THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Commercial Vehicle Package Policy

UIN Number -

Insured's Details Policy Details

Insured's Name: VELSAMY. C Policy number: 73150031170100014031
Customer ID: PO58438901 (PAN No :NA) Period of cover: 22/03/2018 10:09:38 AM to 21/03/2019
11:59:59 PM
Insureds Address: S/O CHIDAMBARAM,,OLD NO:49, NEW Registration no. TN-30-AJ-7926
NO:308, KANSAPURAM METTU STREET,
KANSAPURAM-PO,,
SRIVILLIPUTHUR ,TAMIL NADU, 626125
Prev. Policy no. 73150031160100010839 Make/Model: ASHOK LEYL/2214
Email: Receipt no. 73150081170000018654 - 22/03/18
Phone Number : / 09500394041 / 7708884567 Fax Number : NA / NA

GSTIN/UIN NA / NA
Issuing office New India Contact
Address SIVAKASI D.O (731500), Agent / Corp. Agent /
75,77 SIVAN MADA VEETHI , , , Broker / Banc Mr. Kannan V -
TAMIL NADU , 626123. Assurance / Referral
Code - Name / (NIAAG00000935)
POS/IMF
Phone no / 9894609191 / 9843909191
Phone no 04562-220137 / 4562229449 Fax no. /
Fax no. NA / NA Email vkld011210@gmail.com /
Email nia.731500@newindia.co.in Development officer Mr. S.N. RAMAMOORTHY "BUSINESS ASSOCIATE" -
level Name/Code (DE00003003)
Claim Contact SIVAKASI D.O (731500) Claim Contact Detail 75,77 SIVAN MADA VEETHI,,;04562-
220137//4562229449
GSTIN 33AAACN4165C4ZV
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/C Year of manufacture: 2006
Type of Commercial Vehicles: A - Goods Carrying Sub Type: Other than 3 wheeler - Public Carrier
Name of the Financier: INDUSIND BANK LTD CHENNAI Chassis no./Engine no.: BFH106649/DFH360882
Type of fuel: Diesel Cubic capacity ( cc): 0
Type of body: Open Gross Vehicle Weight (GVW): 25000
Seating capacity including Driver: 3 Variant: AL 2214/19 180WB TUSKER
Automobile Association none Colour: N P COLOUR
membership:
Cover Note No/Cover Note Issue / Name of registration authority: Salem - TN 30
Date:
Transit From NA Transit To NA Distance Covered NA
IDV(In `) Based on annexure-I
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
400000 0 0 0 0 400000
Schedule of Premium
Own Damage Liability
Basic OD Cover Basic TP Cover
GVW above 12000KG, Inclusion of IMT 23 LL to persons employed for opn and/or
maint.and/or loading and/or unloading, LL
to paid driver conductor cleaner employed
for oprn
NCB(50%)
OD Premium in ` 2475 TP Premium in ` 31976
Net Premium in `: 34451
GST in `: 6202
Total Payable in `: 40653
Total Payable in `(in words): RUPEES FORTY
THOUSAND SIX
HUNDRED FIFTY-
THREE ONLY

Signature Not
Verified
Digitally signed
by Srinivasan Policy No. : 73150031170100014031Document generated by AG_VKANNAN at 22/03/2018 10:09:39 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: 2018.03.22
For 10:09:40
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.
(Wholly owned by the Govt. of India)

Limitations as to use Limits of Liability

The Policy covers use only under a permit within the meaning of the Limit of the amount the Company's Liability Under Section II 1(i) in
Motor Vehicles Act, 1988 or such a carriage falling under Sub-section 3 respect of any one accident: as per the Motor Vehicles Act, 1988. Limit
of Section 66 of the Motor Vehicles Act, 1988.The Policy does not of the amount of the Company's Liability Under Section II 1(ii) in
cover use FOR a)Organised racing b) Pace Making c)Reliability Trials d) respect of any one claim or series of claims arising out of one event:
Speed Testing Up to ` 7,50,000
For individual covers (OD) in `: 400000
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 1500
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
NONE 0 NONE NA NA
PA cover for named persons
Name CSI Opted(`) Nominee Relationship
NA NA NA NA

Premium and GST Details

Rate of Tax Amount in INR
Premium ` 34451.00
SGST 9 3101
CGST 9 3101
IGST 0 0

In witness where of this policy has been signed at Mumbai on this 22/03/2018
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 21,23,40.
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.
Date of Issue: 22/03/2018

(Mr ANANTHARAMAN K)
[DIVISIONAL MANAGER]

Duly Constituted Attorney(s)

Policy No. : 73150031170100014031Document generated by AG_VKANNAN at 22/03/2018 10:09:39 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.

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

Tax Invoice No : 7315003101014031

IRDA Registration Number: 190

Policy No. : 73150031170100014031Document generated by AG_VKANNAN at 22/03/2018 10:09:39 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