Hi PURUSHOTAM KUMAR,

Thank you so much for choosing Coverfox.com for your car insurance.

Coverfox guarantees you a FREE 72 hours express claims service with your policy in selected cities. When you need
to make a claim, just:

1 Call us on 1800 209 9960 or email us at expressclaims@coverfox.com

2 We’ll pick up your car

3 We’ll get your car repaired & deliver it back in 72 hours

Log on to www.coverfox.com/express-claims for more information

Have to change anything in the policy or need any other help? We’ll be on our toes to assist you anytime.

1800 209 9970

help@coverfox.com

Coverfox Insurance Broking Pvt. Ltd., Unit B2-601, Boomerang, Chandivali Farm Road, Near Chandivali Studio, Andheri East, Mumbai - 400072
IRDA Direct Broker License No IRDA/DB 556/13, Valid till: 26/12/2019.
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

The New India Assurance Co.Ltd.

NEW INDIA CENTRE DO (131300)
Tel. No.: 22844989//
Email: nia.131300@newindia.co.in/nodal.MAHARASHTRA@newindia.co.in

Private Car Package Policy

Policy Number: 13130031190100024604

Vehicle: HYUNDAI/EON

Period of Cover
From: 03/08/2019 12:00:01 AM
To: 02/08/2020 11:59:59 PM

Insured Details
PURUSHOTAM KUMAR
To: No 11, Infant House, 17th cross, Ramesh Nagar, Bangalore, , ,BANGALORE ,KARNATAKA,
560037

For Insurance Renewals contact

COVERFOX INSURANCE BROKING PVT LTD
Tel. No.: 18002099970 / 18002099970 /
Email: ramesh.gupta@coverfox.com / help@coverfox.com

For Claims contact our OFFICE

New India Centre, 13th Floor, 17/A, Cooperage Road, Mumbai 400039
Tel. No.: 02222023513
Email: nodal.MAHARASHTRA@newindia.co.in

OR

NEW INDIA CENTRE DO 131300

10TH FLOOR, NEW INDIA CENTRE,,,,400039
Tel. No.: 22844989
Email: nia.131300@newindia.co.in

Tax Invoice No : 13130019P0028915

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2019.06.29
18:38:35 IST
Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 1 of 7
 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: PURUSHOTAM KUMAR Policy number: 13130031190100024604
Customer ID: PO70561984 (PAN No :NA) Period of cover: 03/08/2019 12:00:01 AM to 02/08/2020
11:59:59 PM
Insureds Address: No 11, Infant House, 17th cross, Ramesh Registration no. KA-03-MS-1723
Nagar, Bangalore,,,
BANGALORE ,KARNATAKA, 560037
Prev. Policy no. OG-19-9906-1801-00044395 Make/Model: HYUNDAI/EON
Email: purushotamkmr@gmail.com Receipt no. 13130081190000028332 - 29/06/19
Phone Number : / / 8050430405 Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address NEW INDIA CENTRE DO (131300), Agent / Corp. Agent /
10TH FLOOR, NEW INDIA CENTRE, , , , Broker / Banc Coverfox Insurance Broking
MAHARASHTRA , 400039. Assurance / Referral
Code - Name / Pvt Ltd - (BR00000166)
POS/IMF/SPECIFIED
PERSON/Designated
Person for MISP
Phone no 18002099970 / 18002099970 /
Phone no 22844989 Fax no. /
Fax no. NA / NA Email ramesh.gupta@coverfox.com / help@coverfox.com
Email nia.131300@newindia.co.in Development officer NA
level Name/Code
Claim Contact MRO-IV (130001) Claim Contact Detail New India Centre, 13th Floor, 17/A, Cooperage Road,
Mumbai 400039,,;02222023513//
OR
OR
NEW INDIA CENTRE DO (131300)
10TH FLOOR, NEW INDIA CENTRE,,,,400039
22844989
nia.131300@newindia.co.in
GSTIN 27AAACN4165C3ZP
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/A Year of manufacture: 2013
Name of the Financier: Chassis no./Engine no.: MALA151ALDM185512/G3HADM1610
55
Type of body/Type of Fuel: Saloon/Petrol Variant: D-LITE PLUS
Automobile Association none Colour: As per RC Book
membership:
Seating capacity including Driver: 5 Cubic capacity ( cc)/Wattage(kW): 814cc
Cover Note No/Cover Note Issue / Name of registration authority: Bangalore East
Date:
IDV(In `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
143836.25 0 0 0 0 143836
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
Compulsory PA cover for Owner Driver
(Sum Insured `15,00,000)
NCB(20%)
OD Premium in ` 567 TP Premium in ` 2347
Net Premium in `: 2914
GST in `: 525
Total Payable in `: 3439
Total Payable in `(in words): RUPEES THREE
THOUSAND FOUR
HUNDRED THIRTY-
NINE ONLY

Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 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 7
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Limitations as to use Limits of Liability

The Policy covers use of the vehicle for any purpose other than: a)Hire Limit of the amount the Company's Liability Under Section II 1(i) in
or Reward b)Carriage of goods (other than samples or personal respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
luggage) c)Organized racing d)Pace making e)Speed testing f) of the amount of the Company's Liability Under Section II 1(ii) in
Reliability Trials g)Any purpose in connection with Motor Trade respect of any one claim or series of claims arising out of one event:
Up to ` 7,50,000
For individual covers (OD) in`: 143836
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
Geeta Devi 56 Mother NA NA

PA cover for named persons

Name CSI Opted(`) Nominee Relationship
none 0 NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium ` 2914.00
SGST 0 0
CGST 0 0
IGST 18 525

In witness where of this policy has been signed at NEW INDIA CENTRE DO on this 29/06/2019
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 22.
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: 29/06/2019

( RAMASARE GUPTA)
[DIVISIONAL MANAGER]

Duly Constituted Attorney(s)

Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 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 7
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Tax Invoice No : 13130019P0028915

IRDA Registration Number: 190

Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 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 4 of 7
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : NEW INDIA CENTRE DO (131300)
Address : 10TH FLOOR, NEW INDIA CENTRE,

,400039
MUMBAI
Phone : 22844989
Email : nia.131300@newindia.co.in
Fax :
Collection Number : 13130081190000028332
Collection Date : 29/06/2019
Business Source Code : BR00000166
PAN No of Payer :

Received with thanks from PURUSHOTAM KUMAR.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
13130031190100024604 Bank-131300 3439.00 9100.131300 BA00012549-131300-9100
Total = ` 3439.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
ECS 3439.00 QHMP77 N.A. N.A. N.A. 1313001912821878 N.A.
0145
0160
Total = ` 3439.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
2914.00 525.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA COVERFOX INSURANCE BROKING PVT LTD 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 29/06/2019

( RAMASARE GUPTA)
[DIVISIONAL
MANAGER]

Cashier's Initial Authorized Signatory

Note -
1.Please note the Policy Number, Collection Number and date in all future correspondence. .
2.NIA shall not be liable for any claim arising out of sales made during the period between the due date and date of payment of the
installment if the premium paid has been exhausted by turnover declarations/if there is insufficient premium balance.

Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 Hours.

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

Page 5 of 7
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Tax Invoice No : 13130019P0028915

IRDA Registration Number: 190

Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 Hours.

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

Page 6 of 7
THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IMT.22. COMPULSORY DEDUCTIBLE

(Applicable to Private Cars, three wheelers rated as private cars, all motorized two wheelers, taxis, private car type vehicle plying for
public/private hire, private type taxi let out on private hire)

Notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insured shall
bear under Section 1 of the policy in respect of each and every event (including event giving rise to a total loss/constructive
total loss) the first ` 1000 (or any less expenditure which may be incurred) of any expenditure for which provision has been
made under this policy and/or of any expenditure by the insurer in the exercise of his discretion under Condition no 3 of this
policy.

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such
amount shall be repaid by the insured to the insurer forthwith.

For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause
in connection with the vehicle insured in respect of which indemnity is provided under this policy.

Subject otherwise to the terms conditions limitations and exceptions of this Policy.

IMT 22A. VOLUNTARY DEDUCTIBLE (For private cars/motorized two wheelers other than for hire or reward)

It is by declared and agreed that the insured having opted a voluntary deductible of `0 a reduction in premium of ` under
Section 1 of the policy is hereby allowed.

In consideration of the above, it is hereby understood and agreed that the insured shall bear under Section 1 of the policy in
respect of each and every event (including event giving rise to a total loss/constructive total loss) the first `1000 (or any less
expenditure which may be incurred) of any expenditure for which provision has been made under this policy and/or of any
expenditure by the insurer in the exercise of his discretion under Condition no 3 of this policy .

If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such
amount shall be repaid by the insured to the insurer forthwith.

For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause
in connection with the vehicle insured in respect of which indemnity is provided under this policy.

Subject otherwise to the terms conditions limitations and exceptions of this Policy.

Tax Invoice No : 13130019P0028915

IRDA Registration Number: 190

Policy No. : 13130031190100024604Document generated by Coverfox at 29/06/2019 18:38:31 Hours.

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

Page 7 of 7