THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Bundled Motor Policy for Two Wheeler - Enhanced Covers

UIN Number - IRDAN190RP0022V02201819

Policy Number :76110531240900006491

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
ALATHUR BRANCH (761105), NAME: DI_ALATHUR DI_ALATHUR - (DI761105) Palakkad Non Suit Claim Hub (769009)
A R MALL ,COURT ROAD, ALATHUR , Mr. Majan Paul.C - (NIAAG00072716), ADDRESS: N S TOWERS ,I ST FLOOR , NEAR STADIUM
PALAKKAD DISTRICT , , , PHONE NUMBER: / / 9961490775 BUS STAND,COIMBATORE ROAD , PALAKKAD -
KERALA , 678541. LAND/FAX NUMBER:/ 678013 , , , KERALA , 678013.
PHONE NUMBER:04922222901 / EMAIL:palayoormotors@[Link] / PHONE NUMBER: 04912545643 /
04922224901 / 4922224901 MOBILE NUMBER:
FAX NUMBER:NA / NA Email: ch769009@[Link]
Email:nia.761105@[Link]

INSURED DETAILS
Insured Name KAVYA .T.N Customer ID POB6151782 (PAN No :NA)
Insured Address KUNNATH HOUSE , KARUMATHRA POST , Contact Number / / XXXXXX9941
KARUMATHRA , THRISSUR ,,,
ENKAKAD ,KERALA, 680589
Email
GSTIN NA

POLICY DETAILS
Period of cover OD Cover 09/08/2024 [Link] PM to 08/08/2025 Receipt Number 76110581240000007496 -
[Link] PM 09/08/24
TP Cover 09/08/2024 [Link] PM to 08/08/2029
[Link] PM
Previous Insurer Not applicable Previous Policy Number NA

VEHICLE DETAILS
Registration Number New Vehicle Chassis no./Engine Number MB8DP12PGR8A13306/AF
218062247
Make / Model SUZUKI/ACCESS 125 Variant: DISC BRAKE
Year of manufacture 2024 Type of body / Type of Fuel Metal/Petrol
Colour GREENISH BLUE Cubic capacity(cc) 125cc
/Wattage(kW):
Seating capacity including 2 Name of registration
Driver authority
Geographical Area / Zone India Name of the Financier KERALA GRAMIN BANK
Cover Note No/Cover Note / Automobile Association none
Issue Date: membership
INSURED DECLARED VALUE (in Rs)
Year Duration Vehicle Trailer Non-Elec Acc Electrical Acc Bi- Total Value
fuel/CNG/LP
G kit
First Year 09/08/2024 to 08/08/2025 87570 0 0 0 0 87570

Cover Description Cover Opted Cover Description Cover Opted Cover Description Cover Opted
Consumable Items Cover No Engine Protection Cover No Nil Depreciation Cover Yes
Return to Invoice Cover No Road Tax No No Claim Bonus Protection No
Cover
Roadside Assistance Cover No
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 881 Basic TP Premium 770
(+)Premium for nil depreciation cover 105.08 (+)Compulsory PA Premium for Owner Driver(Sum 275
Insured Rs 1500000)(09/08/2024 to 08/08/2025)
Signature Not
Calculated
Verified OD Premium 986 Calculated TP Premium 1046
Digitally signed
Total
by OD
DHIRAJPremium 986 Total TP Premium 4130
KUMAR
Net Date:
Premium in Rs
2024.08.09 5,116
[Link] IST
GST in Rs 920
Página 1 de 3

Page 1 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Total Payable in Rs 6,036

Total Payable in Rs(in words): RUPEES SIX THOUSAND THIRTY-SIX ONLY
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:Limit of the amount the Company's Liability Under Section II 1(i) in respect of any one accident: as per the Motor Vehicles
Act, 1988. Limit of the amount of the Company's Liability Under Section II 1(ii) in respect of any one claim or series of claims arising out of one
event: Up to Rs. 1,00,000
For individual covers (OD) in RS:87570 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.
PA cover for Owner Driver
Name of Nominee Age of Nominee Relationship with the Name of the Appointee (if Relationship to the
Insured Nominee is a minor) Nominee
ARAVIN 42 SPOUSE NA NA
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
none 0 NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium Rs 5,116
SGST 9 460
CGST 9 460
IGST 0 0
KERALA FLOOD CESS 0 0

In witness where of this policy has been signed at ALATHUR BRANCH on this 09/08/2024WARRANTED 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 Package/Liability policy attached/available on the web site [Link] IMT Endorsement Number(s)
printed herewith attached 22,25.
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.

The compulsory Personal Accident cover opted is valid for a period of one year. Insured is required to renew the cover on due date to keep
the cover active during policy period.
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.
The policy is subject to TWEC endorsement attached.
Date of Issue: 09/08/2024

(Mr. SUDHEEP N K)
[SR. BUSINESS MANAGER]

Duly Constituted Attorney(s)

Página 2 de 3

Page 2 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

BUNDLED MOTOR POLICY FOR TWO WHEELERS - ENHANCED COVERS

(Endorsement Wording for Add on cover - Nil Depreciation)
UIN Number - IRDAN190RP0022V02201819/A0031V02201819

TWO WHEELER INSURANCE POLICY ENHANCED COVERS ENDORSEMENT ATTACHED TO AND FORMING PART OF POLICY
NO.76110531240900006491
Additional Premium: Rs. 105.084

Notwithstanding anything contained to the contrary in the within mentioned policy it is hereby declared and agreed that subject to the
insured having paid the Additional premium as applicable the cover under Section I of the within mentioned policy is hereby extended to
the effect that in the event of any partial loss claim admissible under this policy, no depreciation shall be deducted for the replaced parts
payable under the claim.

Subject to the condition that the above said coverage shall be applicable only for any two partial loss claims admitted and payable under
the policy relating to an accident during the policy period.

Further No claim shall be payable :

[Link] any extra fittings and / or any internal improvements in the policy other than provided by the manufacturer in the vehicle originally.

[Link] relation to any accident occurring in any geographical area outside India.

[Link] the two admissible claims under the Enhanced Cover during the current policy period.

All other terms and conditions of the within mentioned policy shall remain unaltered.

For and on behalf of The New India Assurance Company Limited

Date of Issue: 09/08/2024

(Mr. SUDHEEP N K)
[SR. BUSINESS MANAGER]

Duly Constituted Attorney(s)

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 : 76110524P0007019

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Página 3 de 3

Page 3 of 3