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Issuing Office Name & Address

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Mumbai Direct Agents Branch II,First Floor, Sterling Cinema Building, 65,

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Murzaban Street, Fort, Mumbai, Pin : 400001 ,Telephone No: 18003450330

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Email ID: [email protected]

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GSTIN No: 27AAACN9967E1Z3

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RECEIPT

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Customer Details Collection Details

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Name : PIYUSH Agent Code : 91067500000001

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Mobile No : 7988833940 Collection Number : 26020181235000170182

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Email : [email protected] Collection Date : 28/07/2023

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Bank Account : 9100

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Received with thanks from Sri/Smt PIYUSH
a sum of 13499 (RUPEES ) by ONLINE

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towards 1 Year Package Policy Policy as per details given hereunder

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Sl Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head Credit Amount Debit Amount Amount

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No. Year Number (General Ledger) Received

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1 26020131236130174142 11 CASH PREMIUM A/C 5083 11440.00 0.00 11440.00

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2 26020131236130174142 11 IGST_HR_Int_Liab 7339 2059.00 0.00 2059.00

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74 TOTAL : 13499.00 0.00 13499.00
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Particulars : ONLINE
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For National Insurance Company Ltd.,

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1.Please quote collection no. and date in all correspondeces

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2.The stamp has been defaced and retained at the office against the issued
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policy.
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Authorised Signatory
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NIC/PHONEPE/91067500000001 28/07/2023 08:25 P.M.

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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 Issuing Office Name & Address
MUMBAI DIRECT AGENTS BRANCH II ,FIRST FLOOR, STERLING CINEMA
BUILDING, 65, MURZABAN STREET, FORT, MUMBAI, PIN : 400001
Telephone No: 18003450330 Email ID: [email protected]
GSTIN No: 27AAACN9967E1Z3

National Insurance Company Ltd.

Registered & Head Office: 3, MIDDLETON STREET, POST BOX NO. 9229, KOLKATA - 700 071
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Policy No: 26020131236130174142 1 Year Package Policy from 00:00 Hrs of 31/07/2023 to Midnight of 30/07/2024 IXI
Insured Details
Name : PIYUSH

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Mobile No : 7988833940 Email : [email protected]

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PAN No. : GSTIN No. :

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Channel : PHONEPE INSURANCE BROKING SERVICES PRIVATE LIMITED Tele. No: 080-68727888 Email : [email protected]

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Aadhar : PAN : xxxxxx058K Code. : 260201 / 91067500000001

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Vehicle Details

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Make & Model Private Car MARUTI SUZUKI SWIFT VXI AMT

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

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HR-06-AU-8794 55506 42038 HATCHBACK 1197 2019 1+4 PANIPAT

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Geographical Area : INDIA.

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Registration Date : 28/08/2019

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

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Rs.3,85,560 - - - - Rs.3,85,560

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OD Premium Breakup in Rs. TP Premium Breakup in Rs.

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Basic OD Premium 10,101.67 Basic TP Premium 3,416.00

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(+) Electrical Access. Premium - (+) WC for Driver -

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(+) Bi-fuel kit Loading - (+) Wider Legal Liability to employees -
(+) Geographical Area Extension - (+) Geographical Area Extension
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(-) Vol. Excess Discount - (+) PA to owner driver YES 295.00

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(-) Auto. Assoc Discount - (+) PA to unnamed PAX -

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(-) Anti-theft Discount - (-) Discount For Limited TPPD -

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(-) Other Discount - -4,040.67 (+) Bi-fuel kit Loading -

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(-) NCB Discount 45% -2,727.45 TP Total (Rounded Off) 3,711.00

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(+) Nil Depreciation - OD Total (Rounded Off) 7,729.00

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(+) Nil Depreciation Plus YES 3,778.00 TOTAL PREMIUM 11,440.00

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(+) NCB Protect - GST 2,059.00

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(+) Engine Protect YES 617.00 NET PAYABLE 13,499.00

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(+) Invoice Protect - Collection Number :26020181235000170182 dated 28-Jul-2023

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(+) Consumables Protect - Subject to IMT Endorsement No. 16,22,22A,29

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(+) Lock-Key Protect

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OD Total (Rounded Off) 7,729.00

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Excess : Compulsory: Rs.1,000 Imposed: Rs.0 Voluntary: Rs.0

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Limitation as to use : Use only for social, domestic and pleasure purposes and for the insured's business or profession. The Policy does not cover use for hire or reward, tuition, racing, pace making,
reliability trial, speed testing, carriage of goods(other than samples or personal luggage) in connection with any trade or business or use for any purpose in connection with Motor
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Trade
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Drivers Clause : 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 requirements of Rule 3 of the Central
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Motor Vehicles Rules, 1989.

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Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988.
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Under section 1(ii) Damage to third party property is Upto Rs. 7,50,000 . PA Cover under section 3 for owner-driver is Rs. 15,00,000.
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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 the reason of wider terms
appearing in the certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND
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RIGHT OF RECOVERY" No Claim Bonus will only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy. No Claim Bonus is subject to no
claim on the previous policy. Benefits under the policy stands forfeited if claim is/was made in previous policy. For legal interpretation, the English version will hold good.
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FINANCIER NAME :
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Prev Policy : National Insurance Company Limited (Pol No: 42150031221148037597 Expiry Date: 30/07/2023)
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Nominee Name : RENU Relation : Wife Age : 31 Years

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Transaction Date : 28/07/2023 20:18:29 Transaction Number : VF2307282017514147370050 Inspection ID :

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Disclaimer Note : It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'.
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In the event of misrepresentation, fraud or non-disclosure of material fact, the Company reserves the right to cancel the Policy. The policy is issued based on the information provided by you, which is available
with the company. In case of discrepancy/non recording of relevant information in the policy, the insured is requested to bring the same to the notice of the company within 15 days. This Policy is to be read in
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conjunction with the Policy wordings available on the website https://nationalinsurance.nic.co.in of the Company. On renewal, the benefits provided under the policy and/or terms and conditions of the policy
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including premium rate may be subject to change.

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.
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Authorised Signatory
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For & On behalf of

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National Insurance Company Limited

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NIC/PHONEPE/91067500000001 28/07/2023 08:25 P.M.

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]