THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Commercial Vehicle PackagePolicy

UIN Number - IRDAN190RP0044V01100001

Insured's Details Policy Details

Insured's Name: KARTHIKA G Policy number: 73070331190100001234
Customer ID: PO75638272 (PAN No :NA) Period of cover: 20/11/2019 05:29:36 PM to 19/11/2020
11:59:59 PM
Insureds Address: W/O, GANESH KUMAR,80/1, KOOTTAPPALLI Registration no. TN-34-V-0301
, SAYAVUKAADU,TIRUCHENGODE,
EMAPALLI ,TAMIL NADU, 637214
Prev. Policy no. NA Make/Model: TRACTOR IN/REACH STACKERS 10 TON
Email: omsakthiraja@gmail.com Receipt no. 73070381190000001430 - 20/11/19
Phone Number : / / 9442384041 Fax Number : NA / NA

GSTIN/UIN 33AAQFV1384A1Z9 / NA
Issuing office New India Contact
Address SAWYER PURAM MICRO OFFICE (730703), Agent / Corp. Agent /
10/57, Main Road, Sawyerpuram, Tuticorin Dist. - 628 251 , , , Broker / Banc Mr. Manickam P -
TAMIL NADU , 628251. Assurance / Referral
Code - Name / (NIAAG00098559)
POS/IMF/SPECIFIED
PERSON
Phone no 04612321528 / / 9894501110
Phone no 04630273006 Fax no. /
Fax no. NA / NA Email insurancemanickam@gmail.com /
Email nia.730703@newindia.co.in Development officer DI_SAWYER PURAM MICRO OFFICE DI_SAWYER
level Name/Code PURAM MICRO OFFICE - (DI730703)
Claim Contact SAWYER PURAM MICRO OFFICE (730703) Claim Contact Detail 10/57, Main Road, Sawyerpuram, Tuticorin Dist. - 628
251,,;04630273006//
GSTIN 33AAACN4165C4ZV
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/C Year of manufacture: 2014
Type of Commercial Vehicles: D - Misc-Special Type Sub Type: DRILLING RIGS
Name of the Financier: Chassis no./Engine no.: ZZKDV9902WDRD01123K14/10004W
T19E337668K14
Type of fuel: Diesel Cubic capacity ( cc): 0
Type of body: Open Gross Vehicle Weight (GVW): 0
Seating capacity including Driver: 1 Variant: AGROLUX 80 4WD
Automobile Association Colour: GREEN BLACK
membership:
Cover Note No/Cover Note Issue / Name of registration authority: Trichengode
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
1410000 0 0 0 0 1410000
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Overturning LL to Non-fare Paying Passengers
(Employee of Insured but not Workmen
under WCA), LL to paid driver conductor
cleaner employed for oprn

OD Premium in ` 13931 TP Premium in ` 6972

Net Premium in `: 20903
GST in `: 3762
Total Payable in `: 24665
Total Payable in `(in words): RUPEES TWENTY-
FOUR THOUSAND
SIX HUNDRED
SIXTY-FIVE ONLY

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 73070331190100001234Document generated by AG_0103507 at 20/11/2019 17:29:38 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: 2019.11.20
For 17:29:41
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.

Page 1 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

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 3 respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
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 Up to ` 7,50,000
For individual covers (OD) in `: 1410000
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 7050
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(`) Nominee Relationship
NA NA NA NA

Premium and GST Details

Rate of Tax Amount in INR

Premium ` 20903.00
SGST 9 1881
CGST 9 1881
IGST 0 0

In witness where of this policy has been signed at Mumbai on this 20/11/2019
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: 20/11/2019

(MR GANESAN K)
[ DIV MANAGER]

Duly Constituted Attorney(s)

Policy No. : 73070331190100001234Document generated by AG_0103507 at 20/11/2019 17:29:38 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.

Page 2 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Tax Invoice No : 73070319P0001517

IRDA Registration Number: 190

Policy No. : 73070331190100001234Document generated by AG_0103507 at 20/11/2019 17:29:38 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.

Page 3 of 3