THE NEW INDIA ASSURANCE CO.LTD.

(Wholly Owned by the Govt. of India)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
Two Wheeler Liability Policy
Insured Name Mr TIRUPATHIRAO RATNALA
INSURED'S DETAILS POLICY NUMBER 71230031170250007464
From :26/02/2018 12:00:59 AM
Customer ID 1000032606 Period of Cover
TO 25/02/2019 11:59:59 PM
AYURGREEN STORE, TEKKALI, SRIKAKULAM, ANDHRA
Insured's Address PRADESH, 532201(State Code - AP),GSTIN - NA Registration No AP-30-K-7868

Phone Number 9666430237 Make/Model HONDA-CB

Email Id AYURGREEN9@GMAIL.COM Receipt No/Transaction Id LSBI6086945743
Date of Birth 18/04/1980 RTO Location SRIKAKULAM
Compulsory Personal Accident Cover for Owner-Driver
Name of Nominee Age of Nominee Relationship with the Insured Name of Appointee (If Nominee is a Minor)
Ms KADAMBALA SANTISWARUPA 25 SPOUSE

Vehicle Details
Variant Cubic Capacity Year of Mfg. Seating Capacity Chassis Number Engine Number
TWISTER 109 2010 02 ME4JC474CA8003236 JC47E0013685
Schedule of Premium

Basic Third Party Premium (Including TPPD) (in ) Personal Accident to Owner (Driver) (in ) GST(@18%) in Total Premium in
720 50 139 909

Issuing Office
Address GSTIN Email Phone No
Royapettah DO(712300), 1st Floor, B.Wing, SPS Building No.185,
nia.712300@newindia.co.in 044-23456806/808
Anna Salai, Chennai, Tamil Nadu-600 002 (State Code - TN)

Geographical Area/Zone : India

Limitations as to Use : The Policy covers use for any purpose other than : a) Hire or Reward b) Oraganized racing c) Speed Testing.
Limits of Liability : Limit of the amount of 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/-
Premium Collection Details :Transaction Type: Online, Transaction Id :LSBI6086945743, Transaction Amount:Rs.909/-
In Witness where of this Policy has been signed at Chennai on this 25/02/2018. WARRANTED THAT IN CASE OF NON-CREDIT OF PREMIUM INTO
OUR COLLECTION ACCOUNT ON THE DATE OF COMMENCEMENT OF RISK THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED AB INITIO.
This policy is subject to the Terms, Conditions & exceptions applicable to Liability policy attached/available on the website http://newindia.co.in.
Important Notice
The Insured is not indemnified, if the vehicle is used or driven otherwise than in accordance with 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'.
For and on behalf of
I/We hereby certify that the policy to which this Certificate relates as well as this Certificate
The New India Assurance Company Limited
of Insurance are issued in accordance with the provisions of Chapter X and XI of M.V. Act.1988
Insurance Company PAN : AAACN4165C
Service Tax Registration No : AAACN4165CST178
Category : General Insurance Business Service - 00440005
Consolidated Stamp Duty Paid Duly Constituted Attomey(s)
Policy No: 71230031170250007464 Document generated on this day 25/02/2018. Regd. & Head Office : New India Assurance Bldg.87, M.G.Road, Fort, Mumbai-400001. 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
SAC : 997134, Description of Service : Motor Vehicle Insurance Service, Place of Supply: Delhi (State Code-TN), Invoice Number:'.