THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Standalone Motor Own Damage Policy for Two Wheelers
UIN Number - IRDAN190RP0002V01201920
Policy Number :76140131251700014240
POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
NEYYATTINKARA BRANCH (761401), NAME:Ms. Aswathy L - (AG00159018), Trivandrum Non Suit Claim Hub (769001)
2ND FLOOR , SWADESABHIMANI COMPLEX , PHONE NUMBER: / / 8547131952 ADDRESS: T.C. 26/1436, GOVT. PRESS ROAD, 695001
, LAND/FAX NUMBER:/ , , , KERALA , 695001.
KERALA , 695121. EMAIL:aswathyanusha13@gmail.com / PHONE NUMBER: 04712324058 / 04712324059
PHONE NUMBER:04712226770 / MOBILE NUMBER:
04712222495 Email: ch769001@newindia.co.in
FAX NUMBER:NA /
nia.761401@newindia.co.in
Email:nia.761401@newindia.co.in
INSURED DETAILS
Insured Name SUJAN LAL S R Customer ID POC3457556 (PAN No :NA)
Insured Address KASAVANVILA VEEDU, THIRUPURAM P O Contact Number / / XXXXXX0488
NEYYATTINKARA,THIRUPURAM,,
TIRUPURAM ,KERALA, 695133
Email srsujanlal@gmail.com
GSTIN NA
POLICY DETAILS
Period of cover 30/06/2025 12:00:01 AM to 29/06/2026 11:59:59 PM Receipt Number 10000089250601101760 -
28/06/25
Previous Insurer UNITED INDIA INSURANCE CO. LTD. Previous Policy Number 1004033123P103262167
Related Bundled/Liability 76140131220900012170 Bundled/Liability Policy 30/06/2022 to 29/06/2027
Policy No.: period:
Bundled/Liability Insurer: UNITED INDIA INSURANCE CO. LTD.
VEHICLE DETAILS
Registration Number KL-19-N-0691 Chassis no./Engine Number ME4JF919FNG072435/JF91
EG6072740
Make / Model HONDA/ACTIVA 6G Variant: ACTIVA 6G STD BS VI
Year of manufacture 2022 Type of body / Type of Fuel Metal
Colour REBEL RED METALLIC 2 Cubic capacity(cc) 110cc
/Wattage(kW):
Seating capacity including 2 Name of registration Thiruvananthapuram -
Driver authority Parasala
Geographical Area / Zone India Name of the Financier
Cover Note No/Cover Note / Automobile Association none
Issue Date: membership
INSURED DECLARED VALUE (IN Rs)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel/CNG/LPG kit Total Value
52500 0 0 0 52500
SCHEDULE OF PREMIUM
Own Damage
Basic OD Premium 704
(-)(#)Total NCB Discount(35%) 246.37
Calculated OD Premium 458
Total OD Premium in 458
Net Premium in Rs 458
GST in Rs 82
Total Payable in Rs 540
Total Payable in Rs(in words): RUPEES FIVE HUNDRED FORTY ONLY
Signature valid
Digitally signed
by DHIRAJ Policy No. : 76140131251700014240 Document generated by AG_0167943 at 2025/06/28 20:02:59.
KUMAR
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2025.06.28
20:02:59 IST 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 https://newindia.co.in.
Page 1 of 3
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
GSTIN(Issuing Office) 32AAACN4165C4ZX
SAC 997134 (Motor vehicle insurance services)
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 f) Reliability Trials g) Any purpose in connection with Motor
Trade
Limits of Liability: Coverage is only for Own Damage of the vehicle and does not cover third party property damage/personal injury/TP death
and any other Legal Liability.
For individual covers (OD) in RS:52500 Compulsory excess in Rs:100
Imposed excess in Rs:0 Voluntary excess in Rs:0
Persons or classes 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 requirement of Rule 3 of the Central Motor Vehicles
Rules, 1989.
Premium and GST Details
Rate of Tax Amount in INR
Premium Rs 458
SGST 9 41
CGST 9 41
IGST 0 0
KERALA FLOOD CESS 0 0
In witness where of this policy has been signed at NEYYATTINKARA BRANCH on this 28-JUN-25
WARRANTED THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED ABINITIO
This policy is subject to the Terms, conditions and exceptions applicable to ODWTOTADON/ODWTHADDON policy attached/available on the
web site http://newindia.co.in; IMT Endorsement Number(s) printed herewith attached 25.
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 reason of wider terms appearing in the certificate in order to comply with the Motor Vehicles Act, 1988 is recoverable from the
insured: see clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY". It is clarified that in case the declaration regarding
the ncb or other previous policy details made by the insured, is found to be incorrect, all the benefits (including claim) under section-1 of this
policy, will stand forfeited.
Anti Money Laundering Clause: In the event of a claim under the policy exceeding Rs 1lakh or a claim for refund of premium exceeding Rs 1
lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as well
as Company website.
I/We hereby certify that the policy to which this Certificate relates For and on behalf of The New India Assurance Company Limited
as well as this Certificate of Insurance are issued in accordance
with the provisions of Chapter X and XI of M.V. Act, 1988.
Date of Issue: 28/06/2025
(Mrs LEKSHMY C V)
[Sr.Branch Manager]
Duly Constituted Attorney(s)
Policy No. : 76140131251700014240 Document generated by AG_0167943 at 2025/06/28 20:02:59.
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 https://newindia.co.in.
Page 2 of 3
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 : 76140125P0016937
IRDA Registration Number: 190
NIA PAN NUMBER: AAACN4165C
Policy No. : 76140131251700014240 Document generated by AG_0167943 at 2025/06/28 20:02:59.
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 https://newindia.co.in.
Page 3 of 3
