)/ D@dEo.

TWO WHEELER CERTIFICATE-CUM-POLICY SCHEDULE

NATIONAL INSURANCE COMPANY LIMITED

DO x, Hero Vertical, 101-106,

BMC House, Connaught

Place,

Trusted Since 1906

390r023116620r'
3099
New Delhi - 1 10 001

contac.i No:011-234Eg257

lnsured

Business/Profession
Address of The lnsured

MT M VUAYA

Businessman
w/O MAHENDRAN 2.82 MMAPURAM
MANDHAI MAYILADUTHUM]

NAGAPPATTINAM TAMIL N.ADU 609203

Vehicle Reon No.

Engine No.
Chassis No.
Make & Model

JF,l6EEGGEO46O5

;;il;;]
Hero MotoCorp

PLEASURE

HPLNFDRSMCR
Prev. Gert. No. rEeHH

-
Hef o
-
CORPORATE

;#*f:###
Valid From
To

17-06-2016
Midnight of 16-0t

17t16217
-2017

Year of Mfq
Cubic Caoacitv

20't6 102
NOn-Electflcal _-l

rG---l
o"oo
Declared Value (lDV) of 0.00
Vehicle Electrical
NA
CNG/LPG/Bi-Fuel
44935.00
Total IDV
44935.00
I
Ptace ot negn. PurchaseAgreement
II

I fijlfease/tli
HPrLeaserHire"f-

--l
Accessories IDV re- I-

re
Branch
Office
Accessories IDV Seating I

tDv Capacity
Premium
I

Side Gar IDV NA with

f-- I
I
Purchase

Premium Computation (Se ction l) in Rs.

B. Liabilitv Premium Comoutation {Section ll} in

SHRIRAM CITY UNION Es.
MAYILADUTHURAI
2
1827.00

Basic Premium On 0.00

:
Cleaners) Forany otherextra
:
0.00
a)
Basic Premium lncludinq
Compulsary
PremiuF for TP
PA Cover Sub Total Total Deductions
(Ovvner :
:
Legal
Driver) : Liabilit i)
50.00 y 780.00 0.00

Vehicle
e) Legal Liability Cover (Other Add Servaco Tax
then Paid
: Total : 238.00

o'oo
ND
678.00 Net Own Damage Premium(A)
Vehicle bove Less Discounts
:
: r
619.00 780.00

'
Gross Premium
Accessories :
oriJersicreine.si-- z 1827.00
:
678.00
0.00 b) Optional
PA Cover{Un
CNGTLPG/B|-Fue| Kit Named
: Passenger)
0.00
: : (includes 0.5% Swachh Bharat Cess + 0.5
70.00 Krishi Kalyan
Electronic & Electrical
102.00
Accessories : Add Extras:
_.d)
Legal :
0.00 Liability
Gover
(Paid
Driver
For anti-theft devices Cess)
s, :

,
0.00 0.00
Total Liablity Premium (B)
For any l. Registration No. : 58 ll 2. Licence
other
Add 809.00 No.:1424542 ll 3. CNN No. : U10200Vli
extr 81906GOt001713
c) Optional
a
PA Cover(Un Any other discount
Named :

Bi-Fuel Kit Driver) :

70.00

Total Premium (A + B) not disqualified from Holding or

Geographical obtaining such a licence.Provided also
:
Extensi that the person holdinghn effective
1589.00
Learne/s Licence may also
on
: NCB drive the vehicle and that such a person
: :
satisfies the requirements of Rule 3 of
0.00
the Central Motbr Vehicle Age
lNorninee
Rules, 1989.
- llso
-22,16,18,5

Llql[T.qF L|ABILITY: Limit oJ

7-Jun-
the amount of the
2016
Company'sliability under the FOR
Section tlJ(i) in respect of RENEW
any one accident as per M.V. ALS
I
Act 1988. Limit of the amount CONTA
oJ tlggggpgny'sliability CT:
under Secion ll{[ii) in R.S.
respect_q!any one claim or Motor
seriqs of claims s
arising_outof-oae-- EYE?it:
UDtdTStuffiOS#=_ F;il- Ph.No-
0435-
246556
6
UWe certify that the policy to
which the certificate relates
as well the certificate of
---l
Nominee
insurance are issued in
accordance with the propos
provisions of Chaoter X & Xl er
of M.V. Act {988 218/5,
Main
Road,
Ltd,
S.Puth
ur,
lEecei"".l vid. Thiruvi
Relation
daimar
:ffi uthur

ffi (TK) 1

lCash/Cheque

rF---t Consolidted
Stamp Deale/
s
Stamo
&
Siqnat
ure
I
lRegistration
lNo.
No: CA0034
Tel No: 1800- )ulv
102-4376 Consti
tuted
Attorn
ev
--- --l

Nominee Name IIMEHENDRAN

I Endorsements: IMT

orawn on
:OMPANY
LIMITED