THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

[B]
POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Two Wheeler Package Policy

UIN Number - IRDAN190RP0043V01100001

Policy Number :31150031210100009263

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
GREEN PARK (311500), NAME: DRO I (310001)
R-7A, GREEN PARK MAIN , , , Paytm Insurance Broking Private Limted. - RG CITY CENTRE, LSC, BLOCK B,LAWRENCE ROAD,
DELHI , 110016. (BR00000793), NEW DELHI -
PHONE NUMBER:26966927 PHONE NUMBER: / 01204242890 / 8826390016 110035,CH31@NEWINDIA.CO.IN,;01127004512/0112
FAX NUMBER:NA / NA LAND/FAX NUMBER:/ 7004513/
Email:nia.311500@newindia.co.in EMAIL:insurance.support@paytminsurance.co.in PHONE NUMBER: 01127004512 / 01127004513
/ MOBILE NUMBER:
Email: ch31@newindia.co.in

INSURED DETAILS
Insured Name PAKIRAM P Customer ID PO91262822 (PAN No
:null)
Insured Address 4/84 eshwaran koil Street,Alathur, thiruporur,, Contact Number 7092580453 / /
TIRUPORUR ,TAMIL NADU, 603110
Email rmbormsh@gmail.com
GSTIN NA
CHANNEL PARTNER CONTACT DETAILS
Channel Partner Name Email Address(s) Contact Number(s)
PAYTM service_motor@paytminsurance.co.in 88263 90016

POLICY DETAILS
Period of cover 03/09/2021 12:00:01 AM to 02/09/2022 11:59:59 PM Receipt Number 31150081210000009818 -
30/08/21
Previous Insurer UNITED INDIA INSURANCE CO. LTD. Previous Policy Number 0109823120P105239673

VEHICLE DETAILS
Registration Number TN-14-L-1886 Chassis no./Engine Number MBLJAS050HGF04952/JA0
6ERHGF13901
Make / Model HERO MOTOC/GLAMOUR Variant: KICK START DISC BRAKE
CAST WHEEL (125 CC)
Year of manufacture 2017 Type of body / Type of Fuel Metal/Petrol
Colour As per RC Book Cubic capacity(cc) 125cc
/Wattage(kW):
Seating capacity including 2 Name of registration CHENNAI
Driver authority
Geographical Area / Zone India Name of the Financier null
Cover Note No/Cover Note / Automobile Association
Issue Date: membership
INSURED DECLARED VALUE (in Rs)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
26607 0 0 0 0 26607
SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 182 Basic TP Premium 752
(-)Calculated NCB Discount(45%) 81.8
Calculated OD Premium 100 Calculated TP Premium 752
Total OD Premium 100 Total TP Premium 752
Net Premium in Rs 852
Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 31150031210100009263Document generated by PAYTMUSER at 2021/08/30 17:48:52.
Vaideswaran
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2021.08.30
17:48:52 IST Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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.
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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

GST in Rs 153
Total Payable in Rs 1005
Total Payable in Rs(in words): RUPEES ONE THOUSAND FIVE ONLY
GSTIN(Issuing Office) 07AAACN4165C1ZT
SAC 997134 (Motor vehicle insurance services)
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 f) Reliability Trials g)Any purpose in connection with Motor
Trade
Limits of Liability:Limit of the amount the Company's Liability Under Section II 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 Rs. 1,00,000
For individual covers (OD) in RS:26607 Compulsory excess in Rs:100
Imposed excess in Rs:0 Voluntary excess in Rs:0
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
As per the declaration given,the Insured has opted out of CPA cover under this policy.
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
NONE 0 NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium Rs 852.00
SGST 0 0
CGST 0 0
IGST 18 153

In witness where of this policy has been signed at GREEN PARK on this 30/08/2021WARRANTED 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 18,22.
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.
Anti Money Laundering Clause: In the event of a claim under the policy exceeding Rs 1lakh or a claim for refund of premium exceeding Rs 1
lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as well
as Company website.
I/We hereby certify that the policy to which this Certificate relates For and on behalf of The New India Assurance Company Limited
as well as this Certificate of Insurance are issued in accordance
with the provisions of Chapter X and XI of M.V. Act, 1988.
Date of Issue: 30/08/2021

Duly Constituted Attorney(s)

Tax Invoice No : 31150021P0012480

Policy No. : 31150031210100009263Document generated by PAYTMUSER at 2021/08/30 17:48:52.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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.
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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

IRDA Registration Number: 190

Policy No. : 31150031210100009263Document generated by PAYTMUSER at 2021/08/30 17:48:52.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
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.
Página 3 de 3

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