTIN No. : Aadhar No. : xxxx xxxx 7637
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Channel : NIRDESH BULIWAL Mobile : 9460663994 Email : nirdeshbuliwal.bundi@gmail.com
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Aadhar : PAN : xxxxxx707B Code. : 370801 / 9000161496
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Vehicle Details
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Make & Model Two Wheeler Bajaj V 150 Standard V15
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Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District
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RJ-08-SR-5251 JHZRGG06399 MD2A74BZ1GRG05148 150 2016 1+1 BUNDI
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Geographical Area : INDIA.
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FastTag ID : 0.
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Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV
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Rs.38,475 - - - - Rs.38,475
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OD Premium Breakup in Rs. TP Premium Breakup in Rs.
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Basic OD Premium 677.16 Basic TP Premium 714.00
(+) Geographical Area Extension - (+) Geographical Area Extension :01 -
(-) Vol. Excess Discount - (+) WC for Driver YES 50.00
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(-) Auto. Assoc Discount - (+) PA to owner driver -
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(-) Anti-theft Discount - (+) PA to unnamed PAX -
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(-) Other Discount - (-) Discount For Limited TPPD -
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(-) NCB Discount 35% -237.01 TP Total (Rounded Off) 764.00
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(+) Nil Depreciation - OD Total (Rounded Off) 440.00
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(+) Nil Depreciation Plus - TOTAL PREMIUM 1,204.00
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(+) NCB Protect - GST 216.00
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(+) Engine Protect - NET PAYABLE 1,420.00
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(+) Invoice Protect - Collection Number :37080181230000010080 dated 30-Mar-2024
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OD Total (Rounded Off) 440.00 Subject to IMT Endorsement No. 22,24,25,28
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Excess : Compulsory: Rs. 100 Imposed: Rs.0 Voluntary: Rs. 0
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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
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making (e) Speed Testing and Reliability Trials (f) Use in connection with Motor Trade
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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
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
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Vehicles Rules, 1989 as amended from time to time.
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Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
Under section 1(ii) Damage to third party property is Upto Rs. 1,00,000 .
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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 : National Insurance Company Limited (Pol No: 37080131226260003109 Expiry Date: 30/03/2024)
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Nominee Name : Relation : Age :
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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.
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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Policy Details Cashless Garages Details
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Authorised Signatory
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For & On behalf of
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National Insurance Company Limited
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NIC/UBPORTAL/9000161496 17/07/2024 12:14 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
