THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Enhancement Cover Policy

Insured's Details Policy Details

Insured's Name: NARAYAN PRASAD RAJPUT Policy number: 45020231190300003797
Customer ID: PO52877156 (PAN No :NA) Period of cover: 04/09/2019 12:00:01 AM to 03/09/2020
11:59:59 PM
Insureds Address: S/O DARYAVSINGH RAJPUT Registration no. New Vehicle
ADD. - 10/1 ZHAD PIPLIYA
TEH. - NARSINGHGARH,RAJGARH,,
RAJGARH ,MADHYA PRADESH, 465665
Prev. Policy no. 45020231180300006282 Make/Model: MAHINDRA &/BOLERO Power +
Email: Receipt no. 45020281190000004808 - 03/09/19
Phone Number : / / 9827208784 Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address SHAJAPUR BRANCH (450202), Agent / Corp. Agent /
1ST FLOOR, NITYANAND ASHRAM COMPOUND, , A.B. Broker / Banc Mansingh Khichi -
ROAD, , SHAJAPUR , Assurance / Referral
MADHYA PRADESH , 465001. Code - Name / (NIA2D10665112)
POS/IMF/SPECIFIED
PERSON
Phone no 227338 / / 7697683931
Phone no 07364227338 / 07364227842 Fax no. /
Fax no. NA / NA Email khichimansing@gmail.com /
Email nia.450202@newindia.co.in Development officer B.L. MALVIYA . - (2D10672881)
level Name/Code
Claim Contact SHAJAPUR BRANCH (450202) Claim Contact Detail 1ST FLOOR, NITYANAND ASHRAM
COMPOUND,,A.B.
ROAD,,SHAJAPUR;07364227338/07364227842/
GSTIN 23AAACN4165C1ZZ
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/B Year of manufacture: 2017
Name of the Financier: PUNJAB NATIONAL BANK-TILAK Chassis no./Engine no.: 38437/56048
ROAD
Type of body: Saloon/Diesel Variant: ZLX BS4 Power +
Automobile Association none Colour: WHITE
membership:
Seating capacity including Driver: 7 Cubic capacity ( cc): 1493
Cover Note No/Cover Note Issue / Name of registration authority:
Date:
IDV(In `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
558754 0 0 0 0 558754
Cover Description Cover Opted Cover Description Cover Opted
Additional Towing Charges No Engine Protection Cover No
Return to Invoice Cover No Road Tax No
No Claim Bonus Protection Cover No Loss of Contents Cover No
High Value PA Cover No Personal Belongings Cover No
Consumable Items Cover No Nil Depreciation Yes
Schedule of Premium
Own Damage Liability
Basic TP Cover
Compulsory PA cover for Owner Driver
(Sum Insured `15,00,000),PA cover for
UnNamed Persons, LL cover for Paid
Driver
NCB(25%)
OD Premium in ` 7655 TP Premium in ` 3696
Net Premium in `: 11351
GST in `: 2044
Total Payable in `: 13395

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 45020231190300003797Document generated by AG_MANSING at 03/09/2019 21:31:30 Hours.
Vaideswaran Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2019.09.03
For 21:31:33
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
IST
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 1 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Total Payable in `(in words): RUPEES THIRTEEN

THOUSAND THREE
HUNDRED NINETY-
FIVE ONLY

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`: 558754
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
NA NA NA 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 ` 11351.00
SGST 9 1022
CGST 9 1022
IGST 0 0

In witness where of this policy has been signed at SHAJAPUR BRANCH on this 03/09/2019
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 16,22,7.
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.
The policy is subject to PCEC endorsement attached.

Date of Issue: 03/09/2019

(MR. ARUN KUMAR KEWALIYA)

[BRANCH MANAGER]

Duly Constituted Attorney(s)

Policy No. : 45020231190300003797Document generated by AG_MANSING at 03/09/2019 21:31:30 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 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

PC EC-1
"PRIVATE CAR PACKAGE POLICY -ENHANCED COVERS"
(Endorsement Wording for Add on cover - NIL Depreciation)
UIN Number -
ATTACHED TO AND FORMING PART OF POLICY NO. 45020231190300003797 Additional Premium: ` 3631.901

In consideration of payment of an additional premium by the Insured, it is hereby agreed and declared that notwithstanding anything to the
contrary contained in the Policy, the Company hereby undertakes to indemnify:
1.Depreciation on replacement of parts including tyres, tubes, rubber/plastic for Partial Loss Claims.
2.Midterm inclusion of cover is not permitted.
3.Total Loss and Constructive Total Loss will be settled on the basis of IDV.
Subject otherwise to the terms, exceptions, conditions and limitations of this Policy.
For and on behalf of The New India Assurance Company Limited
Date of Issue: 03/09/2019

(MR. ARUN KUMAR KEWALIYA)

[BRANCH MANAGER]

Duly Constituted Attorney(s)

Tax Invoice No : 45020219E0007306

IRDA Registration Number: 190

Policy No. : 45020231190300003797Document generated by AG_MANSING at 03/09/2019 21:31:30 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 3