THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Private Car Liability Policy
UIN Number - IRDAN190RP0001V01200203
Policy Number :67010031240200085392
POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
BANGALORE DO I (670100), NAME: BANGALORE (670001)
CITY DIVISIONAL OFFICE : I, NO. 40, LAXMI Phonepe Insurance Broking Services Private ADDRESS: 2-B, Unity Buildings Annexe, P. Kalinga Rao
COMPLEX, K R ROAD, , OPP:VANIVILAS Limited - (BR00001128), Road (Mission Road), Bangalore - 560027 , , ,
HOSPITAL , BANGALORE , PHONE NUMBER:08068727888 / / 8068727888 KARNATAKA , 560027.
KARNATAKA , 560002. LAND/FAX NUMBER:/ PHONE NUMBER: 22539433 / 22539435
PHONE NUMBER:08026703898 / EMAIL:insurance-support@[Link] / MOBILE NUMBER:
08026702201 / 8026703898 Email: ch67@[Link]
FAX NUMBER:08026703898 / NA
Email:nia.670100@[Link]
INSURED DETAILS
Insured Name MANIESH D B Customer ID POB8961518 (PAN No :NA)
Insured Address Daradahalli mudigere,,, Contact Number / /
MUDIGERE ,KARNATAKA, 577132
Email samyamgowda2003@gmai
[Link]
GSTIN NA
CHANNEL PARTNER CONTACT DETAILS
Channel Partner Name Email Address(s) Contact Number(s)
POLICY DETAILS
Period of cover 24/12/2024 12:00:01 AM to 23/12/2025 11:59:59 PM Receipt Number 67010081240000086584 -
21/12/24
Previous Insurer Previous Policy Number
VEHICLE DETAILS
Registration Number KA-25-Z-1301 Chassis no./Engine Number 19377/26362
Make / Model HONDA/CITY Variant: 1.5 S MT
Year of manufacture 2011 Type of body / Type of Fuel Saloon/Petrol
Colour as per RC Book Cubic capacity(cc) 1497cc
/Wattage(kW):
Seating capacity including 5 Name of registration Dharwar
Driver authority
Geographical Area / Zone India Name of the Financier
Cover Note No/Cover Note / Automobile Association none
Issue Date: membership
FASTag ID:
INSURED DECLARED VALUE (in Rs)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel/CNG/LPG kit Total Value
0 0 N/A N/A 0
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 0 Basic TP Premium 3416
(+) Additional TP Premium for CNG/LPG/Bi-Fuel
Calculated OD Premium 0 Calculated TP Premium 3416
Total OD Premium 0 Total TP Premium 3416
Net Premium in Rs 3,416
Signature Not
Verified
Digitally signed
by DHIRAJ Policy No. : 67010031240200085392Document generated by PHONEPE at 2024/12/21 13:52:33.
KUMAR
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2024.12.21
13:52:33 IST Give your valuable feedback on [Link]
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 [Link] 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 [Link]
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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
GST in Rs 614
Total Payable in Rs 4,030
Total Payable in Rs(in words): RUPEES FOUR THOUSAND THIRTY ONLY
GSTIN(Issuing Office) 29AAACN4165C2ZM
SAC 997134 (Motor vehicle insurance services)
Limitation as to use:The policy covers use for any purpose other than: a)Hire or reward b)Organized racing, OR c)Speed testing
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. 7,50,000
For individual covers (OD) in RS:0 Compulsory excess in Rs:NA
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
As per the declaration given,the Insured has opted out of CPA cover under this policy.
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
none 0 none NA
Premium and GST Details
Rate of Tax Amount in INR
Premium Rs 3,416
SGST 9 307
CGST 9 307
IGST 0 0
In witness where of this policy has been signed at BANGALORE DO I on this 21-DEC-24WARRANTED 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.
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.
Date of Issue: 21/12/2024
Policy No. : 67010031240200085392Document generated by PHONEPE at 2024/12/21 13:52:33.
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 [Link]
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 [Link] 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 [Link]
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THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)
(Ms. MANJULA VISHAL)
[Off. B O INCHARGE]
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 : 67010024P0088538
IRDA Registration Number: 190
NIA PAN NUMBER: AAACN4165C
Policy No. : 67010031240200085392Document generated by PHONEPE at 2024/12/21 13:52:33.
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 [Link]
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 [Link] 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 [Link]
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