THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Two Wheeler Package Policy

UIN Number - IRDAN190RP0043V01100001

Policy Number :31878856478779

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
DO 710100 (710100), NAME: DIRECT BUSINESS - (2D4949735) CHENNAI (710001)
BOMBAY MUTUAL BUILDING 6TH FLOOR 232 Mr. Shaik Mohammed M S - (NIA2D3900690), ADDRESS: Macmillan House,2nd Floor, "B" Block
NSC BOSE ROAD, CHENNAI , , , PHONE NUMBER: / / 9841828123 21,Patullos Road,Chennai 600002 , , , TAMIL NADU ,
TAMIL NADU , 600001. LAND/FAX NUMBER:/ 600002.
PHONE NUMBER:23456751 / 23456753 EMAIL:[email protected] / PHONE NUMBER: 04428888700 /
FAX NUMBER:23456752 / NA MOBILE NUMBER:
Email:[email protected] Email: [email protected]

INSURED DETAILS
Insured Name VASANTHI V Customer ID PO75687669 (PAN No :NA)
Insured Address NO:33290 3RD MAIN ROAD MANALI, Contact Number / / XXXXXX2587
CHENNAI,TAMIL NADU, 600068
Email [email protected]
GSTIN NA

POLICY DETAILS
Period of cover 28/02/2025 12:00:01 AM to 27/03/2026 11:59:59 PM Receipt Number 10000089221000095528 -
01/01/19
Previous Insurer THE NEW INDIA ASSURANCE COMPANY LTD. Previous Policy Number 02778

VEHICLE DETAILS
Registration Number TN-18-AT-8840 Chassis no./Engine Number ME1RG062BJ0077935/G3
C7E0168482
Make / Model YAMAHA/YZF R15 Variant: YZR15
Year of manufacture 2019 Type of body / Type of Fuel Metal/Petrol
Colour BLUE Cubic capacity(cc) 155cc
/Wattage(kW):
Seating capacity including 2 Name of registration Chennai
Driver authority
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 kit Total Value
92000 0 0 0 0 92000
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 470 Basic TP Premium 119
(-)Calculated Voluntary Deductible Discount 117 (-)Discount over Base TP Premium for Restricting TPPD 275
cover to Rs6000
Calculated OD Premium 353 Calculated TP Premium 1468
Total OD Premium 353 Total TP Premium 1468
Net Premium in Rs 1821
GST in Rs 328
Total Payable in Rs 2149
Total Payable in Rs(in words): RUPEES TWO THOUSAND ONE HUNDRED FORTY-NINE ONLY
GSTIN(Issuing Office) 33AAACN4165C4ZV
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. 6000

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

For individual covers (OD) in RS:43000 Compulsory excess in Rs:100

Imposed excess in Rs:0 Voluntary excess in Rs:1000
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
NONE 0 NONE 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 1025.00
SGST 9 92
CGST 9 92
IGST 0 0

In witness where of this policy has been signed at DO 710100 on this 05/10/2022WARRANTED 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 http://newindia.co.in; IMT Endorsement Number(s)
printed herewith attached 20,22,25.
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.

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: 05/10/2022

(MRS. R NIRMALA)
[Sr. Divnl. 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 : 71010022P0018821

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C
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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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