Address of Issuing Office :

Address of Servicing Branch Office :

Reliance General Insurance Co. Ltd

Rectifier House, Naigaum Cross Road, 570
Wadala (W), Mumbai - 400 031, India

Reliance General Insurance Co. Ltd

Policy Servicing Branch address : Flat No-10-15, 14th Floor, Vijaya
Building, 17, Barakhamba Road , Connaught Place, New Delhi - 110001
Delhi Delhi 110001, India
Branch Contact No. 011-39975617

Burglary and Housebreaking Insurance Policy

Master Policy No :

9202952911000011

Proposal / Covernote No:

P1301952911178147

1301952911178147

Policy Certificate No :

Date of proposal & declaration : 24/08/2015

Name of the Insured :

Mayank Mudgal

Address of the Insured :

House-41, Block-A, Pocket-8, Sector-17, Rohini, City : New Delhi, State : Delhi, PinCode : 110089,
Telephone No : , Mobile No : 9999553976
, Email ID : mayankmudgal@hotmail.co.in

Period of Insurance :

From : 21/08/2015 To : 20/08/2016

Description and situation of the premises containing the property insured :

Address :
House-41, Block-A, Pocket-8, Sector-17, Rohini, City :New Delhi, State : Delhi, PinCode : 110089

Property Insured :
Make and Description

Model No.

HP Pavilion Notebook 15ab032TX

Serial No.

Identification No.

Year of Mfg.

Total Sum
Insured (in Rs.)

5CD5267FXG

90040906

2015

51800.00

Extensions :
The policy covers THEFT as an extension.
Premium Details

Amount (Rs.)

Net Premium :

259.00

Add: Service Tax (14.00% of Net Premium) :

36.26

Total Premium :

296.00

(Service Tax Registration Number: AABCR6747BST001)

Category-General Insurance Business Service 00440005)
Category-General Insurance Business Service 00440005.
Consolidated Stamp Duty Paid with Receipt No. MH006126164201415E Dated 02 Mar 2015 ** Not Applicable for the State of Jammu & Kashmir

Note : In the event of dishonor of cheque, this policy document automatically stands cancelled from inception, irrespective of
whether a separate communication is sent or not.
In witness whereof this policy has been signed at Corporate Group - Delhi on 26-Aug-2015
For any assistance with claims, please contact us on 1800 3009 (toll free) or email us at services.rgicl@relianceada.com.

For Reliance General Insurance Company Limited

Duly Constituted Attorney(s)

Agent Code/Name :

Direct/Direct

Insurance is the subject matter of Solicitation. IRDA of India Registration No. 103
Corporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited.
Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.
Corporate Office: 570, Rectifier House, Naigaum Cross Road, Next to Royal Industrial Estate, Wadala (W), Mumbai 400031.
"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General
Insurance Company Limited under License

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