Servicing Office Address

Patna Division II,Arunachal Bhawan, Exhibition Road, Patna, Bihar, Pin :

800001
GSTIN No: 10AAACN9967E3ZG

RECEIPT

Customer Details Collection Details

Name : BINOD KUMAR SINHA Agent Code : 9000172541
Address : 826, NUTAN BHAWAN, ROAD NO-02, EAST Collection Number : 17080081198000000002
INDIRA NAGAR, NALANDA COLONY, Collection Date : 03/04/2019
KANKARBAGH , BIHAR , PATNA Bank Account : 9173
Pin Code : 800020

Received with thanks from Sri/Smt BINOD KUMAR SINHA

a sum of 1727 (RUPEES ONE THOUSAND SEVEN HUNDRED TWENTY SEVEN ONLY) by CD
towards 1 Year Package Policy Policy as per details given hereunder

Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount
No. Year Number (General Ledger) Received

1 17080031196260000001 11 C.D CONTROL A/C 5076 0.00 1727.00 -1727.00

2 17080031196260000001 11 CASH PREMIUM A/C 5083 1463.00 0.00 1463.00

3 17080031196260000001 11 CGST_BR_Int_Liab 7313 132.00 0.00 132.00

4 17080031196260000001 11 SGST_BR_Int_Liab 7314 132.00 0.00 132.00

TOTAL : 1727.00 1727.00 0.00

Particulars : CD

For National Insurance Company Ltd.,

1.Please quote collection no. and date in all correspondeces
2.The stamp has been defaced and retained at the office against the issued
policy.

Authorised Signatory

NIC/UBPORTAL/9000172541 03/04/2019 11:35 PM

Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal.
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 Issuing Office Name & Address
PATNA DIVISION II , ARUNACHAL BHAWAN, EXHIBITION ROAD, PATNA,
BIHAR, PIN : 800001
Tel: Fax: 0612 2218174-2218558( D ) 2203129
GSTIN No: 10AAACN9967E3ZG
National Insurance Company Ltd.
Registered & Head Office: 3, MIDDLETON STREET, POST BOX NO. 9229, KOLKATA - 700 071
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989
Policy No: 17080031196260000001 1 Year Package Policy from 00:00 Hrs of 04/04/2019 to Midnight of 03/04/2020 IXI
Insured Details
Name : BINOD KUMAR SINHA
Address : 826, NUTAN BHAWAN, ROAD NO-02, EAST INDIRA NAGAR, NALANDA COLONY, KANKARBAGH , BIHAR , PATNA
Pincode : 800020 Telephone : 7004012229 Email : nutanbinod79@gmail.com
PAN No. : GSTIN No. : Aadhar No. :
Channel : PREM PRAKASH KUMAR Mobile : 9097938763 Email : prem.prakash559@gmail.com Code. : 9000172541
Aadhar : PAN : xxxxxx011D
Vehicle Details
Make & Model Honda CB Shine Drum Self Alloy
Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District
BR-01-DR-6407 JC65ET2009355 ME4JC65AAJT006117 125 2018 1+1 PATNA
Geographical Area : INDIA.
Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV
Rs.51,312 - - - - Rs.51,312

OD Premium Breakup in Rs. TP Premium Breakup in Rs.

Basic OD Premium 688.09 Basic TP Premium 720.00
(+) Geographical Area Extension - (+) Geographical Area Extension -
(-) Vol. Excess Discount - (+) WC for Driver YES 50.00
(-) Auto. Assoc Discount - (+) PA to owner driver YES 295.00
(-) Anti-theft Discount - (+) PA to unnamed PAX -
(-) Other Discount - -344.05 (-) Discount For Limited TPPD -
(-) NCB Discount 20% -68.81 TP Total (Rounded Off) 1,065.00
(+) Nil Depreciation - OD Total (Rounded Off) 398.00
(+) Nil Depreciation Plus YES 123.00 TOTAL PREMIUM 1,463.00
GST 264.00
NET PAYABLE 1,727.00
Collection Number :17080081198000000002 dated 03-Apr-2019
OD Total (Rounded Off) 398.00 Subject to IMT Endorsement No. 22,24,25,28
Excess : Compulsory: Rs. 100 Imposed: Rs.0 Voluntary: Rs. 0
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 Reliability Trials (f) Use in connection with Motor Trade
Drivers Clause : Any person including Insured Provided that a person driving holds an effective 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 requirements of Rule 3 of Central Motor
Vehicles Rules, 1989.
Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
Under section 1(ii) Damage to third party property is Upto Rs. 1,00,000 . PA Cover under section 3 for owner-driver is Rs. 15,00,000.
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 reasons of wider terms
appearing in the certificate in order to comply with the Motor Vehicles Act,1988 is recoverable from the insured .See the clause headed "AVOIDANCE OF CERTAIN TERMS AND
RIGHT OF RECOVERY". For legal interpretation, English version will hold good.
Financier : SELF OWNED
Prev Policy : ICICI Lombard Insurance (Pol No: 30052011379238002120 Expiry Date: 03/04/2019)
Nominee Name : NUTAN SINHA Relation : WIFE Age : 58 Years
In consideration of payment of additional premium as indicated in the Schedule it is hereby agreed and understood that indemnification in respect of Partial loss claims shall be done without application of
Depreciation as mentioned in Section 1. of the policy.
Policy stamp to be defaced at the respective policy servicing office.
I/We hereby certify that this Certificate cum Schedule of Insurance is issued in accordance with the provisions of chapter X and chapter XI of Motor Vehicles Act,1988.

Authorised Signatory
For & On behalf of
National Insurance Company Limited

NIC/UBPORTAL/9000172541 03/04/2019 11:35 PM

Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal.
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