THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Package Policy

Insured's Details Policy Details

Insured's Name: MR.VIJAY RAMCHANDRA PAWAR. Policy number: 11280031180100000944
Customer ID: PO37600178 (PAN No :NA) Period of cover: 21/11/2018 12:00:01 AM to 20/11/2019
11:59:59 PM
Insureds Address: B-12, 178 GRD. FLOOR, ADARSH NAGAR, Registration no. MH-02-CH-4647
VEER NARIMAN ROAD, WORLI, MUMBAI,,,
MUMBAI ,MAHARASHTRA, 400030
Prev. Policy no. 11280031170100000894 Make/Model: TOYOTA/ETIOS LIVA
Email: omkar33pawar@gmail.com Receipt no. 10000089181100175374 - 19/11/18
Phone Number : / / 9833843261 Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address D.O. 112800 (112800), Agent / Corp. Agent /
NEW INDIA CENTRE, , 17/A, COOPERAGE ROAD, , MUMBAI , Broker / Banc Mr. Vijay S. Pawar -
MAHARASHTRA , 400039. Assurance / Referral
Code - Name / (NIA1D13697449)
POS/IMF/SPECIFIED
PERSON
Phone no 9820187434 / /
Phone no 22814720 / 22814721 Fax no. /
Fax no. 22844394 / NA Email vsp306@gmail.com /
Email nia.112800@newindia.co.in Development officer MANGESH T. SAWANT - (1D13699146)
level Name/Code
Claim Contact MRO-I (110001) Claim Contact Detail New India Centre, 12th Floor, 17/A, Cooperage Road,
Mumbai 400039,,;02222020693//
GSTIN 27AAACN4165C3ZP
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/A Year of manufacture: 2012
Name of the Financier: KOTAK MAHINDRA PRIME LTD. Chassis no./Engine no.: MBJK49BT000005541/1ND1212734
Type of body: Saloon Variant: 1.4 GD
Automobile Association none Colour: S SILVER
membership:
Seating capacity including Driver: 5 Cubic capacity ( cc): 1364
Cover Note No/Cover Note Issue / Name of registration authority: Mumbai West
Date:
IDV(In `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
239454 0 0 0 0 239454
Cover Description Cover Opted Cover Description Cover Opted
Additional Towing Charges No Engine Protection Cover No
Return to Invoice Cover No Road Tax No
No Claim Bonus Protection Cover No Loss of Contents Cover No
High Value PA Cover No Personal Belongings Cover No
Consumable Items Cover No
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Compulsory PA cover for Owner Driver
(Sum Insured `15,00,000),PA cover for
UnNamed Persons, LL cover for Paid
Driver
NCB(50%)
OD Premium in ` 1651 TP Premium in ` 4163
Net Premium in `: 5814
GST in `: 1046
Total Payable in `: 6860

Policy No. : 11280031180100000944Document generated by QR_RENEWAL at 19/11/2018 10:07:56 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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