Servicing Office Address: Parakadavil Shopping Complex, Opposite : No 1 Private Bus Stand, Palace road, Changanacherry, Kottayam,

Kerala, Pin : 686101

aa
RECEIPT
Customer Details
Name : Mr. SEBIN CHERIAN MATHEWS
Address : CHETTUKANDATHIL HOUSE
ERAVIPEROOR Dist. : PATHANAMTHITTA,
Kerala, Thiruvalla
Pin : 689542

Dealer Details
Office Name : Changanacherry Branch
Address : Parakadavil Shopping Complex,
Opposite : No 1 Private Bus Stand, Palace
road, Changanacherry, Kottayam, Kerala, Pin :
686101
Telephone : 0481 2423018 (G) , 2412124
Fax : 04810
E-mail :

Collection Details
Agent Code :90002327
Collection Number : 570602/81/14/9100000039
Collection Date : 21/11/2014
Bank Account : 9151

Received with thanks from Sri/Smt Mr. Mr. SEBIN CHERIAN MATHEWS a sum of Rs. 776.00 (RUPEES SEVEN HUNDRED SEVENTY SIX
ONLY) by Credit Card/Debit Card/Net Banking towards Motor Package Policy as per details given hereunder
Sl.
No

Policy Number

TR Code

570602/31/14/6265000036

16

570602/31/14/6265000036

16

End/Ren/Dec/Clm
Year

End/Ren/Dec/Clm
Number

A/C Particulars

A/C Head
(General Ledger)

A/C Head
(Sub Ledger)

Credit Amount
(Rs.)

Debit Amount
(Rs.)

PREMIUM
CONTROL
PREMIUM
CONTROL

5083

691.00

691.00

5443

85.00

85.00

TOTAL :

776.00

0.00

Amount Received
(Rs.)

776.00

Particulars : NBANK

.
.
.
For National Insurance Company Ltd.,

Authorised Signatory

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.

.
.
.
Signature of authorised representative
of dealer with rubber stamp
.
Dealer Name :
Dealer Address :

blank line
blank line

MOTOR INSURANCE - MOTORCYCLE/ SCOOTER PACKAGE POLICY SCHEDULE

blank line
Policy Number
Geographical Area
Insured Name
Insured Address

.
.

.
.
.
.
.
.
.

:57060231146265000036
Previous Policy Number
: India(B)
Insurance Start Date & Time
:Mr. Mr. SEBIN CHERIAN MATHEWS
Insurance Expiry Date & Time
:CHETTUKANDATHIL HOUSE ERAVIPEROOR Dist. Policy Issuing Office Address
: PATHANAMTHITTA, Kerala, Thiruvalla

City
: Thiruvalla
District : PATHANAMTHITTA
State : Kerala
Pincode : 689542
blank line
.
.
50572 / 90002327
Channel Code:
Channel Name:
.
.
58
IRDA License Number:
Contact Us :
blank line
VEHICLE DETAILS
.
.
KL-07-AU-168
Registration Number
Engine Number
.
.
Parayil Building, College Road, Chassis Number
RTA Name
Makamkunnu, Pathanamthitta,
Kerala
.
28/11/2004

Registration Date

RIJOY T VARGHESE
portal.support@nic.co.in

.
.
69723

69106

BAJAJ PULSAR & BAJAJ

PULSAR

Vehicle Make &

Model

.
.
AA Membership
Seating Capacity
.
Number
(Including Sidecar)
blank line
ALL AMOUNTS ARE (In Rupees)
.
.
.
.
Vehicle
Trailer
Electrical /Electronic Non-Electrical
.
.
.
.
Accessories
Accessories
.
.
.
.
15900.00
0.00
0.00
0.00

blank line
OTHER DETAILS
.
Financier

:57060231136265000025
:25/11/2014 00:00:00 (hours)
:24/11/2015 midnight
:Changanacherry
Branch Parakadavil
Shopping Complex, Opposite :
No 1 Private Bus Stand, Palace
road, Changanacherry,
Kottayam, Kerala, Pin : 686101

.
.
.

2 In All

2004

Type of Body

Solo

Geographical
Extension

No Extension

CNG Kit

LPG Kit

0.00

0.00

.
.
180

Year of Manufacture
Cubic Capacity

.
.

TOTAL

Co-Insurance
Details
.
100.00

15900.00

Policy Subject to IMT Endorsements

Applicable Add-on covers / Services

22

blank line
NOMINEE DETAILS
.
Nominee Name
.
sophia abraham

Nominee Relation
.
Wife

Nominee Age
.
26

Appointee Name
.

Appointee Relation
.

blank line
PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE: As narrated in the certificate of insurance attached herewith.
LIMITATIONS AS TO USE : As narrated in the certificate of insurance attached herewith.
LIMITS OF LIABILITY : As narrated in the certificate of insurance attached herewith.

blank line
EXCLUSIONS: (1) Any accidental loss or damage and/or liability caused sustained or incurred outside the geographical area. (2) Any claim arising out of any contractual liability. (3) Any
accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising there from or any consequential loss. (4) Any liability of whatsoever nature directly
or indirectly caused by or contributed to or by arising out of ionizing radiations or contamination by radioactivity from any nuclear fuel. For the purpose of this exception, combustion shall include
any self sustaining process of nuclear fission. (5) Any accidental loss or damage or liability directly or indirectly caused by or contributed to, by or arising from nuclear weapons material. (6) Any
accidental loss, damage or liability directly or indirectly or proximately or remotely occasioned by contributed to by or traceable to or arising out of or in connection with war, invasion, the act of
foreign enemies, hostilities or war like operations(whether before or after declaration of war), civil war, mutiny, rebellion, military or usurped power or by any direct or indirect consequence of
any of the said occurrences or any consequences thereof and in default of such proof, the company shall not be liable to make any payment in respect of such a claim.
.

PA COVER CSI (In Rupees)

DEDUCTIBLES (Under Section I) (In Rupees)
.
.
.
.
.
.
.
.
1,00,000.00
100.00
0.00
0.00
Owner- Driver
Compulsory
Imposed
Voluntary
(Under section IV)
.
.
.
.
.
0
0
PA Named
PA Named Number
PA Unamed Number
.
.
.
.
.
And UnNamed Cover
0
0
PA Named Amount
PA Unnamed Amount
blank line
SCHEDULE OF PREMIUM (In Rupees)
.
.
.
A-OWN DAMAGE PREMIUM
B-LIABILITY PREMIUM
TOTAL PACKAGE PREMIUM
.
.
.
.
.
.
235.00 Basic TP Liability
462.00 Package Premium
691.00
Basic Own Damage
.
.
.
.
.
.
235 Sub Total
50.00 Service Tax@12.36%
85.00
Total
.
.
.(Deductions)
ADD
. Incl.Edu.Cess &
.
..
0.00.
0 Employee Insured
Nil Depreciation
.
. Higher Edu. Cess
.
.
.
0.00.
776.00
0.00 Paid drivers,
TOTAL PAYABLE
Sub
.
.
cleaners etc.
Total(Additional)
.
. PREMIUM
..
.
512.00.
TOTAL
Less
1.00
.
.. Stamp Duty
..
.
-47.00 ADD
Bonus (20%)
AAACN9967EST099
Service Tax Regn.
.
.
.
.
.
0.00
-9.4 Sub Total
Discount (5%)
No.
.
.
.
.
-56.40(Additions)
Sub Total
57060281149100000039
.
... Receipt Number
.
LESS
(Deductions-Including
21/11/2014
.
. Receipt Date
NCB)
0.00.
.
Sub
Total
776.00
.
.
Receipt Amount
179.00(Deductions)
.
Total
.
.
. Payment Mode
512.00.
Total
.
Mr. Mr. SEBIN CHERIAN MATHEWS
.
Paying Party
.

blank line
TERMS & CONDITIONS:As per the Indian Motor Tariff, personal copy of the same is available free of cost on request. Further the Indian Motor Tariff is also available and displayed at all
National Insurance Company Offices and on website .
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 Vehicle 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.In case of accident, the insured must inform National Insurance Co.Immediately to arrange spot survey.
Date & Signature of Proposal: 22/11/2011
The coverage under this policy is subject to road worthiness and compliance of provisions of Motor Vehicles Act.
NOTE: POLICY STAMP HAS BEEN AFFIXED AND DEFACED AT THE RESPECTIVE POLICY SERVICING OFFICE
Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal.

blank line
blank line

.
For National Insurance Company Limited

Duly Constituted Attorneys

Print Date:

21/11/2014 20:25:58 hours

blank line
blank line

CERTIFICATE OF INSURANCE
(MOTORCYCLE / SCOOTER)
Insured Name
Occupation
Phone/Mobile/Fax
E-mail
Insured Address

.
.

blank line
:Mr. Mr. SEBIN CHERIAN MATHEWS
Policy Number
:Engineers
Policy Start Date & Time
:2664738 9946666085
Policy Expiry Date
:sebincherian@gmail.com
Geographical Area
:CHETTUKANDATHIL HOUSE ERAVIPEROOR Dist. Policy Issuing Office
: PATHANAMTHITTA, Kerala, Thiruvalla
Address

City
: Thiruvalla
State : Kerala
blank line
Channel Code:
IRDA License Number:
blank line
VEHICLE DETAILS
Registration No:

District : PATHANAMTHITTA
Pincode : 689542
.
.

50572 / 90002327
58

.
.

Engine Number
.69106

RIJOY T VARGHESE
portal.support@nic.co.in

Registering Authority & Place

.College Road, Makamkunnu, Pathanamthitta, Kerala
.

Chassis Number
.69723

Year of Manufacture
.2004

Registration Date
.28/11/2004

Type of Body
.Solo

Vehicle Color
.Black

Seating Capacity (Including Sidecar)

.2 In All (Persons)
blank line
ALL AMOUNTS ARE (In Rupees)
.
.
Vehicle
Trailer /
Electrical /Electronic
.
.
Sidecar
Accessories
.
.
.
15900.00
0.00
0.00

Vehicle Make & Model

.BAJAJ PULSAR & BAJAJ PULSAR

Cubic Capacity
.180

Channel Name:
Contact Us :

.KL-07-AU-168

:57060231146265000036
:25/11/2014 00:00:00 (hours)
:24/11/2015 midnight
: INDIA (B)
:Changanacherry Branch Parakadavil
Shopping Complex, Opposite : No 1
Private Bus Stand, Palace road,
Changanacherry, Kottayam, Kerala, Pin
: 686101

Geographical Extension
.No Extension
.
.

Non-Electrical
Accessories
.
0.00

.
.

CNG Kit
.

0.00

.
.

LPG Kit

.
.

TOTAL

0.00

15900.00

Co-Insurance
Details
.
100.00

blank line
PREMIUM
Premium -Rs.691.00

Service Tax @ 12.36% - Rs. 85.00 Total Payable - Rs. 776.00

Stamp Duty - Rs. 1
Service Tax Registration Number:AAACN9967EST099
Receipt Number:57060281149100000039
Receipt Date: 21/11/2014
Receipt Amount:- Rs.776.00
Payment Mode:
blank line
LIMITATIONS AS TO USE
The policy covers use of 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.
blank line
DRIVER:
Any person including 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 Motor Vehicles Rules, 1989.
blank line
LIMITS OF LIABILITY:
Under Section II-1(i) of the policy
Death of or bodily injury
Such amount as is necessary to meet the
requirement of the Motor Vehicles Act,1988
Under Section II-1(ii) of the policy
Damage to Third Party Property
Rs.100000
blank line
.
.
Policy Subject to IMT Endorsements
Applicable Add-on covers / Services
.
.
22

.
.
.
blank line
I / We hereby certify that the policy to which the certificate relates as well as this certificate of insurance are issued in accordance
with the provisions of Chapter X and Chapter XI of MV Act, 1988.
.
For National Insurance Company Limited
Print Date: 21/11/2014 20:25:58 hours

DULY CONSTITUTED ATTORNEY(S):

blank line
blank line

DO'S and DONT'S FOR MOTOR INSURANCE CUSTOMERS OF National Insurance

blank line
Thank you for placing your business with National Insurance, the fastest growing general insurer in India. Ours is a Government owned
Company at your service. The Company has very high claim paying capacity as may be seen by our high solvency margin ratio and the highest
rating given by ICRA. Our customer service parameters may be seen at our web site
blank line

We give below certain important guiding points which will be of use to you to ensure that your policy serves you in the fullest manner:
blank line

Proposal Form:
blank line

This is a very important document in Motor insurance which seeks vital information regarding the vehicle and also yourself. It should be filled in
all respects giving your contact number and E-mail id (if you have) and signed by you only. The items provided in the proposal are simple and
brief. In case, you need any clarification or information, you may seek the assistance of our Office or the Marketing Representatives viz. Agents,
Development Officers and our Intermediaries. A copy of the proposal will be returned to you along with the policy. In case you do not receive it,
please contact the policy issuing office.
blank line

Policy Document:
blank line

Please ensure that the policy document issued to you is duly checked with regard to the following important information.
blank line

a. The vehicle number, Engine and Chassis Number mentioned in the policy are correct.
blank line

b. Name and address given are correct. The name given in the policy should tally with R.C Book.
blank line

c. The period of insurance is in order.

blank line

d. The policy contains the terms of coverage, exclusions and conditions. In case you need any clarification in respect of any condition or
exclusion, you may seek the help of our Office or our Marketing Representatives.
blank line

Important Conditions for Insurance:

blank line

a. You must have insurable interest. In other words, you must be the Registered Owner of the vehicle. In case of transfer of ownership on sale of
your vehicle, the transferee (buyer of the vehicle) shall apply for transfer of the policy within 14 days from the date of transfer of R.C to the
Company so that the necessary change of ownership is recorded in the policy by the Company and issue a fresh Certificate of Insurance. If this
is not done within the stipulated period of 14 days, claims if any will be rejected. This may kindly be noted.
blank line

b. In case your vehicle is fitted with bi-fuel system such as Petrol/ Diesel and CNG/ LPG as permitted by the concerned RTA, the same should
be mentioned in the proposal form itself so that required premium can be charged. Non-disclosure of this can prejudice the claim.
blank line

c. It is always advised to renew your motor policy before the expiry date so that there is continuity. In case there is any break in insurance policy,
the vehicle needs to be physically inspected at your cost and a fresh proposal form will be collected.
blank line

d. The Insured Declared Value (IDV) of the vehicle will be deemed to be Sum Insured for the purpose of insurance. Therefore, when your
vehicle is brand new, it is covered at 95% of Invoice Price for the first policy period. Thereafter depreciation is charged for the vehicle based on
the usage i.e. age of the vehicle as per schedule of depreciation for arriving at IDV. The said schedule of depreciation is very much available
with our Office and the same can be verified by you if you feel it necessary. However, if your vehicle is beyond 5 years of age or an obsolete
model, IDV fixation under the policy is only based on an understanding between you and our Company. Therefore you may exercise proper care
before fixing IDV under the policy.
blank line

e. We advise you to keep safely all previous policy records so that you are helped in case Third party claims are filed after many years.
blank line

Claims:
blank line

In case an unfortunate loss covered in the policy occurs, we request you to take the following steps to get prompt service:
blank line

blank
1. Contact the policy issuing Office of National Insurance immediately or if the accident takes place anywhere other than the City/ Town
line where policy issuing Office is located, contact the nearest Office of National Insurance so that survey is arranged. List of our Offices with
addresses across the country with Phone Numbers are available in our Company's web site for your ready reference. Check our web site
www.niconline.in for list of our Offices across the country.
blank
2. In case of major accidents including fire/riot losses, keep the vehicle at the accident spot/ site until the spot surveyor comes to the place of
line accident and inspects the same. However, please note that spot survey is necessary in case of accident to all commercial vehicles. Please
keep the phone No. of the agent/ policy issuing Office for quick response from our side.
blank
3. Simultaneously if there are any third party injuries/ deaths, make sure to inform the nearest Police Station about the accident and also full
line details of injuries/ deaths or damage to any Third Party Property as the case may be. In case you provide treatment to any injured person/s
in any Hospital, the name of the hospital and also Doctor's Name who has given the treatment may be informed to us.
blank
4. After completing the said formalities you may move/ tow the vehicle to any authorized workshop of your choice and obtain estimate from
line them and the same may be submitted to us together with completed claim form (this can be obtained from any of our nearest office) for our
arranging final survey. You may also please submit to the surveyor copy of the complaint lodged with the police station along with original
FIR, if immediately available. However, in case where TP injuries are involved, FIR is compulsory and the same must be submitted to the
office.
blank
5. It should be ensured that under no circumstances repair work is commenced until the final surveyor verifies the damage and gives green
line signal to proceed with the repairs.
blank
6. After the repairs are carried out for partial loss claims, you have to submit the cash bills for spare parts and labour and seek
line reimbursement if the claim is admissible.
blank line

Salvage:
blank line

Utmost care should be taken by you to preserve the salvage (wherever replacements of parts are allowed) in whatever form i.e. parts of the
vehicle/vehicle as a whole till the claim is disposed off either by deducting the value of salvage from the claim amount or collecting the salvage
from you and settling the claim in Toto. This is applicable whatever be the mode settlement i.e. whether on repair loss basis/total loss basis/net
of salvage loss basis, as otherwise the claim settlement will be jeopardized which may be carefully noted. At any stage of the claim if the
company feels the necessity to inspect the salvage, the company may do so. In case the claim settlement is delayed due to unavoidable
reasons, you may take the assistance of the surveyor and our Office in prompt disposal of the salvage.
blank line
blank line

Theft losses:
blank line

Immediate intimation to the police as well as our policy issuing office is compulsory. Please note that the delay in lodging FIR and intimating the
claim to our office may ultimately result into rejection of the claim. Please note that filing of the FIR is not only a policy condition, but also a
requirement under law.
blank line

Finally, you should not engage any unauthorized persons for your insurance purpose, so also at the time of claim. It is always safe for you either
to contact the office or any of our authorized representatives of the company viz. Agents, Development Officers, and our Intermediaries.
blank line

Grievance Redressal:
blank line

In case you have a complaint or grievance regarding the services rendered by us, you may approach or write or e-mail to the policy issuing
office, Regional office/Head office for redressal. If you are not satisfied with the response from the Company you are free to take up the matter
with the Hon'ble Ombudsman, details of which may be obtained from the policy issuing office or log on to niconline.in.
blank line

Your support is our strength.