[Merge]scooty document_20201220_214332

Servicing Office Address
Uluberia Branch,Bazar Para, Opposite : Stadium, Uluberia, Howrah,
WestBengal, Pin : 711316
GSTIN No: 19AAACN9967E1Z0

RECE

Customer Details

Name : Mrs RUNA MUKHERJEE
Address : SANTRAGACHI,RAMRAJATALA,SHASTITALA,KONAROD,HMC,JA

, WEST BENGAL , HOWRAH
Pin Code : 711104

Received with thanks from Sri/Smt Mrs RUNA MUKHERJEE
a sum of 4645 (RUPEES FOUR THOUSAND SIX HUNDRED FORTY FIVE O
towards Long Term(1yr OD+5yr TP) Policy as per details given hereunder

Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C P
No.
Year Number

1 15350431206260000754 11 C.D CO
2 15350431206260000754 11 CASH PR
3 15350431206260000754 11 CGST_W
4 15350431206260000754 11 SGST_W

Particulars : CD

1.Please quote collection no. and date in all correspondeces
2.The stamp has been defaced and retained at the office against the issued
policy.

NIC/UBPORTAL/9000015630 23/06/2020 01:13 PM

Visit us at https://nationalinsurance.nic.co.in for inform

-1

EIPT Collection Details
AGACHA
Agent Code : 9000015630
Collection Number : 15350481208000001214
Collection Date : 23/06/2020
Bank Account : 9172

ONLY) by CD

Particulars A/C Head Credit Amount Debit Amount Amount
Received
(General Ledger)

ONTROL A/C 5076 0.00 4645.00 -4645.00
REMIUM A/C 5083 3937.00 0.00 3937.00
WB_Int_Liab 7031 354.00 0.00 354.00
WB_Int_Liab 7032 354.00 0.00 354.00
TOTAL : 4645.00
4645.00 0.00

For National Insurance Company Ltd.,

Authorised Signatory

mation on Products, Services and Grievance Redressal.

1-

Issuing Office Name & Address

ULUBERIA BRANCH ,BAZAR PARA, OPPOSITE : STADIUM, ULUBERIA,
HOWRAH, WESTBENGAL, PIN : 711316

Tel: Fax:
GSTIN No: 19AAACN9967E1Z0

National Insurance Company Ltd.

Registered & Head Office: 3, MIDDLETON STREET, POST BOX NO. 9229, KOLKATA - 700 071
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989

Policy No:15350431206260000754 Long Term(1yr OD+5yr TP) from 13:13 Hrs of 23/06/2020 to Midnight of 22/06/2025 IXI

OD Cover Start Date:23/06/2020 OD Cover End Date:22/06/2021

TP Cover Start Date:23/06/2020 TP Cover End Date:22/06/2025

Insured Details

Name : Mrs RUNA MUKHERJEE

Address : SANTRAGACHI,RAMRAJATALA,SHASTITALA,KONAROD,HMC,JAGACHA , WEST BENGAL , HOWRAH

Pincode : 711104 Telephone : 9163934125 Email : [email protected]

PAN No. : GSTIN No. : Aadhar No. :

Channel : ASISH PRAMANIK Mobile : 9432161751 Email : [email protected]

Aadhar : PAN : xxxxxx244P Code. : 153504 / 9000015630

Vehicle Details

Make & Model Two Wheeler TVS Ntorq 125 Disc

Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District

NEW AK3BL2253309 MD626AK33L2B14535 125 2020 1+1 HOWRAH

Geographical Area : INDIA.

Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV

Rs.72,152 - - - - Rs.72,152

OD Premium Breakup in Rs.

Year Basic Prem. Geo. Area Ext. Vol. Exc.(-) Auto. Assoc(-)Anti-theft(-) Other(-) Nil Dep. Nil Dep. Plus NCB Prot. Eng. Prot. Invoice Prot. Total(Rounded Off)

1 967.56 -484.00 123.00 607.00

Year Basic Prem. Geo. Area Extension PA to owner driver TP Premium Breakup in Rs. Discount For Limited TPPD Total(Rounded Off)
PA to unnamed PAX

1 657.00 295.00 -50.00 902.00

2 657.00 -50.00 607.00

3 657.00 -50.00 607.00

4 657.00 -50.00 607.00

5 657.00 -50.00 607.00

OD Total (Rounded Off) 607.00

TP Total (Rounded Off) 3,330.00

TOTAL PREMIUM 3,937.00

GST 708.00

NET PAYABLE 4,645.00

Collection Number :15350481208000001214 dated 23-Jun-2020 Subject to IMT Endorsement No. 20,24,25

Excess : Compulsory: Rs.100 Imposed: Rs.0 Voluntary: Rs.0
Limitation as to use :
Drivers Clause : 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 and Reliability Trials (f) Use in connection with Motor Trade
Limits of Liability Clause:
IMPORTANT NOTICE : Any person including Insured Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from holding or obtaining such a
licence. Provided also that the person holding an effective Learner's Licence may also drive the vehicle and such a person satisfies the requirements of Rule 3 of Central Motor
Financier : Vehicles Rules, 1989. CSI for PA Cover for owner driver is Rs. 15,00,000 ().

Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
Under section 1(ii) Damage to third party property is Upto Rs. 6,000 .

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 reasons of wider terms
appearing in the certificate in order to comply with the Motor Vehicles 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.

SELF OWNED

Nominee Name : SUMAN MONDAL Relation : HUSBAND Age : 30 Years

In consideration of payment of additional premium as indicated in the Schedule it is hereby agreed and understood that indemnification in respect of Partial loss claims shall be done without application of
Depreciation as mentioned in Section 1. of the policy.
However claims payable in accordance with this endorsement will be subject to a Deductible of 5% of the claim amount subject to a minimum of deductible stated in the Schedule.
NOTE : Warranted that in case of dishonour of the premium cheque, this document stands automatically cancelled 'AB-INITIO'.
Policy stamp to be defaced at the respective policy servicing office.

I/We hereby certify that this Certificate cum Schedule of Insurance is issued in accordance with the provisions of chapter X and chapter XI of Motor Vehicles Act,1988.

Authorised Signatory
For & On behalf of
National Insurance Company Limited

NIC/UBPORTAL/9000015630 23/06/2020 01:13 PM

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
Customer Care Toll Free Number: 1800 345 0330 Email: [email protected]