The New India Assurance Company Limited

Head Office:New India Assurance Building,87, M.G. Road, Fort, Mumbai - 400 001

IRDA Regn. No. 190

Website:www.newindia.co.in

Private Car Package Policy CERTIFICATE CUM POLICY SCHEDULE

Certificate cum Policy No: 71050131160110003446

East Coast Chambers, 92, Gn Chetty Road, T Nagar Chennai Tamil Nadu-600017
Policy Issuing Office Code 710501 Policy Issuing Office Address
Telephone :
Broker Code 10032058 Broker Name TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD
Broker Telephone No 022-66207900 IRDA License No. 375
RTO Location CHENNAI - CENTRAL
Period of Insurance From 00:00 20/12/2016 To 19/12/2017 Midnight
Intermediary Code 201398220160
Endorsement Effective Date NA
Insured Name C SUGUMAR Policy Issued On 16/12/2016
DOOR NO. 8, PLOT NO. 1483, TARA APARTMENT, 13TH MAIN
Insured Address ROAD, ANNA NAGAR ROAD, ANNA NAGAR
WEST,0,CHENNAI,CHENNAI,TAMIL NADU, PIN - 600040
Nominee Name NALINI SUGUMAR Nominee Age 54 Nominee Relationship Wife
Previous Insurer Name NIA Previous Policy Number 71050131150100204807
Date Of Expiry of Previous Policy 19/12/2016
Hypothecated With
Registration Number Make Model Type of body CC GVW Mfg Year Seating Capacity Chassis Number Engine Number
TN-01-AC-4097 FORD IKON - 1.3 SOHC FLAIR Sedan 1297 0 2006 5 MAJAXXMRTA6PA3149 6PA3149
Vehicle IDV Trailer Non-Electrical Accessories Electrical/Electronic Accessories CNG/LPG Unit Total Value
120,000.00 0 0 0 0 120,000.00

Own Damage(A) Liability(B)

Vehicle & Non Electrical Accessories 4,235.00 Basic Third Party Liability 2,237.00
Add Add
Less P.A Cover To Un-name Passenger Other Than Insured
Other Discount 339.00 And Paid Driver And Cleaner for (5) Persons Of Rs. 250.00
Deduct NCB -20.00 % 847.00 (100000) each
Sub Total Legal Liability To Paid Driver/Conductor/Cleaner-IMT
1,186.00 50.00
(Deduction) 28
P.A To Owner Driver Of Rs 2 Lakhs 100.00
Subtotal(additional) 400.00
TOTAL LIABILITY PREMIUM(B) 2,637.00
TOTAL OWN DAMAGE PREMIUM(A) 3,049.00 PACKAGE PREMIUM(A+B) 5,686.00
NET PREMIUM 5,686.00
Add :Service Tax@ 15%(incl. Swach Bharath & Krishi Kalyan Cess) 853.00
( incl. Krishi Kalyan Cess@ 0.5% 28.00)
TOTAL PREMIUM PAYABLE 6,539.00
Geographical Area : India Compulsory deductibles(IMT-22) : 1,000.00
LIMITS OF LIABILITY :
(a)Under Section II - 1 (i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988.
(b)Under Section II - 1 (ii) of the policy -> Damage to Third Party Property Rs 750,000.00 ; PA Cover for Owner-Driver under section III: CSI Rs 2,00,000.00 ; Voluntary Deductable Rs. 0.00
LIMITATIONS AS TO USE: The policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of goods(other than samples or personal luggage), Organized racing, Pace making, Speed
testing, Reliability trials,Any purpose in connection with Motor Trade.
DRIVER'S CLAUSES: 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 requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto : 28,22
Under Hire Purchase/Hypothecation/Lease Agreement with :
Premium Collection Details :- [Collection No / Amount / ReceiptDate] 1000833328 / Rs.6,539.00 / 15/12/2016
Received with thanks from C SUGUMAR an amount of Rs. 6,539.00 by Cheque No. 276755 dated 16/12/2016 drawn on bank UCO BANK towards Insurance Premium. Consolidated Stamp Duty Paid.
WARNING THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE , THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter For The New India Assurance Co. Ltd.
X,XI of M.V.Act 1988
Service Tax Registration No. :
PAN No. :
Insurance Company PAN No. : AAACN4165C
Service Tax Code Number : AAACN4165CST178
Category : General Insurance Business Services - 00440005 Authorised Signatory
Stampduty Challan No. :
Dealer Name: MPL FORD-(GUINDY)
. In Witness whereof this Policy has been signed at CHENNAI this 16day of December of 2016 , 01:26:20 PM.
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 Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For legal
interpretation,English version will hold good.
Please call Toll Free No. 1800 258 2545 for all Insurance Related Assistance