THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
POLICY SCHEDULE FOR PRAVASI BHARTIYA BIMA YOJANA POLICY(2017)
UIN NUMBER - IRDAN190P0115100001
Insured Name : NIZAMUDDIN ALLHABAKSH PEERSABNAVAR
Insured's Details Issuing Office Details
Customer ID : POC4563875 Office Code : SION_SMALL_BUSINESS_OFFICE (113803)
Address : HOUSE NO 272/1AT POST GAVDEWADA TQ JOIDA Address : SHOP No.1 & 2 NEW PARAS LTD, PLOT NO.169A
KARWAR SCHEME6 ROAD NO.15, BEHIND UBI SION (EAST)
KARWAR-581186 ,400022
KARNATAKA
Phone No : XXXXXXXXXX5602 Phone No : 9869436426
E-mail/Fax : mofaskbansal2007@gmail.com, / E-mail/Fax : nia.113803@newindia.co.in /
PAN No : S.Tax Regn. No : AAACN4165CST178
GSTIN/UIN : NA / NA GSTIN : 27AAACN4165C3ZP
: SAC : 997139 (Other non-life insurance services
excl RI)
Policy Number 11380348252100061320 Dev.Off level./Broker/Corp. Mr. DIRECT 113803 - (DI00002179)
Agent/Web Aggregator/CPSC User
Period of Insurance From: 21/07/2025 08:55:51 PM To: 20/07/2027 Agent/Bancassurance/Specified SION MICRO OFFICE 131005
11:59:59 PM Person PHONE NO-+91-022-24041212
Date of Proposal 21-Jul-25 Phone No NA/ /
Prev. Policy no. E-mail/Fax
Premium(`) GST(`) Total (`) Total (` in words) Receipt No. & Date
275 50 325 RUPEES THREE HUNDRED 11380381250000060996 -
TWENTY-FIVE ONLY 21/07/25
Date of Birth 19/09/1987 Passport No. U6792984
Gender Male Date of issue of Passport 20/12/2019
Nominees Name ALLHABAKSH PEERSABNAVAR Country to be visited UNITED ARAB EMIRATES
Nominees Relation Father Period of Employment 2Y
Profession NA Name of the Sponsor / Employer NA
Policy Coverage - Benefits Sum Insured
i.Personal Accident Covering Death & Permanent Total Disability : `10,00,000
ii.Transportation and Airfare for Attendant : Actual Economy Class Return Airfare for one attendant and
Actual Transportation cost of Mortal Remains
iii.Hospitalization Expenses covering Injuries/Diseases : `1,00,000(upto `50,000 per hospitalization)
iv.Maternity Expenses : `35,000(`50,000 for caesarean section)
v.Hospitalization Expenses of Insureds Family in India : `50,000
vi.Employment Contingencies : Actual Economy Class Airfare(Nearest international Airport)
vii.Repatriation Expenses on Medical Grounds : Actual Economy Class Airfare(Nearest international Airport)
viii.Legal Costs : `45,000
Special Condition:
Premium and GST Details
Rate of Tax Amount in INR
Premium ` 275
SGST 0 0
CGST 0 0
IGST 18 50
This Policy is applicable to the Emigrant /ECNR endorsement on his/her passport.
The Policy has been issued based on the information provided by you and the policy will not be valid if any information provided is incorrect. The Insurance Cover is
subject to the terms conditions and exclusion of Pravasi Bharatiya Bima Yojana 2017. Policy will be treated VOID in case of any alteration.
In witness whereof the undersigned being duly authorised by the Insurers and on behalf of the Insurers has (have) hereunder set his (their) hand(s) on this 21st day of
July,2025.
For and on behalf of
The New India Assurance Company Limited
Duly Constituted Attorney(s)
Mudrank_____________Dt.___________consolidated Stamp Fees Paid by Pay Order Number_______________vide receipt
number___________dt.__________.Stamp Duty under the Policy is `
IRDA Registration Number: 190
Signature Not
Verified
Policy No. : 11380348252100061320Document generated by EMIGRATE at 21/07/2025 20:57:09 Hours.
Digitally signed
by DHIRAJ Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
KUMAR Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
Date: 2025.07.21
For redressal
20:57:11 IST 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.
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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover 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.
Tax Invoice No : 11380325P0064291
Policy No. : 11380348252100061320Document generated by EMIGRATE at 21/07/2025 20:57:09 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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 2
