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Servicing Office Address
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Mainpuri Business Office,1212/27, Station Road Mainpuri
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GSTIN No: 09AAACN9967E1Z1
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RECEIPT
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Customer Details Collection Details
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Name : Mr RAJESH KUMAR S/O SADHU SINGH Agent Code : 9000146817
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Address : R/O- GT ROAD ,KAJITOLA UTTARI,BEWAR , Collection Number : 46140881258000001569
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UTTAR PRADESH , MAINPURI UP Collection Date : 08/06/2025
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Pin Code : 205301 Bank Account : 9174
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Received with thanks from Sri/Smt Mr RAJESH KUMAR S/O SADHU SINGH
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a sum of 1590 (RUPEES ONE THOUSAND FIVE HUNDRED NINETY ONLY) by CD
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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80
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1 46140831256260000806 11 C.D CONTROL A/C 5076 0.00 1590.00 -1590.00
00
2 46140831256260000806 11 CASH PREMIUM A/C 5083 1348.00 0.00 1348.00
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3 46140831256260000806 11 CGST_UP_Int_Liab 7397 121.00 0.00 121.00
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4 46140831256260000806 11 SGST_UP_Int_Liab 7398 121.00 0.00 121.00
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TOTAL : 1590.00 1590.00 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/9000146817 08/06/2025 11:15 AM
Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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Issuing Office Name & Address
MAINPURI BUSINESS OFFICE , 1212/27, STATION ROAD MAINPURI
Tel: 05672 236965 (G) Fax:
GSTIN No: 09AAACN9967E1Z1
RSA Service Provider: TVS Automobile 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: 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: 46140831256260000806 2W 1 Year Package Policy from 00:00 Hrs of 10/06/2025 to Midnight of 09/06/2026 IXI
Insured Details
Name : Mr RAJESH KUMAR S/O SADHU SINGH
Address : R/O- GT ROAD ,KAJITOLA UTTARI,BEWAR , UTTAR PRADESH , MAINPURI UP
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Pincode : 205301 Telephone : xxxxxxxx55 Email : xxxxxxxxxx55@gmail.com
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PAN No. : GSTIN No. : Aadhar No. : xxxx xxxx 3809
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Channel : RAKESH BABU DIXIT Mobile : 9720103130 Email : rakeshbabudixit1955@gmail.com
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Aadhar : PAN : xxxxxx128H Code. : 461408 / 9000146817
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Vehicle Details
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Make & Model Two Wheeler SUPER SPLENDOR SELF-DRUM ALLOY BS VI
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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-84-AE-2919 JA07ABL9C03119 MBLJAW175L9C26456 STREET 125 2020 1+1 MAINPURI
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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
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Rs.40,000 - - - - Rs.40,000
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OD Premium Breakup in Rs. TP Premium Breakup in Rs.
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Basic OD Premium 670.40 Basic TP Premium 714.00
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(+) Geographical Area Extension - (+) Geographical Area Extension -
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(-) Vol. Excess Discount - (+) WC for Driver -
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(-) Auto. Assoc Discount - (+) PA to owner driver YES 275.00
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(-) Anti-theft Discount - (+) PA to unnamed PAX -
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(-) Other Discount - -234.64 (-) Discount For Limited As per MV Act -
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(-) NCB Discount 20% -87.15 TP Total (Rounded Off) 989.00
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(+) Nil Depreciation - OD Total (Rounded Off) 359.00
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(+) Nil Depreciation Plus - TOTAL PREMIUM 1,348.00
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(+) NCB Protect - GST 242.00
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(+) Engine Protect - NET PAYABLE 1,590.00
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(+) Invoice Protect - Collection Number :46140881258000001569 dated 08-Jun-2025
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(+) RSA Protect - YES
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OD Total (Rounded Off) 359.00 Subject to IMT Endorsement No. 22,24,25
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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 . PA Cover under section 3 for owner-driver is Rs. 15,00,000.
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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: 46140831246860000606 Expiry Date: 09/06/2025)
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Nominee Name : MANJU LATA Relation : WIFE Age : 49 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.
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.
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/9000146817 08/06/2025 11:15 AM
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
