Servicing Office Address: Sixth Floor, Royal Insurance Building, 14, J N Tata Road, Churchgate, Mumbai, Greater Mumbai,

Maharashtra, Pin
: 400020
aa

RECEIPT

Customer Details Dealer Details Collection Details

Name : RAJIV BASANT CHAUDHARY Office Name : Mumbai Division V Agent Code :261300718
Address : N-504, GOKUL GARDEN THAKUR Address : 5, Sixth Floor, Royal Insurance Collection Number : 261300/81/12/9100000228
COMPLEX KANDIVALI (E) MUMBAI Dist. : Building, 14, J N Tata Road, Churchgate, Collection Date : 16/02/2013
GREATER MUMBAI, Maharashtra Mumbai, Greater Mumbai, Maharashtra, Pin : Bank Account : 9151
Pin : 400101 400020
Telephone :
022-22820595,022-22820592,022-22820639
Fax : 022-22820736
E-mail : nicdo5@vsnl.net
Your Customer ID is
3973910145
Received with thanks from Sri/Smt Mr. RAJIV BASANT CHAUDHARY a sum of Rs. 665.00 (RUPEES SIX HUNDRED SIXTY FIVE ONLY) by
Credit Card/Debit Card/Net Banking towards Motor Package Policy as per details given hereunder
Sl. Policy Number TR Code End/Ren/Dec/Clm End/Ren/Dec/Clm A/C Particulars A/C Head A/C Head Credit Amount Debit Amount Amount Received
No Year Number (General Ledger) (Sub Ledger) (Rs.) (Rs.) (Rs.)

1 261300/31/12/6265000227 16 PREMIUM 5083 0 592.00 592.00

CONTROL
2 261300/31/12/6265000227 16 PREMIUM 5443 0 73.00 73.00
CONTROL

TOTAL : 665.00 0.00 665.00

Particulars : CCARD .
.
.
For National Insurance Company Ltd.,

Authorised Signatory
.
.
.
1.Please quote customerID, collection no. and date in all . Signature of authorised representative
correspondeces. of dealer with rubber stamp
2.The stamp has been defaced and retained at the office .
against the issued policy. Dealer Name :
Dealer Address :
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MOTOR INSURANCE - MOTORCYCLE/ SCOOTER PACKAGE POLICY SCHEDULE
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Policy Number :26130031126265000227 Previous Policy Number :26130031116200002969
Geographical Area : India(A) Insurance Start Date & Time :17/02/2013 00:00:00 (hours)
Insured Name :Mr. RAJIV BASANT CHAUDHARY Insurance Expiry Date & Time :16/02/2014 midnight
Insured Address :N-504, GOKUL GARDEN THAKUR COMPLEX Policy Issuing Office Address :Mumbai Division V Sixth
KANDIVALI (E) MUMBAI Dist. : GREATER MUMBAI, Floor, Royal Insurance
Maharashtra Building, 14, J N Tata Road,
Churchgate, Mumbai, Greater
Mumbai, Maharashtra, Pin :
400020
City : MUMAI District : GREATER MUMBAI
State : Maharashtra Pincode : 400101
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. . . .
Channel Code: 261300/ 99999 Channel Name: Office direct
. . . .
IRDA License Number: 58 Contact Us : website.administrator@nic.co.in
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VEHICLE DETAILS
. .
MH-02-AM-5321
. .
12178
. .
2005
Registration Number Engine Number Year of Manufacture
. . . .
42646
. .
100
RTA Name Chassis Number Cubic Capacity
. . .

. .
12/02/2005
. .
BAJAJ CT-100 & BAJAJ
. .
Solo
Registration Date Vehicle Make & Type of Body
. CT-100 .
Model
. . . .
2 In All
. .
No Extension
AA Membership Seating Capacity Geographical
. . .
Number (Including Sidecar) Extension
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ALL AMOUNTS ARE (In Rupees)
. . . . . . . .
Vehicle Trailer Electrical /Electronic Non-Electrical CNG Kit LPG Kit TOTAL Co-Insurance
. . . . . . .
Accessories Accessories Details
.
23416.00
.
0.00
.
0.00
.
0.00
.
0.00
.
0.00
.
23416.00
.
100.00
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OTHER DETAILS
. . .
Financier Policy Subject to IMT Endorsements Applicable Add-on covers / Services
22
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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.
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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)
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SCHEDULE OF PREMIUM (In Rupees)
. . .
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
. . .
335.79 Basic TP Liability
. .
357.00 Package Premium
.
592.00
Basic Own Damage
. . .
335.79 Sub Total
. .
50.00 Service Tax@12.36%
.
73.00
Total
. .(Deductions) .
ADD . Incl.Edu.Cess &
. ..
0 Employee Insured 0.00.
.
Nil Depreciation
.. . Higher Edu. Cess
0.00. .
Sub 0.00 Paid drivers, TOTAL PAYABLE 665.00
. .
Total(Additional) cleaners etc.
. .. . PREMIUM
407.00. .
Less TOTAL 1.00
. .. .. Stamp Duty .
Bonus (45%) -151.10 ADD AAACU5552CST001
. ..
-151.10 Sub Total
. Service Tax Regn.
0.00.
Sub Total No.
(Deductions-Including (Additions) .
26130081129100000228
.
. . Receipt Number
NCB) LESS .. .
. .
185.00. . Receipt Date 16/02/2013
Total Sub Total 0.00. .
665.00
Receipt Amount
(Deductions) . .
. . Payment Mode
407.00.
Credit Card/Debit Card/Net Banking
Total Mr. RAJIV BASANT CHAUDHARY
.
. Paying Party
.
.

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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: 12/02/2008
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.
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Duly Constituted Attorneys

Print Date: 16/02/2013 18:31:51 hours
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CERTIFICATE OF INSURANCE
(MOTORCYCLE / SCOOTER)
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Customer Id :3973910145 Policy Number :26130031126265000227
Occupation :1003 Policy Start Date & Time :17/02/2013 00:00:00 (hours)
Phone/Mobile/Fax :28706534 9320056270 Policy Expiry Date :16/02/2014 midnight
E-mail :rajivbc@aol.com Geographical Area : INDIA (A)
Insured Address :N-504, GOKUL GARDEN THAKUR COMPLEX Policy Issuing Office :Mumbai Division V Sixth Floor, Royal
KANDIVALI (E) MUMBAI Dist. : GREATER MUMBAI, Address Insurance Building, 14, J N Tata Road,
Maharashtra Churchgate, Mumbai, Greater Mumbai,
Maharashtra, Pin : 400020
City : MUMAI District : GREATER MUMBAI
State : Maharashtra Pincode : 400101
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. . . .
Channel Code: 261300/ 99999 Channel Name: Office direct
. . . .
IRDA License Number: 58 Contact Us : website.administrator@nic.co.in
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VEHICLE DETAILS
. . .
Registration No: Registering Authority & Place Registration Date
.MH-02-AM-5321 . .12/02/2005
. . .
Engine Number Chassis Number Vehicle Make & Model
.12178 .42646 .BAJAJ CT-100 & BAJAJ CT-100
. . . .
Year of Manufacture Cubic Capacity Type of Body Vehicle Color
.2005 .100 .Solo .Red
. .
Seating Capacity (Including Sidecar) Geographical Extension
.2 In All (Persons) .No Extension
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ALL AMOUNTS ARE (In Rupees)
. . . . . . . .
Vehicle Trailer / Electrical /Electronic Non-Electrical CNG Kit LPG Kit TOTAL Co-Insurance
. . . . . . .
Sidecar Accessories Accessories Details
.
23416.00
.
0.00
.
0.00
.
0.00
.
0.00
.
0.00
.
23416.00
.
100.00
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PREMIUM
Premium -Rs.592.00 Service Tax @ 12.36% - Rs. 73.00 Total Payable - Rs. 665.00 Stamp Duty - Rs. 1
Service Tax Registration Number:AAACU5552CST001
Receipt Number:26130081129100000228 Receipt Date: 16/02/2013 Receipt Amount:- Rs.665.00 Payment Mode: Credit Card/Debit
Card/Net Banking
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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.
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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.
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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
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. .
Policy Subject to IMT Endorsements Applicable Add-on covers / Services
.
.
22
.
.
.
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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: 16/02/2013 18:31:51 hours

DULY CONSTITUTED ATTORNEY(S):

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DO'S and DONT'S FOR MOTOR INSURANCE CUSTOMERS OF National Insurance
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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
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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:
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Proposal Form:
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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.
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Policy Document:
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Please ensure that the policy document issued to you is duly checked with regard to the following important information.
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a. The vehicle number, Engine and Chassis Number mentioned in the policy are correct.
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b. Name and address given are correct. The name given in the policy should tally with R.C Book.
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c. The period of insurance is in order.
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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.
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Important Conditions for Insurance:
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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.
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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.
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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.
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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.
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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.
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Claims:
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In case an unfortunate loss covered in the policy occurs, we request you to take the following steps to get prompt service:
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blank1. 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.
blank2. 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.
blank3. 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.
blank4. 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.
blank5. 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.
blank6. 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.
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Salvage:
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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.
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Theft losses:
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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.
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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.
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Grievance Redressal:
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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.
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Your support is our strength.