THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Commercial Vehicle Package Policy Enhanced Covers

UIN Number - IRDAN190RP0044V01100001

BUSINESS CHANNEL/CPSC User:

POLICY ISSUING OFFICE: NAME: M.O.GHATAMPUR (420106) - CLAIM CONTACT:
GHATAMPUR (420106), KANPUR ( 4 2 0 0 0 1 )
(DI00001074) ADDRESS: 15 / 60,, GREEN HOUSE, CIVIL LINES ,
106, SHIV PURI WEST, MOOSA NAGAR ROAD, Mr. Pushpendra Singh Sengar - (NIAAG00063500),
, , , KANPUR - 208005 , , , UTTAR PRADESH , 208001.
PHONE NUMBER: / / 9 9 1 8 5 5 3 5 6 1
UTTAR PRADESH , 209206. LAND/FAX NUMBER:/ PHONE NUMBER: 05122305012 /
PHONE NUMBER:05115270028 EMAIL: / [email protected] MOBILE NUMBER:
FAX NUMBER:NA / NA Email: [email protected]
Email:[email protected]

INSURED DETAILS
Insured's Name SHRAVAN KUMAR Customer ID POA1069562 (PAN No
:GGIPK9633R)
Insured's Address S/O OM PRAKASH, JAHANGIRABAD, Contact Number / /
PATARA, GHATAMPUR, KANPUR NAGAR ,,,
GHATAMPUR ,UTTAR PRADESH, 209206
Email
GSTIN NA

POLICY DETAILS
Period of cover 09/04/2024 01:15:55 PM to 08/04/2025 11:59:59 PM Receipt Number 42010681240000000015 -
09/04/24
Previous Insurer Not Previous Policy Number NA
applica
VEHICLE DETAILS
Geographical Area / Zone: India/C Year of manufacture: 2024
Type of Commercial A - Goods Carrying SubType: Other than 3 wheeler
Vehicles: - Public Carrier
Name of the Financier: HDFC BANK LTD . Chassis no./Engine no.: MAT566018R1B03269/B67
B62300D05142A64361673
Type of fuel: Diesel Cubic capacity ( cc): 0
Type of body: Tipper Gross Vehicle Weight 47500
(GVW):
Make/Model: TATA MOTOR/ TATA SIGNA 4 8 3 0 . T TRUCK Registration no. UP-78
Seating capacity 2 Variant: TATA SIGNA 4830.TK BS-
including Driver: VI TIPPER
Automobile Association Colour: Other
membership:
Cover Note No/Cover / Name of registration Kanpur - Urban
Note Issue Date: authority:
FASTag ID:

INSURED DECLARED VALUE (Rs)

Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
5890000 0 0 0 0 5890000

ENHANCED COVER
Nil Depreciation Add On Cover

Signature Not
Verified

Digitally signed
by DHIRAJ
KUMAR Policy No. : 42010631240300000025Document generated by 22638 at 2024/04/09 15:25:31.
Date: 2024.04.09 Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
15:25:31 IST Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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 office.In 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 http://newindia.co.in.

Page 1 of 4
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 10166 Basic TP Premium 44242
(+)Additional premium for GVW above 12000KG 958.5 (+)LL to paid driver conductor cleaner employed for
(+)Loading for Additional Towing Coverage 500 oprn 100
(+)Loading for Inclusion of IMT 23 1668.7 (+)LL to persons employed for opn and/or maint.and/or
(+)Nil Depreciation Cover Premium 24286.3 loading and/ or unloading( 1 ) 50
(+)Premium for enhancement cover 24286.3
Calculated OD Premium 35911 Calculated TP Premium 44392
Total OD Premium (Rs) 35911 Total TP Premium (Rs) 44392
Net Premium (Rs) 80,303
GST (Rs) 11,800
Total Payable (Rs) 92,103
Total Payable in Rs(in words): RUPEES NINETY-TWO THOUSAND ONE HUNDRED THREE ONLY
GSTIN(Issuing Office) 09AAACN4165C4ZM
SAC 997134 (Motor vehicle insurance services)
Limitation as to use:The Policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage
falling under Sub- section 3 of Section 6 6 of the Motor Vehicles Act, 1 9 8 8 . The Policy does not cover use FOR a) Organised racing b) Pace
Making c) Reliability Trials d) 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:5890000 Compulsory excess in Rs:1500
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
none 0 none none none
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
NA NA NA NA
Premium and GST Details
Rate of Tax Amount in INR

Premium Rs36061
SGST 9 3245
CGST 9 3245
IGST 0 0
Premium Rs44242
SGST 6 2655
CGST 6 2655
IGST 0 0

In witness where of this policy has been signed at GHATAMPUR on this 09/04/2024
WARRANTED 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 website
http://newindia.co.in ; IMT Endorsement Number(s) printed herewith attached 21,23,40,7 .

Important noti

Policy No. : 42010631240300000025Document generated by 22638 at 2024/04/09 15:25:31.

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 https://www.newindia.co.in/portal/policyFeedbackGen.
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 office.In 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 http://newindia.co.in.

Page 2 of 4
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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 thencb 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
was Company websi .
I/We hereby certify that the policy to which this Certificate
For and on behalf of The New India Assurance Company Limited
relates 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: 09/04/2024

Duly Constituted Attorney(s)

NIL DEPRECIATION ADD ON COVER UNDER COMMERCIAL VEHICLE PACKAGE POLICY

(Endorsement Wording for Add on cover - Nil Depreciation)

UIN Number - IRDAN190RP0044V01100001/A0009V01202021

ENDORSEMENT ATTACHED TO AND FORMING PART OF POLICY NO. 42010631240300000025

Additional Premium: Rs.24287

In consideration of payment of an additional premium by the Insured, it is hereby agreed and declared that notwithstanding anything
to the contrary contained in the Policy, the Company hereby undertakes to indemnify:

1.Depreciation on replacement of parts including tyres, tubes, rubber / plastic for Partial Loss Claims.
2.Exclusion and depreciation under IMT 21 & IMT 23 respectively (wherever applicable) .
3 .Mi dterm i ncl usi on of cover i s not perm i tted.
4.Total Loss and Constructive Total Loss will be settled on the basis of IDV.
5.Depreciation waiver is applicable for two claims only.

The Company shall not be liable to make any payment in respect of:

1.Replacement of accessories, extra fittings and/or any internal improvements in the Insured Vehicle unless specifically covered in
IDV. 2.Any damage occurred due to overturning in case of Miscellaneous D vehicle, unless covered under the policy by IMT 47.

Subject otherwise to the terms, exceptions, conditions and limitations of this Policy.

For and on behalf of The New India Assurance Company Limited

Date of Issue: 09/04/2024

Duly Constituted Attorney(s)

Policy No. : 42010631240300000025Document generated by 22638 at 2024/04/09 15:25:31.

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 https://www.newindia.co.in/portal/policyFeedbackGen.
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 office.In 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 http://newindia.co.in.

Page 3 of 4
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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 : 42010624P0000019

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 42010631240300000025Document generated by 22638 at 2024/04/09 15:25:31.

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 https://www.newindia.co.in/portal/policyFeedbackGen.
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 office.In 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 http://newindia.co.in.

Page 4 of 4