Issuing Office Name & Address
MUMBAI BUSINESS OFFICE II, FIRST FLOOR, STERLING CINEMA
BUILDING, 65, MURZABAN STREET, FORT, MUMBAI, PIN : 400001
Tel NO: 18003450330 Email:
[email protected]GSTIN No: 27AAACN9967E1Z3
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
Policy No: 26020131256810100462 1 Year OD Only Policy Issued on 05-May-2025 01:31:58 Effective from 00:00 Hrs of 25-May-2025 to Midnight of 24-May-2026
Insured Details
Name : Mr. Ajay Kumar Singh
Insured Address : F260 Harswaroop Colony Near Asthal Mandir road Fatehpur Beri, New Delhi, DELHI
Pincode :110074 Email :[email protected] Telephone :9999189569 PAN No. :DIOPS4165K GSTIN No. :
Channel : Coverfox Insurance Broking Pvt. Ltd Telephone : 02248971018 PAN : AAFCC2890J Email : [email protected] Code : 260201 / 9104230000000
Vehicle Details
Make & Model Two Wheeler TVS SPORT ELECTRIC START ALLOY
Reg. No. Engine. No. Chassis. No. Geographical Area CC Mfg. Year. Seat. Cap. Reg. Disrict.
HR26FC0995 AK2EP3603217 MD625CK2XP3E03613 INDIA 100 2023 2 Gurgaon
Reg Date Non Elec Access Elec Access Bi-fuel kit Vehicle IDV Total IDV
16-Jun-2023 NA NA NA 47023 Rs.47023
Premium Breakup in Rs.
Basic Own Damage Premium 394.06 (+) Geographical Area Extension
(-) Vol. Excess Discount - (+) Bi-fuel kit Loading
(-) Anti-theft Discount - (-) Auto. Assoc Discount -
(-) NCB Discount 25% -98.52 (-) Other Discount -
(+) Nil Depreciation Plus YES 188.09 (+) Nil Depreciation
(+) Engine Protect NA (+) NCB Protect - NA
TOTAL PREMIUM 484.0 (+) Invoice Protect NA
GST 87.0
NET PAYABLE 571.0 Collection Number : 30942A5PC0100462 dated 05-May-2025
Subject to IMT Endorsement No. 16, 22A, 29
Excess : Compulsory: Rs.100 Imposed: Rs.0 Voluntory: Rs.0
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
Limitation as to use : 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 MotorTrade
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
Drivers Clause : alicense, 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
CentralMotor Vehicles Rules, 1989 as amended from time to time.
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
termsappearing in the certificate in order to comply with the Motor Vehicle Act, 1988, as amended from time to time is recoverable from the Insured. See the clause headed
IMPORTANT NOTICE : "AVOIDANCE OF CERTAIN TERMS ANDRIGHT 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 noclaim 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.
Financer Name: NA
OD Pol No: 0206003124P102376679 OD Expiry Date: 24/05/2025
Prev Policy : TP/Ref Pol No: D104034998 TP Start Date: 17/06/2023 TP Expiry Date: 16/06/2028
OD Insurer : United India Insurance Company Limited TP Insurer : Digit Insurance
Nominee Name : NA Relation : NA Age : NA Years
Transaction Date: 05-May-2025 Transaction Number : BHMP9VY0JZLHGQ Inspection ID : :
Disclaimer: It is warranted that IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'.
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 availablewith 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 inconjunction 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 policyincluding 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 as amended from time to time.
Signatory For & On behalf of
National Insurance Company Limited
