THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

The New India Assurance Co.Ltd.

THE NEW INDIA ASSURANCE CO LTD.DIVISIONAL OFFICE (620500)
Tel. No.: 2462619/2442335/
Email: nia.620500@newindia.co.in/

TWO WHEELER Liability Policy

Policy Number: 62050031160200000593
Vehicle: BAJAJ/PULSAR

Period of Cover
From: 07/05/2016
To: 06/05/2017

Insured Details
SURAMPUDI SRINIVASA RAO
To: S/O SATYANARAYANA,1-94, DWARAPUDI POST,CHINA DWARAPUDI,DWARA PUDI ,ANDHRA
PRADESH, 533341

For Insurance Renewals contact

Y ASHOK KUMAR
Tel. No.: / / 9640740429
Email: /

For Claims contact our OFFICE

THE NEW INDIA ASSURANCE CO LTD.DIVISIONAL OFFICE 620500
THE NEW INDIA ASSURANCE CO LTD,. DIVISIONAL OFFICE ,,DOOR NO 36-12-24, MAIN ROAD
,RAJAHMUNDRY.,EAST- GODAVARI DISTRICT,533101
Tel. No.: 2462619
Email: nia.620500@newindia.co.in

IRDA Registration Number: 190

Policy No. : 62050031160200000593Document generated by QR_RENEWAL at 03/05/2016 20:13:43 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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 THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Two Wheeler Liability Policy

Insured's Details Policy Details

Insured's Name: SURAMPUDI SRINIVASA RAO Policy number: 62050031160200000593
Customer ID: PO25692253 Period of cover: 07/05/2016 12:00:01 AM to 06/05/2017
11:59:59 PM
Insureds Address: S/O SATYANARAYANA,1-94, Registration no. AP-05-CE-7840
DWARAPUDI POST,CHINA
DWARAPUDI,
DWARA PUDI ,ANDHRA PRADESH,
533341
Prev. Policy no. 62050031150200000507 Make/Model: BAJAJ/PULSAR
Email: laxmisadhana03@gmail.com Receipt no. 10000089160500010412 - 03/05/16
Phone Number : / / 9292457856 Fax Number : NA / NA

Issuing office New India Contact

Address THE NEW INDIA ASSURANCE CO LTD.DIVISIONAL Agent / Corp. Agent
OFFICE (620500), / Broker / Banc Mr. Y Ashok Kumar -
THE NEW INDIA ASSURANCE CO LTD,. DIVISIONAL Assurance/ Referral (NIAAG00022620)
OFFICE , , DOOR NO 36-12-24, MAIN ROAD Code - Name
,RAJAHMUNDRY. , EAST- GODAVARI DISTRICT ,
ANDHRA PRADESH , 533101.
Phone no / / 9640740429
Phone no 2462619 / 2442335 Fax no. /
Fax no. 2461019 / NA Email /
Email nia.620500@newindia.co.in Development officer V ADISESHU DEV.OFFICER - (1D4023840)
level Name/Code
Claim THE NEW INDIA ASSURANCE CO LTD.DIVISIONAL Claim Contact THE NEW INDIA ASSURANCE CO LTD,.
Contact OFFICE (620500) Detail DIVISIONAL OFFICE ,,DOOR NO 36-12-24,
MAIN ROAD ,RAJAHMUNDRY.,EAST-
GODAVARI DISTRICT;2462619/2442335/

Policy Details
Geographical Area / Zone: India/B Year of manufacture: 2012
Name of the Financier: Chassis no./Engine no.: MD2DHDHZZUCM14654/DHGBU
M80658
Type of fuel: Petrol Cubic capacity ( cc): 150
Type of body: Metal Variant: PULSAR 150 DTS -I
Seating capacity including 2 Colour: BLACK
Driver:
Automobile Association none Name of registration authority: Kakiinada
membership:
Cover Note No/Cover Note Issue /
Date:

IDV (in `)
Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
0 0 N/A N/A N/A 0

Schedule of Premium
Own Damage Liability
Basic TP Cover
Compulsory PA cover for Owner
Driver
NCB(20%)
OD Premium in ` TP Premium in ` 669

Policy No. : 62050031160200000593Document generated by QR_RENEWAL at 03/05/2016 20:13:43 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.
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 THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

Net Premium in `: 669

Service Tax in `: 98
Total Payable in `: 767

Limitations as to use Limits of Liability

The policy covers use for any purpose other than: a)Hire or Limit of the amount the Company's Liability Under Section II
reward b)Organized racing, OR c)Speed testing 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 ` 1,00,000
For individual covers (OD) in`: 0
Imposed excess in `: 0
Voluntary excess in `: 0
Compulsory excess in `: NA

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 Relationship to the
Insured (if Nominee is a minor) Nominee
RAJESWARI 28 WIFE NA NA
PA cover for named persons
Name CSI Opted(`) Nominee Relationship
none 0 NA NA

In witness where of this policy has been signed at Mumbai on this 03/05/2016
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 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 For and on behalf of The New India Assurance Company
relates as well as this Certificate of Insurance are issued in Limited
accordance with the provisions of Chapter X and XI of M.V.
Act, 1988.NIA S.T.REGN No: AAACN4165CST178.
Date of Issue: 03/05/2016

(Mr. Satyanarayan Mohapatra)

[ Sr. D.M]

Duly Constituted Attorney(s)

IRDA Registration Number: 190

Policy No. : 62050031160200000593Document generated by QR_RENEWAL at 03/05/2016 20:13:43 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.
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THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

COLLECTION RECEIPT CUM ADJUSTMENT VOUCHER

Issuing Office : THE NEW INDIA ASSURANCE CO LTD.DIVISIONAL OFFICE (620500)
Address : THE NEW INDIA ASSURANCE CO LTD,. DIVISIONAL OFFICE ,
DOOR NO 36-12-24, MAIN ROAD ,RAJAHMUNDRY.
EAST- GODAVARI DISTRICT,533101
RAJAHMUNDRY(AP-1)

Phone : 2462619
Email : nia.620500@newindia.co.in
Fax : 2461019

Collection Number : 10000089160500010412

Collection Date : 03/05/2016
Business Source Code : 1D4023840

Received with thanks from SURAMPUDI SRINIVASA RAO.

The amount received/Adjusted is towards -

Policy No. A/C Description Amount` A/C Code Sub A/C Code
62050031160200000593 Bank-100000 767.00 9100.100000 BA00013647-100000-9100

Total = ` 767.00

Your Payment/Adjustment Details are as under -

Mode Amount ` Cheque Cheque Drawee Bank Drawee Reference No. Scroll/BG/
No. Date Branch APD
Balance
EPG 767.00 FHDF44 N.A. N.A. N.A. 6205001610000570 N.A.
Credit 5920
Advice 7062

Total = ` 767.00

Utilization details of the Collected Amount :

Premium Service Tax Stamp Duty Excess Amount
669.00 98.00 0.00 0
Sl no. Agency Code Agency Name Department Code
1 NIAAG00022620 Y ASHOK KUMAR 31

For The New India Assurance Company Limited

Revenue Stamp
__________
| |
| |
| |
| |
|__________|
Date of Issue: 03/05/2016

(Mr. Satyanarayan Mohapatra)

[ Sr. D.M]

Cashier's Initial Authorized Signatory

NIA S.T.REGN No: AAACN4165CST178.

Policy No. : 62050031160200000593Document generated by QR_RENEWAL at 03/05/2016 20:13:43 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

Note -

1.Please quote 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.

IRDA Registration Number: 190

Policy No. : 62050031160200000593Document generated by QR_RENEWAL at 03/05/2016 20:13:43 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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THE NEW INDIA ASSURANCE CO. LTD.
(Wholly owned by the Govt. of India)

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 ` 100 (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.

IRDA Registration Number: 190

Policy No. : 62050031160200000593Document generated by QR_RENEWAL at 03/05/2016 20:13:43 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
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