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Servicing Office Address

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Nimbahera,First Floor, Near RSEB Chouraha, Udaipur Road

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GSTIN No: 08AAACN9967E1Z3

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RECEIPT

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Customer Details Collection Details

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Name : Mr DURGESH SHARMA Agent Code : 9000195628

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Address : S/O JAGDISH SHARMA, KAILASH JOSHI Collection Number : 38600681248000001879

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HEENTA TEH VALLABHNAGAR , Collection Date : 08/09/2024

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RAJASTHAN , Bank Account : 9151
Pin Code : 313001

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Received with thanks from Sri/Smt Mr DURGESH SHARMA
a sum of 55704 (RUPEES FIFTY FIVE THOUSAND SEVEN HUNDRED FOUR ONLY) 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
No. Year Number (General Ledger) Received

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1 38600631246360001122 11 CASH PREMIUM A/C 5083 49440.00 0.00 49440.00

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2 38600631246360001122 11 CGST_RJ_Int_Liab 7379 3132.00 0.00 3132.00
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3 38600631246360001122 11 SGST_RJ_Int_Liab 7380 3132.00 0.00 3132.00
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TOTAL : 55704.00 0.00 55704.00

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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

2.The stamp has been defaced and retained at the office against the issued
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policy.
3.We hereby declare that though our aggregate turnover in any preceding
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financial year from 2017-18 onwards is more than the aggregate turnover
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notified under sub-rule (4) of rule 48, we are not required to prepare an invoice
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in terms of the provisions of the said sub-rule.

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Authorised Signatory
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NIC/UBPORTAL/9000195628 08/09/2024 09:26 PM

Visit us at https://nationalinsurance.nic.co.in for information on Products, Services and Grievance Redressal.
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 Issuing Office Name & Address
NIMBAHERA ,FIRST FLOOR, NEAR RSEB CHOURAHA, UDAIPUR ROAD
Tel: Fax:
GSTIN No: 08AAACN9967E1Z3
RSA Service Provider: M/s ki MOBILITY SOLUTIONS PRIVATE LIMITED
RSA Service Provider Toll Free Number :- 1800 570 1906
For feedback to RSA:- Email: [email protected]

National Insurance Company Ltd.

Registered & Head Office: PREMISES NO.18-0374, PLOT NO. CBD-81, NEW TOWN, KOLKATA-700156
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
Form 51 of the Central Motor Vehicle Rules, 1989
Policy No: 4(or more) Wheeler Public Carrier Policy Period
38600631246360001122 GCV 1 Year Package Policy from 00:00 Hrs of 09/09/2024 to Midnight of 08/09/2025
Insured Details
Name : Mr DURGESH SHARMA
Address : S/O JAGDISH SHARMA, KAILASH JOSHI HEENTA TEH VALLABHNAGAR , RAJASTHAN ,
Pincode : 313001 Telephone : 7145865651 Email : [email protected]
PAN No. : xxxxxx113D GSTIN No. : Aadhar No. : xxxx xxxx 5588
Channel : SUNITA KUMAWAT Mobile : 9414810000 Email : [email protected]
Aadhar : PAN : xxxxxx786Q Code. : 386006 / 9000195628
Vehicle Details

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Make & Model Ashok Leyland Limited Leyland Multi Axle 3118iL

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

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RJ-27-GC-2361 Z117358 MB1KACFD3GPCT8097 OPEN 35000 2016 5+1 UDAIPUR(RJ)

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Geographical Area : INDIA.

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Class of Vehicle Goods Carrying 4(or more) Wheeler Public Carrier

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FasTag ID

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

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Rs.12,80,000 Rs.5,000 - - - Rs.12,85,000

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

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Basic OD Premium 29,494.20 Basic TP Premium 43,950.00

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(+) Electrical Access Premium - (+) Legal Liab.to Driver/Cleaner/Coolies ( 2 No. ) YES 100.00
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(+) Bi-fuel kit Loading - (+) Legal Liability to IO & M Staff ( 4 No. ) YES 200.00
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(+) Geographical Extension - (+) NFPP Premium -

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(-) Other Discount -14,610.06 (+) Geographical Extension -

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(+) Nil Depreciation - (+) PA for Driver/Cleaner/Coolies -

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(-) NCB Discount 45% -15,938.25 (+) PA to owner driver(CPA) YES 295.00
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(+) IMT 23 YES 4,424.13 (+) Bi-fuel kit Loading -

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(+) Towing Charge YES 1,500.00 (+) Private Carrier -

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(+) Trailer No - (+) Trailer No null -

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(+) RSA Protect - YES

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(+) Invoice Protect -

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(+) Nil Depreciation PLus - TP Total (Rounded Off) 44,545.00

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OD Total (Rounded Off) 4,895.00 OD Total (Rounded Off) 4,895.00

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TOTAL PREMIUM 49,440.00

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GST 6,264.00
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Cess Amount
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NET PAYABLE (Rounded Off) 55,704.00

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Collection Number :38600681248000001879 dated 08-Sep-2024

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Subject to IMT Endorsement No. 40

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Limitation as to use : Use only in connection with insured's business.The Policy does not cover use for a) Organised Racing b) Pace Making c) Reliability Trials d) Speed Testing e) Use whilst drawing a
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trailer except the towing (other than for reward) of any one disabled mechanically propelled vehicle.
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Drivers Clause : Any person including the insured Provided that the person driving holds an effective and valid driving license to drive the category of vehicle insured hereunder, at the time of
accident and is not disqualified from holding or obtaining such a license. Provided also that a person holding an effective and valid Learner's License to drive the category of vehicle
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insured hereunder may also drive the vehicle when not used for transport of passengers at the time of accident and that the person satisfies the requirements of Rule 3 of Motor
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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 reasons of wider terms
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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".
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UIN : IRDAN058RP0038V01100001
Financier : SELF OWNED
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Prev Policy : National Insurance Company Limited (Pol No: 38040231236360002211 Expiry Date: 08/09/2024)
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Nominee Name : MISSES SHAFMA Relation : WIFE Age : 40 Years

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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.
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TP Rate Revision Notice: For all policies having an effective date on or after 1st April 2023, the TP premium is subject to revision as may be notified by the IRDAI.
The Insured should contact and submit the difference of premium to the policy issuing office on issuance of such notification by IRDAI.
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If such revised premium is not paid then the motor insurance policy will not be valid.
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NIC/UBPORTAL/9000195628 08/09/2024 09:26 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]
 Issuing Office Name & Address
NIMBAHERA ,FIRST FLOOR, NEAR RSEB CHOURAHA, UDAIPUR ROAD
Tel: Fax:
GSTIN No: 08AAACN9967E1Z3
RSA Service Provider: M/s ki MOBILITY SOLUTIONS PRIVATE LIMITED
RSA Service Provider Toll Free Number :- 1800 570 1906
For feedback to RSA:- Email: [email protected]

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.
Policy Details Cashless Garages Details

Authorised Signatory
For & On behalf of
National Insurance Company Limited

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