THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

The New India Assurance Co.Ltd.

BELAPUR D.O. (170200)
Tel. No.: 27576618/27572823/
Email: nia.170200@newindia.co.in/

Private Car Package Policy

IRDAN190RP0042V01100001
Policy Number: 17020031200100000475
Vehicle: TOYOTA/INNOVA

Period of Cover
From: 28/05/2020 12:00:01 AM
To: 27/05/2021 11:59:59 PM

Insured Details
AMANDEEP SINGH 31981100
To: 41 ST NO 8-A ANAND NAGAR B PTA PATIALA PUNJAB, , ,PATIALA ,PUNJAB, 147001

For Insurance Renewals contact

MRINALINI AHUJA
Tel. No.: / 9757104997 / 7710029600
Email: ahujamrinalini28@gmail.com /

For Claims contact our OFFICE

BELAPUR D.O. 170200
BELAPUR D.O (170200), VINDHYA COMMERCIAL COMPLEX, 2ND FL, PLOT NO. 1, SECTOR
11,CBD BELAPUR NAVI MUMBAI,,400614
Tel. No.: 27576618
Email: nia.170200@newindia.co.in

Tax Invoice No : 17020020E0000722

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2020.04.28
11:56:36 IST
Policy No. : 17020031200100000475Document generated by 31756 at 28/04/2020 11:56:33 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

Page 1 of 6
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Package Policy

UIN - IRDAN190RP0042V01100001

Insured's Details Policy Details

Insured's Name: AMANDEEP SINGH 31981100 Policy number: 17020031200100000475
Customer ID: PO68626522 (PAN No :NA) Period of cover: 28/05/2020 12:00:01 AM to 27/05/2021
11:59:59 PM
Insureds Address: 41 ST NO 8-A ANAND NAGAR B PTA Registration no. PB-65-F-5405
PATIALA PUNJAB,,,
PATIALA ,PUNJAB, 147001
Prev. Policy no. 17020031190100000831 Make/Model: TOYOTA/INNOVA
Email: Receipt no. 17020081200000000382 - 28/04/20
Phone Number : / / Fax Number : NA / NA
GSTIN/UIN NA / NA
Issuing office New India Contact
Address BELAPUR D.O. (170200), Agent / Corp. Agent /
BELAPUR D.O (170200), VINDHYA COMMERCIAL COMPLEX, Broker / Banc Ms. Mrinalini Ahuja -
2ND FL, PLOT NO. 1, SECTOR 11 , CBD BELAPUR NAVI Assurance / Referral
MUMBAI , , Code - Name / (NIAAG00051789)
MAHARASHTRA , 400614. POS/IMF/SPECIFIED
PERSON
Phone no / 9757104997 / 7710029600
Phone no 27576618 / 27572823 Fax no. /
Fax no. NA / NA Email ahujamrinalini28@gmail.com /
Email nia.170200@newindia.co.in Development officer DIRECT 170200 - (2D6491099)
level Name/Code
Claim Contact BELAPUR D.O. (170200) Claim Contact Detail BELAPUR D.O (170200), VINDHYA COMMERCIAL
COMPLEX, 2ND FL, PLOT NO. 1, SECTOR 11,CBD
BELAPUR NAVI MUMBAI,;27576618/27572823/
GSTIN 27AAACN4165C3ZP
SAC 997139 (Other non-life insurance services excl RI)
Policy Details
Geographical Area / Zone: India/B Year of manufacture: 2007
Name of the Financier: Chassis no./Engine no.: 7085420/878061
Type of body: Saloon/Diesel Variant: 2.5 GX
Automobile Association none Colour: METALLIC
membership:
Seating capacity including Driver: 8 Cubic capacity ( cc)/Wattage(kW): 2494cc
Cover Note No/Cover Note Issue / Name of registration authority: Mohali
Date:
IDV(In `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
251100 0 0 0 0 251100
Schedule of Premium
Own Damage Liability
Basic OD Cover 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 ` 1354 TP Premium in ` 8615
Net Premium in `: 9969
GST in `: 1794
Total Payable in `: 11763
Total Payable in `(in words): RUPEES ELEVEN
THOUSAND SEVEN
HUNDRED SIXTY-
THREE ONLY

Limitations as to use Limits of Liability

Policy No. : 17020031200100000475Document generated by 31756 at 28/04/2020 11:56:33 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.
(Government of India Undertaking)

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`: 251100
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: 2000
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 none none

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 ` 9969.00
SGST 0 0
CGST 0 0
IGST 18 1794

In witness where of this policy has been signed at BELAPUR D.O. on this 28/04/2020
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.
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: 28/04/2020

Duly Constituted Attorney(s)

Tax Invoice No : 17020020E0000722

IRDA Registration Number: 190

Policy No. : 17020031200100000475Document generated by 31756 at 28/04/2020 11:56:33 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.
(Government of India Undertaking)

ADJUSTMENT VOUCHER
Issuing Office : BELAPUR D.O. (170200)
Address : BELAPUR D.O (170200), VINDHYA COMMERCIAL COMPLEX, 2ND FL, PLOT NO. 1, SECTOR 11
CBD BELAPUR NAVI MUMBAI
,400614
KOKAN BHAVAN
Phone : 27576618
Email : nia.170200@newindia.co.in
Fax :
Collection Number : 17020081200000000382
Collection Date : 28/04/2020
Business Source Code : 2D6491099
PAN No of Payer :

Received with thanks from AMANDEEP SINGH 31981100.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
17020031200100000475 Cash Deposit 11763.00 5076.170200 CD0000473974
Account-170200
Total = ` 11763.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Date Drawee Bank Drawee Branch Reference No. Scroll/BG/A
No. PD Balance
Advance 11763.00 N.A. N.A. N.A. N.A. 1702002010002108 734989.00
Premium
Deposit
Total = ` 11763.00

Utilization details of the Collected Amount :

Premium GST Stamp Duty Excess Amount
9969.00 1794.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NIAAG00051789 MRINALINI AHUJA 31

For The New India Assurance Company Limited

__________
| |
| |
| |
| |
|__________|
Date of Issue: 28/04/2020

Cashier's Initial Authorized Signatory

Note -
1.Please note 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.

Tax Invoice No : 17020020E0000722

IRDA Registration Number: 190

Policy No. : 17020031200100000475Document generated by 31756 at 28/04/2020 11:56:33 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.
(Government of India Undertaking)

IMT.16. PERSONAL ACCIDENT TO UNNAMED PASSENGERS OTHER THAN INSURED AND THE PAID DRIVER AND CLEANER { For
vehicles rated as Private cars and Motorised two wheelers (not for hire or reward) with or without side car}

In consideration of the payment of an additional premium it is hereby understood and agreed that the insurer undertakes to pay compensation
on the scale provided below for bodily injuries hereinafter defined sustained by any passenger other than the insured and/or the paid driver
attendant or cleaner and/or a person in the employ of the insured coming within the scope of the Workmen's Compensation Act, 1923 and
subsequent amendments of the said Act and engaged in and upon the service of the insured at the time such injury is sustained whilst
mounting into, dismounting from or traveling in but not driving the insured motor car and caused by violent, accidental, external and visible
means which independently of any other cause shall within three calendar months of the occurrence of such injury result in :

Details of Injury Scale of Compensation

i. Death 100%
ii. Loss of two limbs or sight of two eyes or one limb and sight of one 100%
eye
iii. Loss of one limb or sight of one eye 50%
iv. Permanent Total Disablement from injuries other than named above 100%

Provided always that: -

(1) compensation shall be payable under only one of the items (i) to (iv) above in respect of any such person arising out of
any one occurrence and total liability of the insurer shall not in the aggregate exceed the sum of ` 800000 during any one
period of insurance in respect of any such person.
(2) no compensation shall be payable in respect of death or injury directly or indirectly wholly or in part arising or resulting
from or traceable to (a) intentional self injury suicide or attempted suicide physical defect or infirmity or (b) an accident
happening whilst such person is under the influence of intoxicating liquor or drugs.
(3) such compensation shall be payable only with the approval of the insured named in the policy and directly to the injured
person or his/her legal representative(s) whose receipt shall be a full discharge in respect of the injury of such person.
(4) not more than 8 persons/passengers are in the vehicle insured at the time of occurrence of such injury.
Subject otherwise to the terms exceptions conditions and limitations of this policy.

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;

Policy No. : 17020031200100000475Document generated by 31756 at 28/04/2020 11:56:33 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.
(Government of India Undertaking)

(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.

Tax Invoice No : 17020020E0000722

IRDA Registration Number: 190

Policy No. : 17020031200100000475Document generated by 31756 at 28/04/2020 11:56:33 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