THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

The New India Assurance Co.Ltd.

N BLOCK,CONNAUGHT CIRCUS (310300)
Tel. No.: 23723521//
Email: [email protected]/[email protected]

Private Car Package Policy

IRDAN190RP0042V01100001
Policy Number: 31030031210100262919
Vehicle: SKODA/RAPID

Period of Cover
From: 05/12/2021 12:00:01 AM
To: 04/12/2022 11:59:59 PM

Insured Details
Sunita Singh
To: House No.-236 MIG, ADITYAPUR 2 ,,Seraikela-Kharsawan, Jharkha nd- 831013, ,JAMSHEDPUR
,JHARKHAND, 831013

For Insurance Renewals contact

POLICYBAZAAR INSURANCE BROKER PVT LTD
Tel. No.: 18002585970 / /
Email: [email protected] /

For Claims contact our OFFICE

N BLOCK,CONNAUGHT CIRCUS 310300
BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW DELHI,,,110001
Tel. No.: 23723521
Email: [email protected]

Tax Invoice No : 31030021P0279856

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by SRINIVASAN
VAIDESWARAN
Date: 2021.12.02
12:43:08 IST
Policy No. : 31030031210100262919Document generated by Policy Bazaar at 02/12/2021 12:42:46 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Package Policy

UIN Number - IRDAN190RP0042V01100001

Policy Number :31030031210100262919

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
N BLOCK,CONNAUGHT CIRCUS (310300), NAME: N BLOCK,CONNAUGHT CIRCUS (310300)
BOMBAY LIFE BUILDING, N-34, CONNAUGHT Policybazaar Insurance Broker Pvt Ltd - OR
CIRCUS, NEW DELHI , , , (BR00000972), CUSTOMER CARE NUMBER: 1800-209-1415
DELHI , 110001. PHONE NUMBER:18002585970 / /
PHONE NUMBER:23723521 LAND/FAX NUMBER:/
FAX NUMBER:NA / NA EMAIL:[email protected] /
Email:[email protected]

INSURED DETAILS
Insured Name Sunita Singh Customer ID PO93345629 (PAN No :NA)
Insured Address House No.-236 MIG, ADITYAPUR 2 ,,Seraikela- Contact Number / / XXXXXX9279
Kharsawan, Jharkha nd- 831013,,
JAMSHEDPUR ,JHARKHAND, 831013
Email [email protected]
m
GSTIN NA
CHANNEL PARTNER CONTACT DETAILS
Channel Partner Name Email Address(s) Contact Number(s)
Policy Bazaar [email protected] 1800-258-5970

POLICY DETAILS
Period of cover 05/12/2021 12:00:01 AM to 04/12/2022 11:59:59 PM Receipt Number 31030081210000264536 -
02/12/21
Previous Insurer THE NEW INDIA ASSURANCE COMPANY LTD. Previous Policy Number 31030031200100415536

VEHICLE DETAILS
Registration Number JH-05-BB-9500 Chassis no./Engine Number TMBBLDNA9EG012624/CL
N272063
Make / Model SKODA/RAPID Variant: ELEGANCE 1.6 TDI CR MT
Year of manufacture 2014 Type of body / Type of Fuel Saloon/Diesel
Colour As per RC Book Cubic capacity(cc) 1598cc
/Wattage(kW):
Seating capacity including 5 Name of registration Jamsedhpur
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
400000 0 0 0 0 400000

SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 1685 Basic TP Premium 7890
(-)(#)Total NCB Discount(25%) 421.2
Calculated OD Premium 1264 Calculated TP Premium 7890
Total OD Premium 1264 Total TP Premium 7890
Net Premium in Rs 9154

Policy No. : 31030031210100262919Document generated by USRPB at 2021/12/02 12:43:01.

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.
Página 1 de 3

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

GST in Rs 1648
Total Payable in Rs 10802
Total Payable in Rs(in words): RUPEES TEN THOUSAND EIGHT HUNDRED TWO ONLY
GSTIN(Issuing Office) 07AAACN4165C1ZT
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. 7,50,000
For individual covers (OD) in RS:400000 Compulsory excess in Rs:2000
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 NA NA
Premium and GST Details
Rate of Tax Amount in INR
Premium Rs 9154.00
SGST 0 0
CGST 0 0
IGST 18 1648

In witness where of this policy has been signed at N BLOCK,CONNAUGHT CIRCUS on this 02/12/2021WARRANTED 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 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.
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: 02/12/2021

(MS. RASHMI LUCY BARWA)

[SRDivisional Manager]
Duly Constituted Attorney(s)

Policy No. : 31030031210100262919Document generated by USRPB at 2021/12/02 12:43:01.

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.
Página 2 de 3

Page 3 of 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Tax Invoice No : 31030021P0279856

IRDA Registration Number: 190

Policy No. : 31030031210100262919Document generated by USRPB at 2021/12/02 12:43:01.

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.
Página 3 de 3

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

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : N BLOCK,CONNAUGHT CIRCUS (310300)
Address : BOMBAY LIFE BUILDING, N-34, CONNAUGHT CIRCUS, NEW DELHI

,110001
NEW DELHI
Phone : 23723521
Email : [email protected]
Fax :
Collection Number : 31030081210000264536
Collection Date : 02/12/2021
Business Source Code : BR00000972
PAN No of Payer :

Received with thanks from Sunita Singh.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
31030031210100262919 Bank-310300 10802.00 9100.310300 BA00018819-310300-9100
Total = ` 10802.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
ECS 10802.00 PB42744 N.A. N.A. N.A. 31030021626482107 N.A.
331
Total = ` 10802.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
9154.00 1648.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA POLICYBAZAAR INSURANCE BROKER PVT LTD 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 02/12/2021

(MS. RASHMI LUCY

BARWA)
[SRDivisional Manager]

Cashier's Initial Authorized Signatory

Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence. .
2.NIA shall not be liable for any claim arising out of sales made during the period between the due date and date of payment of the
installment if the premium paid has been exhausted by turnover declarations/if there is insufficient premium balance.

Tax Invoice No : 31030021P0279856

IRDA Registration Number: 190

Policy No. : 31030031210100262919Document generated by Policy Bazaar at 02/12/2021 12:42:46 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 5 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMT.22. COMPULSORY DEDUCTIBLE

(Applicable to Private Cars, three wheelers rated as private cars, all motorized two wheelers, taxis, private car type vehicle plying for
public/private hire, private type taxi let out on private hire)

Notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insured shall
bear under Section 1 of the policy in respect of each and every event (including event giving rise to a total loss/constructive
total loss) the first ` 2000 (or any less expenditure which may be incurred) of any expenditure for which provision has been
made under this policy and/or of any expenditure by the insurer in the exercise of his discretion under Condition no 3 of this
policy.

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such
amount shall be repaid by the insured to the insurer forthwith.

For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause
in connection with the vehicle insured in respect of which indemnity is provided under this policy.

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

IMT 22A. VOLUNTARY DEDUCTIBLE (For private cars/motorized two wheelers other than for hire or reward)

It is by declared and agreed that the insured having opted a voluntary deductible of `0 a reduction in premium of ` under
Section 1 of the policy is hereby allowed.

In consideration of the above, it is hereby understood and agreed that the insured shall bear under Section 1 of the policy in
respect of each and every event (including event giving rise to a total loss/constructive total loss) the first `2000 (or any less
expenditure which may be incurred) of any expenditure for which provision has been made under this policy and/or of any
expenditure by the insurer in the exercise of his discretion under Condition no 3 of this policy .

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such
amount shall be repaid by the insured to the insurer forthwith.

For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause
in connection with the vehicle insured in respect of which indemnity is provided under this policy.

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

Tax Invoice No : 31030021P0279856

IRDA Registration Number: 190

Policy No. : 31030031210100262919Document generated by Policy Bazaar at 02/12/2021 12:42:46 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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