s

ur
Ho
Issuing Office Name & Address

: 00
Mumbai Direct Agents Branch II,First Floor, Sterling Cinema Building, 65,

:00
Murzaban Street, Fort, Mumbai, Pin : 400001 ,Telephone No: 18003450330

00
Email ID: [email protected]
GSTIN No: 27AAACN9967E1Z3

m
ro
RECEIPT

yf
lic
Customer Details Collection Details

Po
Name : KRISHNA CHANDRA SINGH YADAV Agent Code : 91067500000001

ge
Mobile No : 9415002107 Collection Number : 26020181225000449377
Email : [email protected] Collection Date : 03/03/2023

ka
Bank Account : 9100

c
Pa
Received with thanks from Sri/Smt KRISHNA CHANDRA SINGH YADAV

ar
a sum of 1040 (RUPEES ) by ONLINE

Ye
towards 1 Year Package Policy Policy as per details given hereunder

61
Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount

32
No. Year Number (General Ledger) Received

49
04
23
1 26020131226230449326 11 CASH PREMIUM A/C 5083 881.00 0.00 881.00
26
2 26020131226230449326 11 IGST_KA_Int_Liab 7345 159.00 0.00 159.00
12

TOTAL : 1040.00 0.00 1040.00

13
20

Particulars : ONLINE
60
:2

For National Insurance Company Ltd.,

No

1.Please quote collection no. and date in all correspondeces

2.The stamp has been defaced and retained at the office against the issued
cy

policy.
oli
.P
td

Authorised Signatory
yL
an
mp
e Co
nc
a
ur
Ins
l
na
tio
Na

NIC/PHONEPE/91067500000001 03/03/2023 04:32 P.M.

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
-1-
 Issuing Office Name & Address
MUMBAI DIRECT AGENTS BRANCH II , FIRST FLOOR, STERLING CINEMA
BUILDING, 65, MURZABAN STREET, FORT, MUMBAI, PIN : 400001
Telephone No: 18003450330 Email ID: [email protected]
GSTIN No: 27AAACN9967E1Z3

National Insurance Company Ltd.

Registered & Head Office: 3, MIDDLETON STREET, POST BOX NO. 9229, KOLKATA - 700 071
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989

4
02
Policy No: 26020131226230449326 1 Year Package Policy from 00:00 Hrs of 06/03/2023 to Midnight of 05/03/2024 IXI

3/2
Insured Details

5/0
Name : KRISHNA CHANDRA SINGH YADAV

f0
Mobile No : 9415002107 Email : [email protected]

to
PAN No. : GSTIN No. :

igh
Channel : PHONEPE INSURANCE BROKING SERVICES PRIVATE LIMITED Tele. No: 080-68727888 Email : [email protected]

dn
Aadhar : PAN : xxxxxx058K Code. : 260201 / 91067500000001

Mi
Vehicle Details

to
Make & Model Two Wheeler TVS STAR CITY ALLOY WHEELS

23
Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District

-20
UP-78-EA-1130 70256 70543 STREET 110 2015 1+1 KANPUR NAGAR

ar
Geographical Area : INDIA.

6-M
Registration Date : 29/08/2015

n0
Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV

so
Rs.16,959 - - - - Rs.16,959

ur
Ho
OD Premium Breakup in Rs. TP Premium Breakup in Rs.

:00
Basic OD Premium 238.78 Basic TP Premium 714.00
(+) Geographical Area Extension - (+) Geographical Area Extension -
:00
(-) Vol. Excess Discount - (+) WC for Driver -
00

(-) Auto. Assoc Discount - (+) PA to owner driver -

m
ro

(-) Anti-theft Discount - (+) PA to unnamed PAX -

yf

(-) Other Discount - -71.63 (-) Discount For Limited TPPD -

lic

(-) NCB Discount TP Total (Rounded Off) 714.00

Po

(+) Nil Depreciation - OD Total (Rounded Off) 167.00

ge

(+) Nil Depreciation Plus - TOTAL PREMIUM 881.00

ka

(+) NCB Protect - GST 159.00

P ac

(+) Engine Protect - NET PAYABLE 1,040.00

ar

(+) Invoice Protect - Collection Number :26020181225000449377 dated 03-Mar-2023

Ye

OD Total (Rounded Off) 167.00 Subject to IMT Endorsement No. 16,22,22A,29

1
26

Excess : Compulsory: Rs. 100 Imposed: Rs.0 Voluntary: Rs. 0

Limitation as to use : Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover use for hire or reward, tuition, racing, pace making,
93

reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any trade or business or use for any purpose in connection with Motor
44

Trade
Drivers Clause : 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
30

license, Provided also that the person holding an effective Learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central
62

Motor Vehicles Rules, 1989.

Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
22

Under section 1(ii) Damage to third party property is Upto Rs. 1,00,000 .
31

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 the reason of wider terms
appearing in the certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND
01

RIGHT OF RECOVERY" No Claim Bonus will only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy. No Claim Bonus is subject to no
02

claim on the previous policy. Benefits under the policy stands forfeited if claim is/was made in previous policy. For legal interpretation, the English version will hold good.
FINANCIER NAME :
26

Prev Policy : The New India Assurance Company Ltd. (Pol No: 42030031160300001884 Expiry Date: 01/09/2017)
o:
yN

Nominee Name : Relation : Age :

Disclaimer Note : It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'.
lic

In the event of misrepresentation, fraud or non-disclosure of material fact, the Company reserves the right to cancel the Policy. The policy is issued based on the information provided by you, which is available
Po

with the company. In case of discrepancy/non recording of relevant information in the policy, the insured is requested to bring the same to the notice of the company within 15 days. This Policy is to be read in
conjunction with the Policy wordings available on the website https://nationalinsurance.nic.co.in of the Company. On renewal, the benefits provided under the policy and/or terms and conditions of the policy
including premium rate may be subject to change.
d.

I/We hereby certify that this Certificate cum Schedule of Insurance is issued in accordance with the provisions of chapter X and chapter XI of Motor Vehicles Act,1988.
y Lt
an
mp

Authorised Signatory
Co

For & On behalf of

National Insurance Company Limited
ce
an
ur
lIns
na
tio
Na

NIC/PHONEPE/91067500000001 03/03/2023 04:32 P.M.

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email: [email protected]