National Isurance Company Limited

Registered Office Address :- 3 Middleton Street, Post Box No.9229, Kolkata -700071
Policy issuing Office
179, Civil Lines, Station Road, Bareilly, Uttar Pradesh Pin- 243001
Tele: - 0581 2470705 (D) 2422848 (G)
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
New Policy Prev Policy No : 46131031136700003556
Policy No : 461300/31/14/6700004559 [ Issued on 06/04/2019
Collection No : 46130081140044502748 Collection Date : 06/04/2019
INSURED DETAILS : Name : MR. ANIL KUMAR
Address : R/O VILL PEEPAL NAGRI KAMLA NAGAR BALDEVPURI
MORADABAD UTTAR PRADESH PIN - 244402
Telephone : Profession/Business : Businessmen :
PERIOD OF INSURANCE From : 06/04/2019 00:00:00 To : Midnight of 05/04/2020
Agent Code : 1009 Agent Contact No: 9837314478 Business Source Code: 26617
Agent Name: SH. SHAHID AHMAD
Vehicle make TATA ACE ZIP CX
Geopgraphical Type of Yr of Seats/ Place of
Engine No Chassis No. CC Regd. Number
Area Body Mfg G.V.W. Registrtion
India 12456 10921 OPEN BODY 611 2012 1285 kgs UP21AN-5951 Not Required
INSURANCE DECLARED VALUE Extension: No Extenssion
IDV of vehicle Non-Electrical Accessories Electrical CNG/LPG Kit IDV of Trailer Total IDV
Rs. 0 Rs. 0 Rs . 0 Rs. 0 Rs. 0 Rs. 0
SCHEDULE OF PREMIUM
A. OWN DAMAGE B. LIABILITY
B.T.P BASIC 1800.00
---- --
Compulsory PA to Owner Cum Driver 300.00
Amount 100000
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GROSS (B) 1800

Grand Toatl 1800
NOTE: 1, WARRANTED THAT IN CASE OF DISHONOUR OF THE PREMIUM Service Tax @ 14.50 %: Rs. 320.00
CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED AB - INITIO Total Premium: Rs. 2420
Stamp Duty: 1.00
Compulsory Excess : Rs. 0 Imposed Excess: Rs. 0 Voluntary Excess : Rs. 0
Nominee Details of Compulsory PA:
Nominee Name Relationship Nominee Age Name of Appointee Relation of Appointee
--- --- ----- ------ -----

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 And Reliabity Trials F) Use in connection with Motor Trade
Driver Clause: Any persion including provided that a person driving holds an effectie driving licence at the time of the accident and is not disqualified from
holding or obtaining such a licence . Provided also that the person holding an effective learner's licence may also drive the vehicle and such a person
satisfies the requirments of rule 3 of central motar vehicles rules, 1989.
Limits of liability clause: under section II 1(i) of the policy -death or bodily injury. Such amount as is necessary to meet the requirments of the motor vehicle
act 1988. under section II 1 (ii) or the policy-damage to third party property is RS. 10000 PA cover under section 3 for owner-driver is Rs. 1.0 lakhs
Financier NIL
Financier Type NIL

This Policy is subjected to IMT Endorsement numbers printed herwith endorsement here to: NA
IMPORTANT NOTICE:
The insured is not indemnified,if, the vehicle is used or driven othervise than in
accordance with this schedule. Any payment made by the company be reason of
wider terms appearing in the Certificate in order to company with the Motar Vehicles
Act.1988 is recoverable from the insured: See the clause headed "AVOIDANCE OF related as well as the certificate of insurance are issured in account
CERTAIN TERMS AND RIGHT OF RECOVERY" for legal interpretation, english
version will hold good.

CIN NO: U10200WB1906GO1001713, IRDA NO: 58 Authorised signatory National Insurance Company Limited
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