पॉिलसी

पॉिलसी सं%ा Policy Number: व D वसाय क 5 Business Source: 910631-G

36140031236203538678
िव य चैनल कोड Sales Channel Code:
91063100000001
वनाम Name: Policybazaar Insurance Brokers Private
जारीकता´ काया´लय Issuing Office
काया´लय कोड Office Code: 361400 Limited
काया´लय का पता Office Address:
National Insurance Company Ltd., UIN: IRDAN058RP0034V01100001
Gurgaon DO-I,SCO No.- 41-42-43., Sector-31, Customer Care Toll Free Number:
Gurgaon - 122001. 1800 345 0330
GSTIN: 06AAACN9967E2Z6 email:customer.support@nic.co.in
अनुसूची Policy Schedule - Motor - Two Wheelers - PACKAGE POLICY
Contact Number: 0124-2380932,933
RSA Service Provider Toll Free Number:
Mobile Number:
1800 570 1906
For feedback to RSA: email: rsa.service@tvs.in

ाहक का नाम Customer Name: Sanjaykumar M ाहक आई.डी Customer ID: पैन PAN:
पता Address: 10-5-112 POONGA NAGAR 2ND STRE ET OORMETCHIKULAM फोन Phone:7092209715
SAMAYANALLUR City: Madurai, District:
State: Tamil Nadu, PIN: 625402. ई-मेल E-Mail: sanjaymurugesan26@gmail.com
Cell: 7092209715

Policy Effective from 00:00 hours, on 12/02/2025 की अध´राि तक to midnight of 11/02/2026

ीिमयम Premium ₹ 729 कवर नोट सं. व तारीख Cover Note Number NA
and Date
CGST ₹ 0.00
SGST/UTGST ₹ 0.00 ™ाव सं%ा व तारीख Proposal Number PB16261291349681075 Dt. 31/01/2025
and Date
IGST ₹ 131.00
वसूली यो ™ां
ूटी ₹ 0.00 रसीद सं%ा व तारीख Receipt Number PB86543496 Dt. 31/01/2025
and Date
Recoverable Stamp
36140031226202511167 / / NATIONAL
ि पॉिलसी सं%ा व समाि™ ितिथ Previous Policy
कुल रािश Total Amount ₹ 860 Number INSURANCE CO.LTD.
and Expiry Date Dt. Dt. 11/02/2026
(Rupees Eight Hundred Sixty केवल Only.)

वाहन का िववरण Vehicle Details

वाहन का आई.डी.वी/Vehicle IDV ₹ 9234 पंजी. सं%ा Regn. Number TN64L1744
IDV (Trailer / Sidecar) NA इंजन व एम/सी सं.Engine or M/c HA10EVFGJ01163
इले4 ी ए ेसरी Electrical No.
NA इचेिसस सं%ाChassis Number MBLHA10BUFGJ01062
Accessories
गैर इले4 ीउपकरण Non Electrical
NA पंजीकरण अिध.Regn. Authority Madurai
Accessories
फाइवर ास ट क Fiber Glass Tank NA भौगोिलक े Geographical Area इंिडया India
सीएनजी/एलपीजी यूिनटCNG/LPG Unit NA बनावट Make Hero Honda
Total IDV 9234 मॉडल Model Passion Pro
अित. टािवंग शु Addl. Towing NA वे रएंट Variant Drum Brake (97 cc)
Charges
सी.सी – जी.भी ड ू CC / GVW वाहन की ेणी/Class of Vehicle
100 Motor Cycle
लाइस स िसिटंग/वहन की मता मत
2 इढ़ाचा का कार/रंग Body Type /
Licensed Seating / Carrying
Color
Capacity
ि मा
न
´ण वष´ Year of Mfg. 2015 पंजीकरण ितिथ Regn. Date 09/11/2015
RSA Vendor Details: ki MOBILITY SOLUTIONS PRIVATE LIMITED 8 th Floor, "Kochar Bliss", Plot No. Super A8 & 9, Thiru-Vi-Ka Industrial Estate,
Guindy, Chennai – 600032
RSA Service Provider Toll Free Number: 1800 570 1906
For feedback to RSA: email: rsa.service@tvs.in
For policy terms and conditions including Add-ons please refer to the NICL Corporate website: https://nationalinsurance.nic.co.in
ीिमयम की अनुसूची Schedule of Premium
प 4- ित Own Damage ₹ िकदािय Legal Liability
ध
वि ₹
4- ि आवरण (उिचत पूरक ीिमयम के साथ) Own Legal Liability Cover 714
Damage Cover(Incl. of applicable add-ons) 15
Dि4गत दुघ´टना Personal Accident 0
सकुल Total 15 कुल Total 714
पवाहन 4- ित बीमा िववरण Vehicle Own Damage Insurance Details
नो 4ेम बोनस % No Claim Bonus% 25 Loss of Accessories Covered No
िशी
दे
वदूतावास का नाम Foreign Embassy Name N Nil Depreciation Plus Covered No
कंपलसरी ए ेस Compulsory Excess ₹ 100 Roadside Assistance Covered No
इंपो ए ेस Imposed Excess ₹ 0.00 Engine Protection Covered No
तृतीय प बीमा िववरण Third Party Insurance Details
मोटर वाहन अिधिनयम 1988 के अनुसार आव 4 क रािश Such amount as is necessary to meet the
Limit of liability under section II-I(i) requirement of the motor vehicles Act 1988
under section II-I(ii) ₹ 1,00,000.00 (In respect of any one claim or series of claims arising out of one event/occurrence.)

पृ सं.Page no:
1
 ित Dि4 मूल बीमा रािश
Dि4 गत दुघ´टना बीमा िववरण Personal Accident Cover Details
CSI per head
वाहन का मािलक चालक Owner driver of the vehicle
Nominee: MURUGESAN P ₹ 0.00
ासंिगक अनु ेद,पृ ांकन और वारंटी Clauses, Endorsements and Warranties Applicable: IMT 22.
उपयोग की सीमाएं : Limitations as to Use: Use only for social, domestic and pleasure purposes and for the insured's business or profession. The
Policy does not cover use for hire or reward, tuition, racing, pace making, reliability trial, speed testing, carriage of goods(other than samples or
personal luggage) in connection with any trade or business or use for any purpose in connection with Motor Trade.
वाहन चालन के िलए अिधकृत Dि4 या Dि4 वग´ Persons or Class 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 requirements of Rule 3 of the Central Motor Vehicles
Rules, 1989.
मह पूण´ सूचना Important Notice: यिद वाहन का योग या चालन इस अनुसूची म उ T िसे ि भ होता है तो बीमाधारक को कोई ितपूित´ नहीं की जायेगी। मोटर
वाहन अिधिनयम,1988 के अनपालन ◌ उ ेिखत िकसी ™ ™
तिनयमों के कारण कंपनी ारा िकया गया कोई भी भुगतान बीमाधारक से वसूली यो होगा। " कुछ िनयमों
™ृ™
और वसूली के अिधकार के प रहार" के शीष´क के तहत कंड को देख । 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 the reason of wider terms appearing in the certificate in order to comply
with the Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF
RECOVERY"
उपरो4 ि काया´लय पते पर िविधवत प से ािधकृत ™ा री को ी मानकर िदनांक [12/02/2025] को ™ा
र िकया जा रहा है।
वेबसाइट www.nationalinsuranceindia.nic.co.in म उपल इस अनुसूची, संल पॉिलसी, ख , पृ ांकन और पॉिलसी श ों को
एक अनुबंध के प म एक साथ पढ़ा जाएगा और पॉिलसी के िकसी भी िह 4े या अनुसूची म संल कोई भी श या अिभ Dि4, जो
िवशेष अथ´ कट करता हो, जहां भी कट हो समान अथ´ वहन करेगा करेगा । यह वारंटी दी जाती है िक ीिमयम चेक की
अ 4ीकृित की ि थित ◌े , यह पॉिलसी आरंभ होने की तारीख से ही 4 तः िनर™ माना जाएगा ।

IN WITNESS WHEREOF, the undersigned being duly authorized hereunto set his/ her hand at the office address mentioned above, this 12/02/2024.This
schedule, the attached policy, the clauses, the endorsements and policy wordings as available in the website www.nationalinsuranceindia.nic.co.in
shall be read together as one contract and any word or expression to which the specific meaning has been attached in any part of this policy or
of the schedule shall bear the same meaning wherever it may appear. It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS
DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'

कृ
ते नेशनल इ 4ोरे
कंपनी िलिमटेड
For and on behalf of National Insurance
Company Limited

Ombudsman Details: Shri K.M.Chadha Insurance ™ा

Ombudsman Office of the Insurance Ombudsman S.C.O. No.101-103 ूटी
2nd Floor Batra Building Sector 17-D CHANDIGARH-160017 Stamp Duty:
Fax : 0172-2708274 ( ₹ 0.25 )
Email ombchd@yahoo.co.in,0172-2706468.

™ रकता´
क ािधकृत ™ा
Authorized
Signatory

पृ सं.Page no:
2
Motor

- Two Wheelers - PACKAGE POLICY

Policy Number: 36140031236203538678 D वसाय ोत Business Source: 910631-G
िव य चैनल कोड Sales Channel Code:
91063100000001
जारीकता´ काया´लय Issuing Office नाम Name: Policybazaar Insurance Brokers Private
काया´लय कोड Office Code: 361400 Limited
काया´लय का पता Office Address:
National Insurance Company Ltd.,
Gurgaon DO-I,SCO No.- 41-42-43., Sector-31, UIN: IRDAN058RP0034V01100001
Gurgaon - 122001. Customer Care Toll Free Number:
1800 345 0330

बीमा माण-प CERTIFICATE OF INSURANCE

के ीय मोटर वाहन िनयम 1989 के फाम´ 51 Form 51 of the Central Motor Vehicle Rules, 1989

माण-प
361400312362035386 IYI
Certificate No.: 78

बीिमत वाहन का िववरण Particulars of vehicle insured

पंजी सं.Reg. इं. व चे. सं Engine इबनावट, मॉडल ि´ण वष´ Year of
मा
न ब़डी का सया ी मता ीिमयम
Mark, No. & Make, Model सी सी C.C
No. & Chassis Manufacture कारType Seating capacity Premium()
Place of No & Variant of Body
Registration
Hero Honda,
TN64L1744 / HA10EVFGJ01163 Passion Pro &
2015 Solo 100 2 729
Madurai MBLHA10BUFGJ01062 Drum Brake
(97 cc).

पंजीयन अिधकारी का नाम Name of Registration Authority Madurai

Sanjaykumar M,10-5-112 POONGA NAGAR 2ND STRE ET OORMETCHIKULAM
बीिमत का नाम व पता Name & Address of Insured SAMAYANALLUR
,Madurai,Tamil Nadu,625402.
भौगोिलक े Geographical Area India
Business or Profession
बीमा के ारंभ होने की भावी ितिथ Effective date of commencement of
----- बजे िदनांक से म राि िदनांक --तकFrom 00:00 O' Clock on
Insurance for the purpose of Act.
12/02/2025.
बीमासमाि™ की ितिथ Date of expiry of the insurance Midnight on:11/02/2026

गाड़ी चलाने के अिधकृत D रि4 या Dि4 यों का समुह PERSONS OR CLASS 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 requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
ासंिगक अनुचछेद,पृषांकन और वारंटी Clauses, Endorsements and Warranties
Applicable: IMT RSA UIN:IRDAN058RP0034V01100001/A0017V01202223

योगाथ´ सींमाएं LIMITATIONS AS TO USE

Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover use for hire or reward,
tuition, racing, pace making, reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any
trade or business or use for any purpose in connection with Motor Trade.

◌ै /हम एतहवारा मािणत करते है िक पॉिलसी िजससे यह माण-प संबंिधत है एवं यह बीमा माण-प मोटर वाहन अिधिनयम, 1988 के अ ाय X और XI के
ावधानों के अनुसार जारी िकये गए हैँ। I/We hereby certify that the Policy to which this Certificate relates as well as this Certificate of Insurance
are issued in accordance with the provisions of Chapter X and Chapter XI of M.V. Act, 1988.
जारीकता´ काया´लय का पूरा पता Full address of Issuing Office: National Insurance
Company Ltd.,
Gurgaon DO-I,SCO No.- 41-42-43., Sector-31, कृते नेशनल इ 4ोरे क नी िलिमटेड क
Gurgaon - 122001. नी िलिमटेड
GSTIN: 06AAACN9967E2Z6 For and on behalf of National Insurance Company
Contact Number: 0124-2380932,933 Limited
Mobile Number:

जारी करने की ितिथ Date of issue: 31/01/2025 िविधवत गिठत अटॉन (ओं) Duly Constituted
Attorney(s)

office
In case of any claim, please contact our nearest
Authorized Signatory