THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Private Car Package Policy

Insured's Name:
Customer ID:
Insureds Address:

Prev. Policy no.

Email:
Phone Number :

Address

Insured's Details
AMIT P. JAIN
PO30673653

A/4 SIDDHARTH KUTIR MANCHUBHAI Registration no.

ROAD MALAD E MUMBAI,,,
,,0
14050131140300004908
Make/Model:
Receipt no.
/ / 8655597911
Fax Number :

Issuing office
VIRAR BRANCH - 140501 (140501),
SHAKTI SADAN, 1ST FLOOR, , NR. POST OFFICE,
VARTAK ROAD, , VIRAR (W) ,
MAHARASHTRA , 401303.

Phone no
Fax no.
Email

2509243 / 2502653
2507166 / NA
nia.140501@newindia.co.in

Claim
Contact

MRO-II (140001)

Geographical Area / Zone:

Name of the Financier:
Type of body:
Automobile Association
membership:
Seating capacity including
Driver:
Cover Note No/Cover Note Issue
Date:

Vehicle
590000

Policy Details
14050131150100005010
06/11/2015 03:47:58 PM to 05/11/2016
11:59:59 PM
MH-02-DS-4373

Policy number:
Period of cover:

Trailer
0

FORD/ECO SPORT
14050181150000008524 - 06/11/15
NA / NA
New India Contact

Agent / Corp. Agent

/ Broker / Banc
Assurance/ Referral
Code - Name
Phone no
Fax no.
Email
Development officer
level Name/Code
Claim Contact
Detail

Vashishth N. Shukla (NIA2D6490371)

/ / 9321656551
/
/
MR. S.R. TIWARI - (2D6490387)
2nd floor, Jeevan Seva Bldg, Santacruz, West,
Mumbai 400054,,;02226633247//

Policy Details
Year of manufacture:
Chassis no./Engine no.:
Variant:
Colour:

India/A
Saloon
none

2014
MAJAXXMRKAER45252/KA45252
FORD ECO SPORT
WHITE COLOR

Cubic capacity ( cc):

1499

Name of registration authority:

Mumbai West

Non-Elec Acc
0

IDV(In `)
Electrical Acc
0

Bi-fuel kit
0

Total Value
590000

Schedule of Premium
Own Damage

Liability
Basic TP Cover
Compulsory PA cover for Owner
Driver, PA cover for UnNamed
Persons, LL cover for Paid Driver

Basic OD Cover

NCB(20%)
OD Premium in `

7129

TP Premium in `

1848

Signature Not
Verified

Policy No. : 14050131150100005010Document generated by 37592 at 06/11/2015 15:55:01 Hours.

Digitally signed
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
by Srinivasan
For Vaideswaran
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
Date: 2015.11.06
our own
grievance
15:55:01
IST 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.
Page No. 1

THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

Net Premium in `:
Service Tax in `:
Total Payable in `:
Limitations as to use
The Policy covers use of the 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

8977
1257
10234
Limits of Liability
Limit of the amount 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 ` 7,50,000
For individual covers (OD) in`:
590000
Imposed excess in `:
0
Voluntary excess in `:
0
Compulsory excess in `:
1000

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
NA
NA
NA
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 VIRAR BRANCH - 140501 on this 06/11/2015
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 16,22.
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: 06/11/2015
Duly Constituted Attorney(s)

Policy No. : 14050131150100005010Document generated by 37592 at 06/11/2015 15:55:01 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.
Page No. 2