ऩॉि रसीअनुसूची Policy Schedule-Motor-Three Wheeler Passenger Carrying Vehicle-Package
ऩॉि रसीसंखमा Policy Number:
ववसामकेद BusinessSource:556010
556010312410001589
जायीकतायकामायरम Issuing Office ि वकमचैनरकोड Sales Channel Code:9000200417
कामायरमकोडOfficeCode:556010 नाभName: Ms Ratlawath Sumitra
कामायरमकाऩताOffice Address: HYDERABAD- संऩकयसंखमाContact Number: 9440496099
MADINAGUDA BC G 6 Vijaya Krishna
Residency, Near St Anns School, Customer Care Toll Free Number:
Madinaguda, Hyderabad, - 500049.State 1800 345 0330
Code: 36 , Telangana जीएसटीआईएन/ email: customer.support@nic.co.in
GSTIN: 36AAACN9967E6ZZ
संऩकयसंखमा/ContactNumber:4023043422
भोफाइरनंफय/MobileNumber:7799901318
गाहककानाभ Customer Name: MUJEEB MOHAMMED गाहकआई.डी Customer ID: 9701436514 ऩैन PAN:
ऩता Address: S/O MD BASHU, H NO 5-7-30/L/5, HABEEB NAGAR, पोन Phone:********01
MAHBUBNNAGAR,,शहय/,ि जरा/ District: MAHBUBNAGAR,
याजम/ State: TELANGANA,ि ऩन/ PIN: 509001.
ई-भेर E-Mail: ******ua@gmail.com
सेर/Cell:********62
ऩॉि रसीऩबावीसभमघंटे ,को Policy Effective from effect time 00:00 hours, on 25/11/2024 कीअधययाि ततकto midnight of 24/11/2025
ऩीि भमभPremium ₹
7,178.00 कवयनोटसं.वतायीख Cover Note Number and Date NA
सीजीएसटी/CGST ₹
,545.00
एसजीएसटी/मूटीजीएसटी/ SGST/UTGST ₹545.00
ऩसतावसंखमावतायीखProposal Number and Date
आईजीएसटी/ IGST ₹
0.00
कभ :जीएसटी _टीडीएस/
₹
0.00
Less:GST_TDS
वसूरीमोगमसटांऩ डू टी Recoverable
₹
0.00 यसीदसंखमावतायीख Receipt Number and Date 556010812410003587 Dt.25/11/2024
Stamp Duty
ि ऩछरीऩॉि रसीसंखमावसभाि ऩततततथPrevious Policy
कुरयाि शTotal Amount ₹
8,600.00
Number and Expiry Date
(यऩए/Rupees Eight Thousand Six Hundred tकेवरOnly.)
वाहनकाि ववयणVehicle Details
वाहनकाआई .डी.वी/Vehicle IDV ₹80000 ऩंजी.संखमा Regn. Number TS-06-UB-6883
आई.डी.वीIDV(टे रयTrailer) NA इंजनवएभ/सीसं.Engine No. BAZWGK00885
इरेकटीकरएकसेसयी Electrical NA चेि सससंखमाChassis Number MD2A26AZXGWK02263
Accessories
गैय इरेकटीकर उऩकयण Non Electrical NA ऩंजीकयणिअध .Regn. Authority Mahaboobnagar
Accessories
पाइवयगरासटै क FiberGlassTank NA बौगोि रक केत Geographical इंि डमाIndia
Area
सीएनजी/एरऩीजीमूि नट CNG/LPGUnit फनावट Make Bajaj Auto Ltd
NA
कुरकीभतTotal Value ₹80000 भॉडर Model Re Compact Diesel
िअत.टाि वगशुरकAddl.TowingCharge वेि यएंट Variant BSIII
s
सी.सी–जी.बीडफरमू CC/GVW 447
वाहनकीशेणी/Class of Vehicle AUTO RICKSHAW
ईधनकाऩकाय /Type of Fuel DIESEL
राइसेससससटग /वहनकीकभताकभत 4 ढाचाकाऩकाय /यं ग Body Type Hackney
Licensed Seating/Carrying /Color
Capacity
ि नभायणवषयYear of Mfg. 2016 खयीदनेकीतायीख/ Date of 26/10/2016
Purchase
भुदणकीतायीख Printedon25/11/2024 आई.डी.दायाbyID:73311,सहामताAID:73566 ऩष
ृ सं.Pageno:2
Policy Schedule-Motor- Three Wheeler Passenger Carrying Vehicle-Package
ऩॉि रसीसंखमा Policy Number:
ववसामसोत BusinessSource:556010
556010312410001589
जायीकतायकामायरम Issuing Office ि वकमचैनरकोड Sales Channel Code: 9000200417
काय़ायरमकोड OfficeCode:556010 नाभ Name: Ms Ratlawath Sumitra
संऩकयसंखमाContactNumber:9440496099
कामायरमकाऩताOffice Address: HYDERABAD-
CustomerCareTollFreeNumber:18003450330
MADINAGUDA BC G 6 Vijaya Krishna
email: customer.support@nic.co.in
Residency, Near St Anns School,
Madinaguda, Hyderabad, -
500049.याजमकोड/State Code: 36 , Telangana
जीएसटीआईएन/GSTIN:36AAACN9967E6ZZ
संऩकयसंखमा/ ContactNumber:4023043422
भोफाइरसंखमा /MobileNumber:7799901318
ववकगतदघयटना/ Personal Accident NA
कुर Total
कुर/ Total 7,000.00
8,600.00
वाहनसव-ककतफीभाि ववयण Vehicle Own Damage Insurance Details
नोकरेभफोनस% No Claim Bonus% 25.00 IMT 23 Included Yes
CNG/LPG Kit No
कंऩरसयीएकसेस Compulsory Excess ₹
1,500.00
Yes
Nil Depreciation
तत
ृ ीमऩकफीभाि ववयण Third Party Insurance Details
ऩॉि रसीकेअनुचछे द I(i)औयअनुचछे द I(ii)के
सभम-सभमऩयसंशोि धतभोटयवाहनिअधधनमभ1988केअनुसायआवशमकयाि श Such amount as is necessary to meet the
तहत Limit of liability under section-
requirement as per Motor vehicles Act 1988 as amended from time to time
I(i)and section - I(ii)
ऩूंजीरगानेवारे का नाभ वऩता Financier
Hypothecation, Aryan Auto Finance
Name and Address:
ऩासंि गकअनुचछे द,ऩष
ृ ांकनऔय वायं टी Clauses,Endorsements and Warranties Applicable: IMT23,39, Nil Depreciation (UIN):NIC-MO-A00-00-54-V01-14-15,22,23,7,21
आईआयडीएआई वऩयऩत संदबय केअनुसाय:IRDAI/NL/CIR/MISC/188/10/2023, ि दनांक: 27/10/2023, भधमसथता खंड को ऩॉि रसी से हटा ि दमा गमा भाना जाएगा/As per IRDAI Circular
Ref:IRDAI/NL/CIR/MISC/188/10/2023, Arbitration Clause shall be deemed deleted from the policy
उऩमोगकीसीभाएं/ Limitations as to Use::
भारवहनकयनेवाराभार -वाहन-वगयक:ऩॉि रसीसभम -सभमऩयसंशोि धतभोटयवाहनिअधधनमभ ,1988के अंतगयतजायीऩरयभटके तहतमासभम -सभमऩयसंशोि धतभोटयवाहनिअधधनमभ 1988कीधाया66
कीउऩ-धाया3के तहतआनेवारेवाहनोके के वरउऩमोगकोआववयतकयतीहै।ऩॉि रसीि नभतनसरखतकोआववयतनहीकयतीहै :
(1) आमोि जतये ि सग ,ऩेस -भेि कग,ि वशसनीमताऩयीकणमाधगतऩयीकणके ि रएउऩमोग कयना।
(2) ि कसीमांि तकयऩसेअसभथयचाि रतवाहनके टोि वग (ि यवाडयके अरावा )कोछोडकयएकटे रयडाइंगकाउऩमोग कयना।
(3) वाहनोभेकभयचाि यमोकोछोडकयमाि तमोको (डाइवयके अरावा )ऩंजीकयणदसतावेजभेअनुभतसंखमासेिअधकऔयकभयचायीके भुआवजािअधधनमभ 1923के दामये सेऩये ,रेजानाहे तुउऩमोग कयना।
The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the
Motor Vehicle's Act 1988. The Policy does not cover:(1) Use for organised racing, pace-making, reliability trial or speed testing.(2) Use whilst drawing a trailer
except the towing (other than for reward) of any one disabled mechanically propelled vehicle.(3) Use for carrying passengers in the vehicles; except
employees(other than the driver) not exceeding the number permitted in the registration document and coming under the purview of Workmen's Compensation
Act 1923
डाइवकयनेकाहकदायववकमाववकमोकावगय/ Persons or Class of Persons entitled to drive: Any person including 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 when not used for the transport of goods at the time of the accident and that such a person satisfies the
requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
The policy does not cover liability for death, bodily injury or damage as excluded in section 150(2) (a)(ii) and (iii);(b) and (c) of the Motor Vehicle Act,1988
asamended from time to time"
सभम-सभमऩयसंशोि धतभोटयवाहनिअधधनमभ,1988कीधाया150(2)(क)(ii)औय(iii)(ख)औय(ग)केअनुसायऩॉि रसीभत
ृ मु,शायीि यकचोटमाककतके ि रएदे मताकोकवयनहीकयतीहै ।
भहतवऩूणयसूचना/ Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule. Any
paymentmadebythecompanybythereasonofwidertermsappearinginthecertificateinordertocomplywiththeMotorVehicleAct,1988asamendedfromtimetotimeis
recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY"
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.
भुदणकीतायीखPrintedon25/11/2024 आई.डी.दायाbyID:73311,सहामताAID:73566 ऩष
ृ सं.Pageno:3
Policy Schedule-Motor- Three Wheeler Passenger Carrying Vehicle-Package
ऩॉि रसीसंखमाPolicy Number:
ववसामसोत BusinessSource:556010
556010312410001589
जायीकतायकामायरम Issuing Office ि वकमचैनरकोड Sales Channel Code: 9000200417
काय़ायरमकोड OfficeCode:556010 नाभ Name: Ms Ratlawath Sumitra
संऩकयसंखमाContactNumber:9440496099
कामायरमकाऩताOffice Address: HYDERABAD-
CustomerCareTollFreeNumber:18003450330
MADINAGUDA BC G 6 Vijaya Krishna email: customer.support@nic.co.in
Residency, Near St Anns School,
Madinaguda, Hyderabad, - 500049.याजमकोड/
State Code: 36 , Telangana
जीएसटीआईएन/ GSTIN:36AAACN9967E6ZZ
संऩकयसंखमा/ ContactNumber:4023043422
भोफाइरसंखमा /MobileNumber:7799901318
उऩयोकिउरसरखतकामायरमऩतेऩरयववधवतयऩसेऩाि धकृतअधोहसताकयीकोसाकीभानकरयदनांक 25 October 2024 कोहसताकरयकमाजायहाहै । वेफसाइट
https://nationalinsurance.nic.co.inभेउऩरफधइसअनस
ु च
ू ी,संरगनऩॉि रसी,खणड,ऩष
ृ ांकनऔयऩॉि रसीशफदोकोएकअनफ
ु ंधकेयऩभेएकसाथऩढाजाएगाऔयऩॉि रसीकेि कसी बी
ि हससेमाअनुसूचीभेसंरगनकोईबीशफदमािअबववक ,जोि वशेषअथयऩकटकयताहो ,जहांबीऩकटहोसभानअथयवहनकये गा।महवायं टीदीजातीहै ि कऩीि भमभचेककीअसवीकृि त की
ि सधथतभे,महऩॉि रसीआयं बहोनेकीतायीखसेहीसवत्ि नयसतभानाजाएगा
।
IN WITNESS WHEREOF, the undersigned being duly authorized hereunto set his/ her hand at the office address mentioned above, this 25 October
2024.Thisschedule, the attached policy, the clauses, the endorsements and policy wordings as available in the website https://nationalinsurance.nic.co.inshall
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
STANDSAUTOMATICALLY CANCELLED 'AB-INITIO'
कृते
OfficeoftheInsuranceOmbudsman,6-2- नेशनरइनशमोये नसकं ऩनीि सरभटे ड
46,1stfloor,MoinCourt,LaneOpp.HyundaiShowroom, A. C. Guards, Lakdi-Ka-Pool, सटाभऩडू टी For and on behalf of National Insurance
Hyderabad - 500 004. Stamp Company Limited
Tel.: 040 - 23312122 / 23376991/ 23376599 / 23328709/23325325
Duty:
Email: bimalokpal.hyderabad @cioins.co.in.
(₹0.25)
FAST TAG NO: 245657137
ऩाि धकृतहसताकयकताय Authorized Signatory
भुदणकीतायीख Printedon25/11/2024 आई.डी.दायाbyID:73311,सहामताAID:73566 ऩष
ृ सं.Pageno:4
Policy Schedule-Motor- Three Wheeler Passenger Carrying Vehicle-Package
ऩॉि रसीसंखमा Policy Number:
ववसामसोत BusinessSource:556010
556010312410001589
जायीकतायकामायरम Issuing Office ि वकमचैनरकोड Sales Channel Code:9000200417
काय़ायरमकोड OfficeCode:556010 नाभ Name: Ms Ratlawath Sumitra
संऩकयसंखमाContact Number:9440496099
कामायरमकाऩताOffice Address: HYDERABAD-
CustomerCareTollFreeNumber:18003450330
MADINAGUDA BC G 6 Vijaya Krishna email: customer.support@nic.co.in
Residency, Near St Anns School,
Madinaguda, Hyderabad, -
500049.याजमकोड/State Code: 36 , Telangana
जीएसटीआईएन/GSTIN:36AAACN9967E6ZZ
संऩकयसंखमा/ ContactNumber:4023043422
भोफाइरसंखमा/MobileNumber:7799901318
फीभाऩभाण-ऩत CERTIFICATE OF INSURANCE
ऩभाण- 556010312410001589
ऩतCertificateNo.:
सभम-सभमऩयसंशोि धतकेनदीमभोटयवाहतननमभ1989केपाभय51Form51oftheCentralMotorVehicleRules,1989asamendedfromtimetotime
फीि भतवाहनकाि ववयणParticulars of vehicle insured
सकरवाहनबाय
इं.वचे.सं Engine No ि नभायणवषय
ऩंजीसं. Reg. Mark, No. & फनावट,भॉडर Make, Model फडीकाऩकाय Gross Vehicle सावयिजनक Public Carrier / ऩीि भमभ
.& Chassis No Year of Weight
Place of Registration & Variant Type of Body Private Carrier Premium(₹
)
Manufacture
BAZWGK00885 &
Bajaj Auto Ltd, Re
TS-06-UB-6883 / MD2A26AZXGWK
Compact Diesel BSIII 2016 Hackney 681 ₹8,600.00
Mahaboobnagar 02263
ऩंजीमनिअधकायीकानाभName of Registration Authority Mahaboobnagar
MUJEEB MOHAMMED,S/O C MD BASHU, HABEEB NAGAR,,
फीि भतकानाभवऩता Name & Address of Insured HNO 5-7-30/l/5, HABEEB NAGAR, MAHBUBNAGAR,
MAHBUBNAGAR, TELANGANA, 509001
वाहनभाि रकका भानम भोफाइर नंफय Validated Mobile number of the vehicle owner 9247324099
बौगोि रककेत Geographical Area India
फीभाकेऩायं बहोनेकीऩबावीि ततथ Effective date of commencement of Insurance for the
फजेि दनांकसेभधमयाि ततदनांकतक From 00:00O'Clock on 25/11/2024.
purpose of Act.
फीभासभाि ऩतकीि ततथ Date of expiry of the insurance भधमयाि तको/Midnight on: 24/11/2025
डािइवगकरफ:गाडीचरानेकेिअधकृतवरयकमाववकमोकासभुहDRIVER'SCLAUSE:PERSONSORCLASSOFPERSONSENTITLEDTODRIVE
फीि भतससहतकोईबीववक,फशतेि कदघयटनाकेसभमडाइवकयनेवारेववककेऩासऩबावीडािइवगराइसेसहोतथाउसेइसतयहकेराइसेसऩाऩतकयनेमाधायणकयनेसेअमोगमघोि षतनहीि कमागमाहो।फशतेमहबीि कतमदववककेऩासऩबावी
रनययराइसेसहोतोवहवाहनचरासकताहैतथाऐसाववकसभम
-सभम ऩय संशोि धत केनदीमभोटयवाहतननमभ,1989केि नमभ3कीआवशमकताओकीऩूि तकयताहो।/
Anypersonincludinginsured:Providedthatapersondrivingholdsaneffectivedrivinglicenseatthetimeoftheaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.
Provided also that the person holding an effective Learner's license may also drive the vehicle when not used for the transport of goods at the time of the accident and that such a
personsatisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
ऩमोगाथयसीभाएंLIMITATIONS ASTO USE
भारवहनकयनेवाराभार-वाहन-वगयक:ऩॉि रसीसभम-सभमऩयसंशोि धतभोटयवाहनिअधधनमभ,1988केअंतगयतजायीऩरयभटकेतहतमासभम-सभमऩयसंशोि धतभोटयवाहनिअधधनमभ1988कीधाया66कीउऩ-
धाया3केतहतआनेवारेवाहनोकेकेवरउऩमोगकोआववयतकयतीहै ।ऩॉि रसीि नभतनसरखतकोआववयतनहीकयतीहै :
(1) आमोि जतये ि सग ,ऩेस -भेि कग,ि वशसनीमताऩयीकणमाधगतऩयीकणके ि रएउऩमोग कयना।
(2) ि कसीमांि तकयऩसेअसभथयचाि रतवाहनके टोि वग (ि यवाडयके अरावा )कोछोडकयएकटे रयडाइं गकाउऩमोग कयना।
(3) वाहनोभेकभयचाि यमो कोछोडकयमाि तमोको (डाइवयके अरावा )ऩंजीकयणदसतावेजभेअनुभतसंखमासेिअधकऔयकभयचायीके भुआवजािअधधनमभ 1923के दामये सेऩये ,रेजानाहे तुउऩमोग कयना।
The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor Vehicle's Act
1988.The Policy does not cover:(1) Use for organised racing, pace-making, reliability trial or speed testing.(2) Use whilst drawing a trailer except the towing (other than for reward) of any
one disabled mechanically propelled vehicle.(3) Use for carrying passengers in the vehicles; except employees (other than the driver) not exceeding the number permitted in the
registrationdocument and coming under the purview of Workmen's Compensation Act 1923
The policy does not cover liability for death, bodily injury or damage as excluded in section 150(2) (a)(ii) and (iii);(b) and (c) of the Motor Vehicle Act,1988 as amended from time to time"
सभम-सभमऩयसंशोि धतभोटयवाहनिअधधनमभ,1988कीधाया150(2)(क)(ii)औय(iii)(ख)औय(ग)केअनुसायऩॉि रसीभत
ृ मु,शायीि यकचोटमाककतके ि रएदे मताकोकवयनहीकयतीहै ।
TP RATEREVISION NOTICE
For all policies having an effective date on or after1st 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.
भै/हभएतदवायाऩभाि णतकयतेहैि कऩॉि रसीि जससे महऩभाण-ऩतसंफंि धतहैएवंमहफीभाऩभाण-ऩतसभम-सभमऩयसंशोि धतभोटयवाहनिअधधनमभ,1988केअधमामXIकेऩावधानोकेअनुसायजायीि कमेगएहै। 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 XI of M.V. Act, 1988 as
amended from time to time.
जायीकतायकामायरमकाऩूयाऩता Full address of Issuing Office: HYDERABAD-MADINAGUDABCG 6
FAST TAG NO: 245657137
Vijaya Krishna Residency, Near St Anns School, Madinaguda, Hyderabad, - 500049
जायीकयनेकीि ततथDateofissue:25/11/2024
भुदणकीतायीखPrintedon25/11/2024 आई.डी.दायाbyID:73311,सहामताAID:73566 ऩष
ृ सं.Pageno:5
कृतेनेशनरइनशमोये नसकभऩनीि सरभटे डकभऩनीि सरभटे ड For and on behalf of
National Insurance Company Limited
ि ववधवतधगठतअटॉनी(ओ) Duly Constituted Attorney(s)
भुदणकीतायीख Printedon25/11/2024 आई.डी.दायाbyID:73311,सहामताAID:73566 ऩष
ृ सं.Pageno:6
