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Address of Issuing Office : Address of Servicing Branch Office :

Reliance General Insurance Co. Ltd Reliance General Insurance Co. Ltd
Rectifier House, Naigaum Cross Road, 570 Policy Servicing Branch address : Flat No-10-15, 14th Floor, Vijaya
Wadala (W), Mumbai - 400 031, India Building, 17, Barakhamba Road , Connaught Place, New Delhi - 110001
Delhi Delhi 110001, India
Branch Contact No. 011-39975617

Burglary and Housebreaking Insurance Policy


Master Policy No : 9202952911000011 Policy Certificate No : 1301952911182841
Proposal / Covernote No: P1301952911182841
Date of proposal & declaration : 28/08/2015
Name of the Insured : Kisan Dere
Address of the Insured : 9, Rh-57, Dnyan Sarita Chs, Near Model College, Midc, Dombivli East, City : Thane, State : Maharashtra, PinCode :
421201,
Telephone No : , Mobile No : 9920578560
, Email ID : vdere03@gmail.com
Period of Insurance : From : 28/08/2015 To : 27/08/2016
Description and situation of the premises containing the property insured :
Address :
9, Rh-57, Dnyan Sarita Chs, Near Model College, Midc, Dombivli East, City :Thane, State : Maharashtra, PinCode : 421201
Property Insured :
Make and Description Model No. Serial No. Identification No. Year of Mfg. Total Sum
Insured (in Rs.)
HP Pavilion Notebook 15- 5CD528014Y 90046593 2015 56000.00
ab032TX

Extensions :
The policy covers THEFT as an extension.
Premium Details Amount (Rs.)
Net Premium : 280.00
Add: Service Tax (14.00% of Net Premium) : 39.20
Total Premium : 320.00
(Service Tax Registration Number: AABCR6747BST001)
Category-General Insurance Business Service 00440005)
Category-General Insurance Business Service 00440005.
Consolidated Stamp Duty Paid with Receipt No. MH006126164201415E Dated 02 Mar 2015 ** Not Applicable for the State of Jammu & Kashmir
Note : In the event of dishonor of cheque, this policy document automatically stands cancelled from inception, irrespective of
whether a separate communication is sent or not.
In witness whereof this policy has been signed at Corporate Group - Delhi on 29-Aug-2015
For any assistance with claims, please contact us on 1800 3009 (toll free) or email us at services.rgicl@relianceada.com.
For Reliance General Insurance Company Limited

Duly Constituted Attorney(s)


Agent Code/Name : Direct/Direct

Insurance is the subject matter of Solicitation. IRDA of India Registration No. 103
Corporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited.
Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.
Corporate Office: 570, Rectifier House, Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai 400031.
"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General
Insurance Company Limited under License An ISO 9001:2008 Certified Company

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