THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

The New India Assurance Co.Ltd.

SINDRI BRANCH (540703)
Tel. No.: 03262381445//
Email: nia.540703@newindia.co.in/

PRIVATE CAR Liability Policy

Policy Number: 54070331160200002477
Vehicle: MAHINDRA &/SCORPIO M HAWK

Period of Cover
From: 24/11/2016
To: 23/11/2017

Insured Details
NASIMUL HAQUE.
To: NO.1 JORAPOKHAR ,JEALGORA ,DISRTT.- DHANBAD. ,JEALGORA ,JHARKHAND, 828110

For Insurance Renewals contact

Tel. No.: NA
Email: NA

For Claims contact our OFFICE

SINDRI BRANCH 540703
SINDRI BRANCH,,,826001
Tel. No.: 03262381445
Email: nia.540703@newindia.co.in

IRDA Registration Number: 190

Policy No. : 54070331160200002477Document generated by QR_RENEWAL at 20/11/2016 21:47:00 Hours.

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

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 THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Liability Policy

Insured's Details Policy Details

Insured's Name: NASIMUL HAQUE. Policy number: 54070331160200002477
Customer ID: PO38069014 Period of cover: 24/11/2016 12:00:01 AM to 23/11/2017
11:59:59 PM
Insureds Address: NO.1 JORAPOKHAR ,JEALGORA Registration no. JH-10-X-6005
,DISRTT.- DHANBAD. ,
JEALGORA ,JHARKHAND, 828110
Prev. Policy no. 54070331150200002511 Make/Model: MAHINDRA &/SCORPIO M HAWK
Email: ERIMAMUL07@GMAIL.COM Receipt no. 10000089161100150729 - 20/11/16
Phone Number : / / 9835111679 Fax Number : NA / NA

Issuing office New India Contact

Address SINDRI BRANCH (540703), Agent / Corp. Agent
SINDRI BRANCH , , , / Broker / Banc
JHARKHAND , 826001. Assurance /
Referral Code -
Name / POS/IMF
Phone no NA
Phone no 03262381445 Fax no. NA
Fax no. NA / NA Email NA
Email nia.540703@newindia.co.in Development officer PRADIP KUMAR ROY - (2D10673816)
level Name/Code
Claim SINDRI BRANCH (540703) Claim Contact SINDRI BRANCH,,;03262381445//
Contact Detail

Policy Details
Geographical Area / Zone: India/B Year of manufacture: 2010
Name of the Financier: Chassis no./Engine no.: MA1TA2HANA2H58649/HAA4H35
756
Type of body: Hatch-Back Variant: SPECIAL EDITION (VLX) 7
SEATER
Automobile Association none Colour: WHITE
membership:
Seating capacity including 7 Cubic capacity ( cc): 2179
Driver:
Cover Note No/Cover Note Issue / Name of registration authority: Dhanbad
Date:

IDV(In `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
0 0 N/A N/A N/A 0

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 No Loss of Contents Cover No
Cover

Schedule of Premium
Own Damage Liability
Basic TP Cover
Compulsory PA cover for Owner
Driver, LL cover for Paid Driver

OD Premium in ` TP Premium in ` 6314

Net Premium in `: 6314
Service Tax in `: 948

Policy No. : 54070331160200002477Document generated by QR_RENEWAL at 20/11/2016 21:47:00 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 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

Total Payable in `: 7262

Limitations as to use Limits of Liability

The policy covers use for any purpose other than: a)Hire or Limit of the amount the Company's Liability Under Section II
reward b)Organized racing, OR c)Speed testing 1(i) in respect of any one accident: as per the Motor Vehicles
Act, 1988. Limit of the amount of the Company's Liability
Under Section II 1(ii) in respect of any one claim or series of
claims arising out of one event: Up to ` 7,50,000
For individual covers (OD) in`: 0
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: NA

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 Relationship to the
Insured (if Nominee is a minor) Nominee
NA NA NA NA NA
PA cover for named persons
Name CSI Opted(`) Nominee Relationship
none 0 NA NA

In witness where of this policy has been signed at SINDRI BRANCH on this 20/11/2016
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 For and on behalf of The New India Assurance Company
relates as well as this Certificate of Insurance are issued in Limited
accordance with the provisions of Chapter X and XI of M.V.
Act, 1988.NIA S.T.REGN No: AAACN4165CST178.
Date of Issue: 20/11/2016

Duly Constituted Attorney(s)

IRDA Registration Number: 190

Policy No. : 54070331160200002477Document generated by QR_RENEWAL at 20/11/2016 21:47:00 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 6
THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : SINDRI BRANCH (540703)
Address : SINDRI BRANCH

,826001
DHANBAD

Phone : 03262381445
Email : nia.540703@newindia.co.in
Fax :

Collection Number : 10000089161100150729

Collection Date : 20/11/2016
Business Source Code : 2D10673816

Received with thanks from NASIMUL HAQUE..

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
54070331160200002477 Bank-100000 7262.00 9100.100000 BA00013647-100000-9100

Total = ` 7262.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Drawee Bank Drawee Reference No. Scroll/BG/
No. Date Branch APD
Balance
EPG 7262.00 HCTR4 N.A. N.A. N.A. 5407031610003660 N.A.
Credit 91101
Advice 2612

Total = ` 7262.00

Utilization details of the Collected Amount :

Premium Service Tax Stamp Duty Excess Amount
6314.00 948.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NA NA 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 20/11/2016

Cashier's Initial Authorized Signatory

NIA S.T.REGN No: AAACN4165CST178.

Note -

1.Please quote 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. : 54070331160200002477Document generated by QR_RENEWAL at 20/11/2016 21:47:00 Hours.

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

Page 4 of 6
THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

IRDA Registration Number: 190

Policy No. : 54070331160200002477Document generated by QR_RENEWAL at 20/11/2016 21:47:00 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 6
THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

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 ` 2000 (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. 28. LEGAL LIABILITY TO PAID DRIVER AND/OR CONDUCTOR AND/OR CLEANER EMPLOYED IN CONNECTION WITH THE
OPERATION OF INSURED VEHICLE (For all Classes of vehicles.)

In consideration of an additional premium of ` 50/- notwithstanding anything to the contrary contained in the policy it is
hereby understood and agreed that the insurer shall indemnify the insured against the insured's legal liability under the
Workmen's Compensation Act,1923, the Fatal Accidents Act, 1855 or at Common Law and subsequent amendments of these
Acts prior to the date of this Endorsement in respect of personal injury to any paid driver and/or conductor and/or cleaner
whilst engaged in the service of the insured in such occupation in connection with the vehicle insured herein and will in
addition be responsible for all costs and expenses incurred with its written consent.

Provided always that

(1) this Endorsement does not indemnify the insured in respect of any liability in cases where the insured holds or
subsequently effects with any insurer or group of insurers a Policy of Insurance in respect of liability as herein defined for
insured's general employees;

(2) the insured shall take reasonable precautions to prevent accidents and shall comply with all statutory obligations;

(3)the insured shall keep record of the name of each paid driver conductor cleaner or persons employed in loading and/or
unloading and the amount of wages and salaries and other earnings paid to such employees and shall at all times allow the
insurer to inspect such records on demand.

(4) in the event of the Policy being cancelled at the request of the insured no refund of the premium paid in respect of this
Endorsement will be allowed.

Subject otherwise to the terms conditions limitations and exceptions of the Policy except so far as necessary to meet the
requirements of the Motor Vehicles Act, 1988.

IRDA Registration Number: 190

Policy No. : 54070331160200002477Document generated by QR_RENEWAL at 20/11/2016 21:47:00 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 6