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Issuing Office Name & Address

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Mumbai Business Office II,First Floor, Sterling Cinema Building, 65Murzaban

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Street, Fort, Mumbai Greater Mumbai ,Telephone No: 18003450330

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Email ID: phonepe.tieup@nic.co.in
GSTIN No: 27AAACN9967E1Z3

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RECEIPT

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Customer Details Collection Details

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Name : AMAN DEEP Agent Code : 91067500000001

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Mobile No : 9368826080 Collection Number : 26020181245000086625
Email : amandeepgkvmuz@gmail.com Collection Date : 31/05/2024

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Bank Account : 9100

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Received with thanks from Sri/Smt AMAN DEEP

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a sum of 891 (RUPEES ) by ONLINE

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towards 1 Year Package Policy Policy as per details given hereunder

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Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount

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No. Year Number (General Ledger) Received

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1 26020131246230091939 11 CASH PREMIUM A/C 5083 755.00 0.00 755.00
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2 26020131246230091939 11 IGST_DL_Int_Liab 7324 136.00 0.00 136.00
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TOTAL : 891.00 0.00 891.00

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Particulars : ONLINE
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For National Insurance Company Ltd.,

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1.Please quote collection no. and date in all correspondeces

2.The stamp has been defaced and retained at the office against the issued
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policy.
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Authorised Signatory
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NIC/PHONEPE/91067500000001 31/05/2024 05:51 P.M.

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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 Issuing Office Name & Address
MUMBAI BUSINESS OFFICE II , FIRST FLOOR, STERLING CINEMA
BUILDING, 65MURZABAN STREET, FORT, MUMBAI GREATER MUMBAI
Telephone No: 18003450330 Email ID: phonepe.tieup@nic.co.in
GSTIN No: 27AAACN9967E1Z3

National Insurance Company Ltd.

Registered & Head Office: PREMISES NO.18-0374, PLOT NO. CBD-81, NEW TOWN, KOLKATA-700156
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989 as amended from time to time

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Policy No: 26020131246230091939 1 Year Package Policy from 00:00 Hrs of 03/06/2024 to Midnight of 02/06/2025 IXI

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Insured Details

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Name : AMAN DEEP

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Mobile No : 9368826080 Email : amandeepgkvmuz@gmail.com

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PAN No. : GSTIN No. :

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Channel : PHONEPE INSURANCE BROKING SERVICES PRIVATE LIMITED Tele. No: 080-68727888 Email : support@phonepe.com

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Aadhar : PAN : xxxxxx058K Code. : 260201 / 91067500000001

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Vehicle Details

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Make & Model 2W YAMAHA FZ S V 2.0 STANDARD

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

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DL-03-SCV-1587 40978 22963 STREET 149 2014 1+1 SOUTH DELHI

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Geographical Area : INDIA.

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Registration Date : 20/10/2014

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

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Rs.22,692 - - - - Rs.22,692

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

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Basic OD Premium 406.87 Basic TP Premium 714.00
(+) Geographical Area Extension - (+) Geographical Area Extension -
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(+) RSA Protect - (+) WC for Driver -
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(-) Auto. Assoc Discount - (+) PA to owner driver -

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(-) Anti-theft Discount - (+) PA to unnamed PAX -

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(-) Other Discount - -325.50 (-) Discount For Limited TPPD -

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(-) NCB Discount 50% -40.69 TP Total (Rounded Off) 714.00

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(+) Nil Depreciation - OD Total (Rounded Off) 41.00

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(+) Nil Depreciation Plus - TOTAL PREMIUM 755.00

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(+) NCB Protect - GST 136.00

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(+) Engine Protect - NET PAYABLE 891.00

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(+) Invoice Protect - Collection Number :26020181245000086625 dated 31-May-2024

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OD Total (Rounded Off) 41.00 Subject to IMT Endorsement No. 16,22,22A,29

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Excess : Compulsory: Rs. 100 Imposed: Rs.0 Voluntary: Rs. 0

Limitation 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,
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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
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Trade
Drivers Clause : 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
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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
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Motor Vehicles Rules, 1989 as amended from time to time.

Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988 as amended from time to time.
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Under section 1(ii) Damage to third party property is Upto Rs. 1,00,000 .
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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 the reason of wider terms
appearing in the certificate in order to comply with the Motor Vehicle Act, 1988 as amended from time to time is recoverable from the Insured. See the clause headed "AVOIDANCE
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OF CERTAIN TERMS AND RIGHT OF RECOVERY" No Claim Bonus will only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy. No
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Claim Bonus is subject to no claim on the previous policy. Benefits under the policy stands forfeited if claim is/was made in previous policy. For legal interpretation, the English
version will hold good.
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FINANCIER NAME :
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Prev Policy : Go digit general insurance limited (Pol No: D102563706 Expiry Date: 16/05/2024)
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Nominee Name : Relation : Age :

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Transaction Date : 31/05/2024 17:48:16 Transaction Number : VF2405311748090523653252 Inspection ID :

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Disclaimer Note : It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'.
In the event of misrepresentation, fraud or non-disclosure of material fact, the Company reserves the right to cancel the Policy. The policy is issued based on the information provided by you, which is available
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with the company. In case of discrepancy/non recording of relevant information in the policy, the insured is requested to bring the same to the notice of the company within 15 days. This Policy is to be read in
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conjunction with the Policy wordings available on the website https://nationalinsurance.nic.co.in of the Company. On renewal, the benefits provided under the policy and/or terms and conditions of the policy
including premium rate may be subject to change.
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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 as amended from time to time.
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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/PHONEPE/91067500000001 31/05/2024 05:51 P.M.

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
 Issuing Office Name & Address
MUMBAI BUSINESS OFFICE II , FIRST FLOOR, STERLING CINEMA
BUILDING, 65MURZABAN STREET, FORT, MUMBAI GREATER MUMBAI
Telephone No: 18003450330 Email ID: phonepe.tieup@nic.co.in
GSTIN No: 27AAACN9967E1Z3

PROPOSAL FORM
PROPOSER'S DETAILS
Name AMAN DEEP
Mobile No 9368826080 email id amandeepgkvmuz@gmail.com

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Nominee's Name Relation Nominee's Age

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VEHICLE DETAILS

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Model Two Wheeler YAMAHA FZ S V 2.0 STANDARD Year of Make 2014

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Reg No DL-03-SCV-1587 Engine No 40978 Chassis No 22963

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Reg. Date 20/10/2014 Fuel PETROL

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Financier FastTag ID
IDV Rs. Rs.22,692

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Accessories Electrical Rs. - NIL Non-Electrical Rs. - NIL Bi-fuel Kit Rs. - NIL
POLICY/COVERAGE OPTION DETAILS

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Type of Policy/Cover Required Two Wheeler 1 Year Package Policy

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Policy Number 26020131246230091939

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Policy (period) from 00:00 Hrs of 03/06/2024 to Midnight of 02/06/2025

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CPA Owner/Driver NOT OPTED

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Add-ons Included NOT OPTED

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PREMIUM DETAILS

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Total OD Premium Rs. 41.00 Total TP Premium Rs. 714.00 GST Rs. 136.00 Premium Payable Rs. 891.00

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PREVIOUS POLICY DETAILS *
Previous Policy Type PACKAGE Previous Policy Expiring on :00 16/05/2024
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Previous Policy No D102563706 issued by Go digit general insurance limited

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Previous NCB % 50 Claims reported in Previous Policy No

Declaration by the Insured
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I. I/We hereby declare that the statements made by me/us in this Proposal Form are true to the best of my/our knowledge and belief and I/We hereby agree
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that this declaration shall form the basis of the contract between me/us and National Insurance Company Ltd. I/We also declare that if any additions or
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alterations are carried out after the submission of this proposal form then the same would be conveyed to National Insurance Company immediately.
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II. It is declared that vehicle is not imported.

III. I/We hereby declare that the vehicle proposed for insurance has not met with an accident during the period of break in insurance. Any liability arising during
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this period of break will not be admissible under the policy. The vehicle proposed for insurance is in existence and is roadworthy at the time of taking the policy.
IV. I/We hereby declare that the vehicle proposed for insurance has a valid Pollution Under Control Certificate & Fitness Certificate (in case of transport
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vehicles) on the date of fresh issuance / renewal of the policy.

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V. I/We hereby declare that the rate of NCB claimed by me/us is correct and that no claim has arisen in the expiring policy period. I/We further undertake that if
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this declaration is found to be incorrect, all benefits under the policy in respect of Section I of the Policy will stand forfeited.
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VI. Any changes to the details post payment might require additional payment.
VII. Claim can be denied by the Insurer if the declaration made by you about claims & NCB in previous policy is found to be incorrect.
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VIII. Previous year policy copy and PUC certificate may be asked by the insurance company at the time of claim.
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IX. In case of any premium difference due to any incorrect information provided including but not limited to vehicle/previous policy related dates, the premium
difference will be borne by the customer.
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X. Your IDV should be 10% less than Previous Year Policy IDV or as per depreciation norms of Indian Motor Tariff. In case of a total loss claim or a theft claim,
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the purchase invoice will also be taken into consideration for the vehicle's final valuation (as per the depreciation).
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XI. If vehicle class selected above is found to be incorrect at any time during the policy, the policy shall be cancelled without any refund and all rights to recover
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there under in respect of past or future accidents shall forfeit.

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XII. I/We also declare that details regarding previous year NCB, past claims history and ownership transfer during past 12 months are true and if found to be
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false at any time during the policy, the policy shall be void and all rights to recover there under in respect of past or future accidents shall forfeit.
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XIII. I/We agree and understand the provision of Section 41 Insurance Laws (Amendment) Act, 2015, Prohibition of Rebates: 1) No person shall allow or offer
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to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives
or property in India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy, nor shall any person taking out
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or renewing or continuing a policy accept any rebate except such rebate as may be allowed in accordance with the published prospectus or tables of the
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insurer. 2) If any person fails to comply with the provisions of this section, s/he shall be liable to payment of a fine which may extend to Ten Lakh rupees.
XIV. I/We confirm that my Vehicle will be re-registered as per statutory requirement (whenever the RC is about to cross the validity period), failing which the
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policy will not be considered valid.

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XV. I/We declare that no CTL claim has arisen in the previous policy periods and paid by the previous insurer for the proposed vehicle. I/We further undertake
that if this declaration is found to be incorrect, all benefits under the policy in respect of Section I of the policy will stand forfeited.
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Date : 31/05/2024
This Proposal form has been electronically accepted
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NIC/PHONEPE/ 91067500000001 31/05/2024 05:51 P.M.

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