ORIGINAL FOR RECIPIENT/DUPLICATE FOR SUPPLIER

Tax Invoice/Endorsement Certificate

 THE NEW INDIA ASSURANCE CO. LTD.
CIN NO.:   U99999MH1919GOI000526
GSTIN :   07AAACN4165C1ZT
Address : 1215, NAURANG HOUSE 21, K G MARG, NEW DELHI - 110001-110001
 Tel. : 011-23358751/011-23358750                     Fax :
           Email  niamaruti@gmail.com                
                            IRDA Reg No.:  190                                                          
State Name : Delhi                       
 Endorsement Schedule
 Endorsement No.  98000031180307224987 / 752019 / 1  Endorsement Date  07-May-2019 05:51:10
 Policy No  98000031180307224987  Policy Type  Package Policy
 Risk Inception Date  16-Nov-2018  Policy Expiry Date  15-Nov-2019
 Original
 Invoice
 11180693087E01 Invoice  11180693087
No.
No.
  Accounting Code of Service  997134
 Insured Name   MR CHANDRAKANTH DESAI
 Insured Address  S/O V R DESAI,RAJANAGARA, SRINGERI
 Insured State name & Code Karnataka-29
 Place of Supply Karnataka
 GSTIN of Customer 29AICPD2453L1Z9
 Type of Endorsement  Ownership Transfer
 Transfer Fee  50
 Part A Premium  1143
 Part B Premium  0
 Endorsement Charges(Taxable Value)  1193
IGST @ 18%  215
 Total Endorsement Charges  1408

 At the request of the insured, it is hereby declared and agreed that the following items under the withstanding policy has been changed / altered.

 Notwithstanding anything herein to the contrary contained, at the request of the insured, it is hereby declared and agreed that under the within mentioned policy.

THE CORRECT

SNO. Endorsed Field New Value Old Value

1 Customer Type Individual Individual
2 Title MR MR
3 First Name SUJAYA CHANDRAKANTH
4 Middle Name KIRAN  
5 Last Name JATHANNA DESAI
6 Pin 574102 577139
7 Mobile 9448115236 9448775817
8 Address S/O RL JATHANNA "SUVASINI " MISSION COMPOUND BAILOOR POST NEERE BAILOOR KARKALA -- S/O V R DESAI,RAJANAGARA, SRINGERI
9 Finance Status HYPOTHECATION REMOVED  
10 Nominee Name SUHAN JOANNA SUVARNA C DESAI
11 Nominee Age 12 48
12 Nominee Relation Daughter Wife
13 Nominee Appointee Name SUJAY  
14 Nominee Relation To Appointee Father  

 And not as stated therein.

 
 Subject to fulfillment of conditions, if any,mentioned in remarks
I / We hereby certify that the policy to which this certificate relates as well as this certificate of insurance are issued in
accordance with the provisions of chapter X and chapter XI of M.V. act, 1988.
For THE NEW INDIA ASSURANCE CO. LTD.

                                                       Authorized Signatory
Authorized Signatory
 Approved for transfer of veh subject to LSO verifying correctness of rc and inspection photos claim not admissible after 14days of transfer and
Remarks: 
before insurance transfer
Note*     This is a Transfer Case