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RECEIPT
Received with thanks from Sri/Smt Mr. Mr. J.S. SENTHIL KUMAR a sum of Rs. 6,971.00 (RUPEES SIX THOUSAND NINE HUNDRED
SEVENTY ONE ONLY) by Credit Card/Debit Card/Net Banking towards Motor Package Policy as per details given hereunder
Sl. Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head A/C Head Credit Amount Debit Amount Amount Received
No Year Number (General Ledger) (Sub Ledger) (Rs.) (Rs.) (Rs.)
Authorised Signatory
.
.
.
1.Please quote collection no. and date in all correspondeces. . Signature of authorised representative
2.The stamp has been defaced and retained at the office of dealer with rubber stamp
against the issued policy. .
Dealer Name :
Dealer Address :
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MOTOR INSURANCE - PRIVATE CAR PACKAGE POLICY SCHEDULE
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Policy Number :65030531146165000047 Previous Policy Number :65030531136165000018
Geographical Area : India(P3) Insurance Start Date & Time :26/01/2015 00:00:00 (hours)
Insured Name :Mr. Mr. J.S. SENTHIL KUMAR Insurance Expiry Date & Time :25/01/2016 midnight
Insured Address :3 /604 - A, RAMA GOUNDER STREET OLD Policy Issuing Office Address :Royal Towers, 185/1,
QUARTERS, DHARMAPURI Dist. : Meyyanoor Road, Opposite:
DHARMAPURI, Tamil Nadu,Dharmapuri ARRS Multiplex Theatre, PB
,DHARMAPURI, Tamil Nadu, PIN - 636705 No: 438 , Salem, Tamil Nadu,
Pin : 636004
City : Dharmapuri District : DHARMAPURI
State : Tamil Nadu Pincode : 636705
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. . . .
Channel Code: 46142 / 52848 Channel Name: A.SRIKANTHAN (cell : 98427-33994)
. . . .
IRDA License Number: 58 Contact Us : portal.support@nic.co.in
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VEHICLE DETAILS
. .
TN-29-AL-1985
. .
K10BN7117731
. .
2012
Registration Number Engine Number Year of Manufacture
. . .
Vehicle Weight(kg.)
. .
Regional Transport Officer,
. .
MA3EADE1S00307777
. .
998
RTA Name Chassis Number Cubic Capacity
. Dharmapuri, Tamil Nadu . .
. . .
. .
27/01/2012
. .
MARUTI ALTO K 10 VXI &
. .
Saloon
Registration Date Vehicle Make & Type of Body
. . MARUTI ALTO K 10 VXI .
Model
. . . .
No Extension
. .
4 In All
AA Membership Geographical Seating Capacity
. . .
Name Extension (Including Driver)
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ALL AMOUNTS ARE (In Rupees)
. . . . . . . .
Vehicle Trailer Electrical Non-Electrical CNG Kit LPG Kit TOTAL Co-Insurance
. . . . . .
/Electronic Accessories Details
.
Accessories
.
247059.00
.
0.00
.
0.00
.
0.00
.
0.00
.
0.00
.
247059.00 100.00
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OTHER DETAILS
. . .
Financier Policy Subject to IMT Endorsements Applicable Add-on covers / Services
100019
7, 22, 24, 16, 28
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NOMINEE DETAILS
. . . . .
Nominee Name Nominee Relation Nominee Age Appointee Name Appointee Relation
.
Selvarani
.
Wife
.
40
. .
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PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE: As narrated in the certificate of insurance attached herewith.
LIMITATIONS AS TO USE : As narrated in the certificate of insurance attached herewith.
LIMITS OF LIABILITY : As narrated in the certificate of insurance attached herewith.
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EXCLUSIONS: (1)Any accidental loss or damage and/or liability caused sustained or incurred outside the geographical area. (2) Any claim arising out of any ntractual liability. (3) Any accidental
loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising there from or any consequential loss. (4) Any liability of whatsoever nature directly or
indirectly caused by or contributed to or by arising out of ionizing radiations or contamination by radioactivity from any nuclear fuel. For the purpose of this exception, combustion shall include
any self sustaining process of nuclear fission. (5) Any accidental loss or damage or liability directly or indirectly caused by or contributed to, by or arising from nuclear weapons material. (6) Any
accidental loss, damage or liability directly or indirectly or proximately or remotely occasioned by contributed to by or traceable to or arising out of or in connection with war, invasion, the act of
foreign enemies, hostilities or war like operations(whether before or after declaration of war), civil war, mutiny, rebellion, military or usurped power or by any direct or indirect consequence of
any of the said occurrences or any consequences thereof and in default of such proof, the company shall not be liable to make any payment in respect of such a claim.
. .
PA COVER CSI (In Rupees) DEDUCTIBLES (Under Section I) (In Rupees)
. .
2,00,000.00
. .
1000.00
. .
0.00
. .
0.00
Owner- Driver Compulsory Imposed Voluntary
(Under section IV)
. . . . .
PA Named PA Named Number 0 PA Unamed Number 5
. . . . .
And UnNamed Cover PA Named Amount 0 PA Unnamed Amount 100000
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SCHEDULE OF PREMIUM (In Rupees)
. . .
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
. . .
5410.59 Basic TP Liability
. .
1129.00 Package Premium
.
6204.00
Basic Own Damage
. . .
5410.59 PA Cover
. .
100.00 Service Tax@12.36%
.
767.00
Total
. .. .
ADD Owner Driver Incl.Edu.Cess &
. ..
734.00 Employee Insured
..
0.00 Higher Edu. Cess
Sub
Total(Additional)
. ..
0.00 TOTAL PAYABLE
.
6971.00
. .. Paid drivers, .
Less
. .. cleaners etc. ..
PREMIUM
.
Bonus (20%) -1224.92 TOTAL 1229.00 Stamp Duty 1.00
. .
-209.28. . .
Discount (5%) AAACN9967EST099
. . ADD
-1434.204. 300.00.
Service Tax
Sub Total Sub Total Regn. No.
(Deductions-Including (Additions)
.
65030581149100000053
.
Receipt Number
NCB) .
.. .
. . LESS
4675.00. . Receipt Date
25/01/2015
Total Sub Total 0.00. .
6971.00
Receipt Amount
(Deductions)
.
1529.00
.
Total
.
. .
Net Banking
Payment Mode
. .
Mr. Mr. J.S. SENTHIL KUMAR
Paying Party
.
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TERMS & CONDITIONS:As per the Indian Motor Tariff, personal copy of the same is available free of cost on request. Further the Indian Motor Tariff is also available and displayed at all
National Insurance Company Offices and on website .
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. In case of accident, the insured must inform National Insurance Co. Immediately to arrange spot survey.
Date & Signature of Proposal: 23/01/2013
The coverage under this policy is subject to road worthiness and compliance of provisions of Motor Vehicles Act.
NOTE: POLICY STAMP HAS BEEN AFFIXED AND DEFACED AT THE RESPECTIVE POLICY SERVICING OFFICE
Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal.
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CERTIFICATE OF INSURANCE
(PRIVATE CAR)
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Insured Name :Mr. Mr. J.S. SENTHIL KUMAR Policy Number :65030531146165000047
Occupation :Engineers Policy Start Date & Time :26/01/2015 00:00:00(hours)
Phone/Mobile/Fax :236429 9655047282 Policy Expiry Date :25/01/2016 midnight
E-mail :sel_27@yahoo.com Geographical Area : INDIA (P3)
Insured Address :3 /604 - A, RAMA GOUNDER STREET OLD Policy Issuing Office :Salem Branch III Royal Towers,
QUARTERS, DHARMAPURI Dist. : DHARMAPURI, Address 185/1, Meyyanoor Road, Opposite:
Tamil Nadu,Dharmapuri ,DHARMAPURI, Tamil Nadu, ARRS Multiplex Theatre, PB No: 438 ,
PIN - 636705 Salem, Tamil Nadu, Pin : 636004
City : Dharmapuri District : DHARMAPURI
State : Tamil Nadu Pincode : 636705
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. . . .
Channel Code: 46142 / 52848 Channel Name: A.SRIKANTHAN (cell : 98427-33994)
. . . .
IRDA License Number: 58 Contact Us : portal.support@nic.co.in
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VEHICLE DETAILS
. . .
Registration Number: Registering Authority & Place : Registration Date:
.TN-29-AL-1985 .Dharmapuri, Tamil Nadu .27/01/2012
. . . .
Engine Number: Chasis Number: Vehicle Make & Model Vehicle color
.K10BN7117731 .MA3EADE1S00307777 .MARUTI ALTO K 10 VXI & MARUTI ALTO K 10 .Copper
VXI
. . . . .
Year of Cubic Type of Seating Capacity Geographical
. . . . .
Manufacture Capacity Body (Including Driver) Extension
.2012 .998 .Saloon .4 In All (Persons) .No Extension
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ALL AMOUNTS ARE (In Rupees)
. . . . . . . .
Vehicle Trailer Electrical /Electronic Non-Electrical CNG Kit LPG Kit TOTAL Co-Insurance
. . . . . . .
Accessories Accessories Details
.
247059.00
.
0.00
.
0.00
.
0.00
.
0.00
.
0.00
.
247059.00
.
100.00
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PREMIUM
Premium - Rs.6204.00 Service Tax @ 12.36% -Rs. 767.00 Total Payable -Rs.6971.00 Stamp Duty - Rs.1
Service Tax Registration Number:>AAACN9967EST099
Receipt Number:65030581149100000053 Receipt Date: 25/01/2015 Receipt Amount:- Rs. 6971.00 Payment Mode: Net Banking
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PERSONS OR CLASSES OF PERSON ENTITLED TO DRIVE
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Any person including insured: Provided that a person driving holds an effective Driving license at the time of 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 that
such a person satisfies the requirement of Rule 3 of the Central Motor Vehicles Rule 1989.
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LIMITATIONS AS TO USE
The policy covers use of 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.
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LIMITS OF LIABILITY:
Under Section II-1(i) of the policy Death of or bodily injury Such amount as is necessary to meet the
requirement of the Motor Vehicles Act,1988
Under Section II-1(ii) of the policy Damage to Third Party Property Rs.750000
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. .
Policy Subject to IMT Endorsements Applicable Add-on covers / Services
. .
. .
7, 22, 24, 16, 28 .
. .
. .
.
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I / We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in accordance
with the provisions of Chapter X and Chapter XI of MV Act, 1988.
.
For National Insurance Company Limited
Print Date: 25/01/2015 21:14:38 hours