पॉिलसी अनुसूची Policy Schedule - PRIVATE CAR LIABILITY ONLY

पॉिलसी सं या Policy Number:

व यवसाय क Business Source: 361400-G
36140031236702688849
जारीकता काया लय Issuing Office िव य चैनल कोड Sales Channel Code: 91063100000001
काया लय कोड Office Code: 361400
वनाम Name: Policybazaar Insurance Brokers Private
काया लय का पता Office Address:
Limited
National Insurance Company Ltd.
Gurgaon DO-I
SCO No.- 41-42-43.
Sector-31
संपक सं या Contact Number: 18002585970 (Service) ,
Gurgaon-122001
18002585881 (Claims)
GSTIN: 06AAACN9967E2Z6
Contact Number: 0124-2380932,933
Mobile Number:

ाहक का नाम Customer Name: Mr. YASHPALSINH Indrasinh Jadeja ाहक आई.डी Customer ID: पैन PAN:

पता Address: Shivam Complex, Honda Showroom, Desar Udalpur road, Taluka फोन Phone:9429133166
Desar, District Vadodara 391774
Vadodara,
State: Gujarat, PIN: 391774. ई-मेल E-Mail: 77yashpal77@gmail.com
Cell: 9429133166

Policy Effective from 00:00 hours, on 12-05-2023 00:00 क अधराि तक to midnight of 11-05-2024 Midnight
ीिमयम Premium ₹ 8192 कवर नोट सं. व तारीखCover Note Number and Date NA
CGST ₹0
SGST/UTGST ₹0 ताव सं या व तारीखProposal Number and Date PB157PG0011301000 Dt. 09-May-2023
IGST ₹ 1475
वसूली यो य टांप ड्यूटी
₹ 0.00 रसीद सं या व तारीख Receipt Number and Date PG70870692 Dt. 09/05/2023
Recoverable Stamp Duty
िपछली पॉिलसी सं या व समाि ितिथ Previous Policy Number and /ICICI Lombard General Insurance Company Ltd
कुल रािश Total Amount ₹ 9,667.00
Expiry Date Dt. 03/05/2021
(Rupees Nine Thousand Six Hundred Sixty Six केवल Only.)

वाहन का िववरण Vehicle Details

वाहन का आई.डी.वी/Vehicle IDV NA पंजी. सं या Regn. Number GJ-01-HF-1114
IDV (Trailer / Sidecar) NA इंजन व एम/सी सं.Engine or M/c No. 1421707
इले ीकल ए सेसरी Electrical Accessories NA इचेिसस सं याChassis Number 6803571
गैर इले ीकल उपकरणNon Electrical
NA पंजीकरण अिध.Regn. Authority AHMEDABAD
Accessories
फाइवर लास टक Fiber Glass Tank NA भौगोिलक े Geographical Area इंिडया India
सीएनजी/एलपीजी यूिनटCNG/LPG Unit NA बनावट Make TOYOTA
Total IDV NA मॉडल Model COROLLA
अित. टािवंग शु कAddl. Towing Charges NA वे रएंट Variant H2 1.8 E
सी.सी – जी.भी ड यू CC / GVW 1794 वाहन क ेणी/Class of Vehicle Private Car
लाइस स िसिटंग/वहन क मता मत Licensed
5 इढ़ाचा का कार/रंग Body Type / Color Other
Seating / Carrying Capacity
िनमा ण वष Year of Mfg. 2003 पंजीकरण ितिथ Regn. Date 24/07/2003
ीिमयम क अनुसूची Schedule of Premium
प व- ित Own Damage ₹ TP Premium Breakup in Rs. ₹
व- ित आवरण (उिचत पूरक ीिमयम के साथ) Own Damage Basic TP Premium 7,897.00
NA
Cover(Incl. of applicable add-ons)
PA to owner driver 295.00
सकुल Total NA
Total 8,192.00
तृतीय प बीमा िववरण Third Party Insurance Details
मोटर वाहन अिधिनयम 1988 के अनुसार आव यक रािश Such amount as is necessary to meet the requirement of the motor
Limit of liability under section II-I(i)
vehicles Act 1988
under section II-I(ii) ₹ 750000.00 (In respect of any one claim or series of claims arising out of one event/occurrence.)
ित यि मूल बीमा रािश CSI per
यि गत दुघटना बीमा िववरण Personal Accident Cover Details
head
वाहन का मािलक चालक Owner driver of the vehicle
NA
Nominee: Sonal Solanki, Others
ासंिगक अनु छेद,पृ ांकन और वारंटी Clauses, Endorsements and Warranties Applicable:
उपयोग क सीमाएं : Limitations as to Use: Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover
use for hire or reward, tuition, racing, pace making, reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any
trade or business or use for any purpose in connection with Motor Trade.
वाहन चालन के िलए अिधकृत यि या यि वग Persons or Class 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

मु ण क तारीख Printed on 09-05-2023 07:53:16hours आई.डी. ारा by ID : 74096, सहायता AID : पृ सं.Page no: 1

an effective Learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
मह वपूण सूचना Important Notice: यिद वाहन का योग या चालन इस अनुसूची म उ सिलिखत से िभ न होता है तो बीमाधारक को कोई ितपूित नह क जायेगी। मोटर वाहन अिधिनयम,1988 के अनपालन मं◌े
उ लेिखत िकसी िव तृत िनयम के कारण कंपनी ारा िकया गया कोई भी भुगतान बीमाधारक से वसूली यो य होगा। " कुछ िनयम और वसूली के अिधकार के प रहार" के शीषक के तहत कंड को देख। 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 the reason of wider terms
appearing in the certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN
TERMS AND RIGHT OF RECOVERY"
उपरो उि लिखत कायालय पते पर िविधवत प से ािधकृत अधोह ता री को सा ी मानकर िदनांक [12-May-2023] को ह ता र िकया जा रहा है। वेबसाइट
www.nationalinsuranceindia.nic.co.in म उपल ध इस अनुसच
ू ी, संल न पॉिलसी, ख ड, पृ ांकन और पॉिलसी श द को एक अनुबध
ं के प म एक साथ पढ़ा जाएगा और
पॉिलसी के िकसी भी िह से या अनुसच
ू ी म संल न कोई भी श द या अिभ यि , जो िवशेष अथ कट करता हो, जहां भी कट हो समान अथ वहन करेगा करेगा । यह वारंटी दी जाती है
िक ीिमयम चेक क अ वीकृित क ि थित मं◌े, यह पॉिलसी आरंभ होने क तारीख से ही वतः िनर त माना जाएगा ।

IN WITNESS WHEREOF, the undersigned being duly authorized hereunto set his/ her hand at the office address mentioned above, this 12-May-2023.This schedule,
the attached policy, the clauses, the endorsements and policy wordings as available in the website www.nationalinsuranceindia.nic.co.in shall be read together as
one contract and any word or expression to which the specific meaning has been attached in any part of this policy or of the schedule shall bear the same meaning
wherever it may appear. It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'

कृते
ने श नल इ योरे स कंपनी िलिमटेड
For and on behalf of National Insurance
Company Limited

Ombudsman Details: Shri K.M.Chadha Insurance

Ombudsman Office of the Insurance Ombudsman S.C.O. No.101-103 2nd Floor टा प ड्यूटी
Batra Building Sector 17-DCHANDIGARH-160017 Stamp Duty:
Fax:- 0172-2708274 ( ₹ 0.50 )
Email:-Email ombchd@yahoo.co.in,0172-2706468.

क ािधकृत ह ता रकता Authorized

Signatory

मु ण क तारीख Printed on 09-05-2023 07:53:16hours आई.डी. ारा by ID : 74096, सहायता AID : पृ सं.Page no: 2

Policy Schedule - PRIVATE CAR LIABILITY ONLY

 Policy Number: 36140031236702688849 यवसाय ोत Business Source: 361400-G
जारीकता काया लय Issuing Office िव य चैनल कोड Sales Channel Code: 91063100000001
काया लय कोड Office Code: 361400
नाम Name: Policybazaar Insurance Brokers Private
काया लय का पता Office Address:
Limited
National Insurance Company Ltd.
Gurgaon DO-I
SCO No.- 41-42-43.
Sector-31
संपक सं या Contact Number: 18002585970 (Service) ,
Gurgaon-122001
18002585881 (Claims)
GSTIN: 06AAACN9967E2Z6
Contact Number: 0124-2380932,933
Mobile Number:

बीमा माण-प CERTIFICATE OF INSURANCE

के ीय मोटर वाहन िनयम 1989 के फाम 51 Form 51 of the Central Motor Vehicle Rules, 1989

माण-प
36140031236702688849 IXI
Certificate No.:

बीिमत वाहन का िववरण Particulars of vehicle insured

पंजी सं.Reg. Mark, इबनावट, मॉडल
इं. व चे. सं Engine No. & िनमा ण वष Year of डी का कारType of सया ी मता
No. & Place of Make, Model & सी सी C.C ीिमयम Premium()
Chassis No Manufacture Body Seating capacity
Registration Variant
TOYOTA,
GJ-01-HF-1114/
1421707 6803571 COROLLA & H2 2003 Other 1794 5 8192
AHMEDABAD
1.8 E.

पंजीयन अिधकारी का नाम Name of Registration Authority AHMEDABAD

Mr. YASHPALSINH Indrasinh Jadeja Shivam Complex, Honda Showroom,
Desar Udalpur road, Taluka Desar, District Vadodara 391774 Vadodara, State:
बीिमत का नाम व पता Name & Address of Insured
Gujarat .
Gujarat,Vadodara,391774.
भौगोिलक े Geographical Area India
Business or Profession
बीमा के ारंभ होने क भावी ितिथ Effective date of commencement of Insurance for
----- बजे िदनांक-----से म य राि िदनांक --तकFrom 00:00 O' Clock on 12-05-2023 00:00.
the purpose of Act.
बीमासमाि क ितिथ Date of expiry of the insurance Midnight on: 11-05-2024 Midnight

गाड़ी चलाने के अिधकृत यरि या यि य का समुह PERSONS OR CLASS 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
requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

योगाथ स माएं LIMITATIONS AS TO USE

Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover use for hire or reward, tuition, racing,
pace making, reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any trade or business or use for any
purpose in connection with Motor Trade.

मं◌ै/हम एत वारा मािणत करते है िक पॉिलसी िजससे यह माण-प संबंिधत है एवं यह बीमा माण-प मोटर वाहन अिधिनयम, 1988 के अ याय X और XI के ावधान के अनुसार जारी िकये गए हैँ। I/We hereby
certify that the Policy to which this Certificate relates as well as this Certificate of Insurance are issued in accordance with the provisions of Chapter X and Chapter XI
of M.V. Act, 1988.
जारीकता काया लय का पूरा पता Full address of Issuing Office: National Insurance कृते ने श नल इ योरे स क पनी िलिमटेड क पनी िलिमटेड
Company Ltd. Gurgaon DO-I SCO No.- 41-42-43, Sector-31 For and on behalf of National Insurance Company
Gurgaon-122001 Limited

जारी करने क ितिथ Date of issue: 12-05-2023 00:00 िविधवत गिठत अटॉन (ओं) Duly Constituted Attorney(s)

In case of any claim, please contact our nearest office Authorized Signatory