Issuing Office Name & Address

HANUMANGARH BRANCH ,PLOT NO. 98, NEAR BUS STAND, HANUMANGARH

JUNCTION, HANUMANGARH, RAJASTHAN, PIN : 335512
Tel: Fax: 01552 268934 (G)
GSTIN No: 08AAACN9967E1Z3

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: 38030231236160001404 Private Car 1 Year Package from 00:00 Hrs of 04/08/2023 to Midnight of 03/08/2024 IXI
Policy
Insured Details
Name : Mr NIRESH KUMAR
Address : S/O HARPAL TEH GANNAUR SAMBHAL UTTAR PRADESH
Pincode : 335001 Telephone : 8058682000 Email : tanyainsuranceadvisor@gmail.com
PAN No. : GSTIN No. : Aadhar No. :
Channel : SUNEEL KUMAR VERMA Mobile : 9688888563 Email : tanyainsuranceadvisor@gmail.com

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Aadhar : PAN : xxxxxx970D Code. : 874795 / 9800008701

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Break-in Approver : NORANG LAL(24737)

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Vehicle age>10 Years Approver : NORANG LAL(24737)

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Vehicle Details

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Make & Model Private Car MAHINDRA BOLERO ZLX BS IV

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Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District

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UP-38-K-2835 GRG4E75392 MA1XB2GRK2GE73981 SUV 2523 2017 1+6 SAMBHAL

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Geographical Area : INDIA.

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Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV

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Rs.4,50,000 1,00,000 - - - Rs.5,50,000

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

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Basic OD Premium 5,148.00 Basic TP Premium 8,192.00

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(+) Electrical Access. Premium - (+) WC for Driver so YES 50.00
(+) Bi-fuel kit Loading - (+) Wider Legal Liability to employees -
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(+) Geographical Area Extension - (+) Geographical Area Extension -

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(-) Vol. Excess Discount - (+) PA to owner driver -

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(-) Auto. Assoc Discount - (+) PA to unnamed PAX -

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(-) Anti-theft Discount - (-) Discount For Limited TPPD -

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(-) Other Discount - (+) Bi-fuel kit Loading -

8,242.00
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(-) NCB Discount TP Total (Rounded Off)

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(+) Nil Depreciation - OD Total (Rounded Off) 5,148.00

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(+) Nil Depreciation Plus - TOTAL PREMIUM 13,390.00

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(+) NCB Protect - GST 2,410.00

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(+) Engine Protect - NET PAYABLE 15,800.00

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(+) Invoice Protect - Collection Number :38030281230000002560 dated 27-Jul-2023

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(+) Consumables Protect - Subject to IMT Endorsement No. 7,24,25,28

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(+) Lock-Key Protect - Prem: SI:

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(+) Loss of Personal Belongings - Prem: SI:

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OD Total (Rounded Off) 5,148.00

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Excess : Compulsory: Rs.2,000 Imposed: Rs.0 Voluntary: Rs.0

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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
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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
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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.
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Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
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Under section 1(ii) Damage to third party property is Upto Rs. 7,50,000 .
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
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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
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RIGHT OF RECOVERY". For legal interpretation, English version will hold good.
UIN : IRDAN058RP0034V01100001
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HYPOTHECATION :
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Prev Policy :
:

Nominee Name : HARPAL

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Relation : FATHER Age : 50 Years

NOTE : Warranted that in case of dishonour of the premium cheque, this document stands automatically cancelled 'AB-INITIO'.
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Policy stamp to be defaced at the respective policy servicing office.

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TP Rate Revision Notice: For all policies having an effective date on or after 1st April 2023, the TP premium is subject to revision as may be notified by the IRDAI.
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The Insured should contact and submit the difference of premium to the policy issuing office on issuance of such notification by IRDAI.
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.
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Authorised Signatory
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For & On behalf of

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National Insurance Company Limited

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NIC/UBPORTAL/9800008701 03/08/2023 09:05 PM

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email: customer.support@nic.co.in