THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Commercial Vehicle Package Policy

UIN Number -

Insured's Details Policy Details

Insured's Name: ALI AKBAR Policy number: 76280031180100014908
Customer ID: PO63368906 (PAN No :NA) Period of cover: 29/09/2018 12:00:01 AM to 28/09/2019
11:59:59 PM
Insureds Address: HAMSA Registration no. KL-52-L-9563
VALLATHIL HOUSE
MARAYAMANGALAM POST
PALAKKAD,,,
NELLAYA ,KERALA, 679335
Prev. Policy no. 4412023120184320 Make/Model: TATA MOTOR/BUSES
Email: Receipt no. 76280081180000015644 - 28/09/18
Phone Number : / / 9562086637 Fax Number : NA / NA

GSTIN/UIN NA / NA
Issuing office New India Contact
Address PERINTHALMANNA DO (762800), Agent / Corp. Agent /
1ST FLOOR, V.V. COMPLEX, CALICUT ROAD , Broker / Banc Mr. Anver Sadath V -
PERINTHALMANNA , , , Assurance / Referral
KERALA , 679322. Code - Name / (NIAAG00061319)
POS/IMF/SPECIFIED
PERSON
Phone no / / 9947034068
Phone no 4933220040 Fax no. /
Fax no. NA / NA Email /
Email nia.762800@newindia.co.in Development officer BRANCH MANAGER.. DIRECT - (1D4316939)
level Name/Code
Claim Contact PERINTHALMANNA DO (762800) Claim Contact Detail 1ST FLOOR, V.V. COMPLEX, CALICUT ROAD ,
PERINTHALMANNA,,;4933220040//
GSTIN 32AAACN4165C4ZX
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/C Year of manufacture: 2017
Type of Commercial Vehicles: C - Passenger Carrying Sub Type: C2-Four Wheeler(Carrying >6)
Name of the Financier: Chassis no./Engine no.: MAT513102H7H12119/497TC41HSY8
25834
Type of fuel: Diesel Cubic capacity ( cc): 3783
Type of body: Bus Gross Vehicle Weight (GVW): 0
Seating capacity including Driver: 34 Variant: LP712/38 28S DELUXE BUS FBV BS
III
Automobile Association none Colour: BLUE WHITE AND GREY
membership:
Cover Note No/Cover Note Issue / Name of registration authority: Pattambi
Date:
Transit From NA Transit To NA Distance Covered NA
IDV(In `) Based on annexure-I
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
1400000 0 0 0 0 1400000
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Compulsory PA cover for Owner Driver
(Sum Insured `15,00,000), Legal liability
to passangers, LL to paid driver conductor
cleaner employed for oprn
NCB(20%)
OD Premium in ` 5673 TP Premium in ` 39031
Net Premium in `: 44704
GST in `: 8046
Total Payable in `: 52750

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 76280031180100014908Document generated by 28119 at 28/09/2018 19:01:50 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2018.09.28
For 19:01:52
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
IST
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.

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

Total Payable in `(in words): RUPEES FIFTY-TWO

THOUSAND SEVEN
HUNDRED FIFTY
ONLY

Limitations as to use Limits of Liability

The Policy covers use only under a permit within the meaning of the Limit of the amount the Company's Liability Under Section II 1(i) in
Motor Vehicles Act, 1988 or such a carriage falling under Sub-Section respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
(3) of Section 66 of the Motor Vehicles Act, 1988.The Policy does not of the amount of the Company's Liability Under Section II 1(ii) in
cover use for a)Organised racing b)Pace Making c)Reliability Trials d) respect of any one claim or series of claims arising out of one event:
Speed Testing e) Use whilst drawing a trailer except the towing (other Up to ` 7,50,000
than for reward) of any one disabled Mechanically propelled vehicle.
For individual covers (OD) in `: 1400000
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 1000
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
NA NA NA N N
PA cover for named persons
Name CSI Opted(`) Nominee Relationship
NA NA NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium ` 44704.00
SGST 9 4023
CGST 9 4023
IGST 0 0

In witness where of this policy has been signed at Mumbai on this 28/09/2018
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 web site
http://newindia.co.in; IMT Endorsement Number(s) printed herewith attached 21,40.
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.
I/We hereby certify that the policy to which this Certificate relates as For and on behalf of The New India Assurance Company Limited.
well as this Certificate of Insurance are issued in accordance with
the provisions of Chapter X and XI of M.V. Act, 1988. NIA S.T.REGN
No: AAACN4165CST178.
Date of Issue: 28/09/2018

Duly Constituted Attorney(s)

Tax Invoice No : 7628003101014908

IRDA Registration Number: 190

Policy No. : 76280031180100014908Document generated by 28119 at 28/09/2018 19:01:50 Hours.

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

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