Issuing Office Name & Address
ETAWAH BUSINESS OFFICE ,MAMTA PRESS BUILDING, FARUKHABAD CROSSING,
ETAWAH, UTTAR PRADESH ETAWAH
Tel: Fax:
GSTIN No: 09AAACN9967E1Z1
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 as amended from time to time
Policy No: 45050631256760002956 Private Car 1 Year Liability from 17:37 Hrs of 12/07/2025 to Midnight of 11/07/2026 IXI
Only
Insured Details
Name : HUKUM SINGH
Address : MOH - SUDAMAPURI, PO&PS - GANJDUNDWARA,DIST - KASGANJ , UTTAR PRADESH , KASGANJ
Pincode : 205303 Telephone : xxxxxxxx47 Email :
[email protected] PAN No. : GSTIN No. : Aadhar No. :
Channel : KUNAL DUBEY Mobile : 6397417526 Email :
[email protected] Aadhar : PAN : xxxxxx303P Code. : 450506 / 9800011628
Vehicle Details
Make & Model Private Car MARUTI SUZUKI ERTIGA PASEO VXI
6
02
Reg. No. Engine No. Chassis No. Type of Body CC Mfg. Year Seat Cap. Reg. District
7/2
UP-80-DF-5593 D13A-5114845 MA3FLEB1S00318349 MPV 1373 2015 1+6 AGRA
1/0
Geographical Area : INDIA.
1
of
Vehicle IDV Non Elec Access. Elec Access. Bi-fuel kit Trailer Total IDV
ht
- - - - - -
ig
dn
OD Premium Breakup in Rs. TP Premium Breakup in Rs.
Mi
Basic OD Premium Basic TP Premium 3,416.00
to
(+) Electrical Access. Premium - (+) WC for Driver -
25
(+) Bi-fuel kit Loading - (+) Wider Legal Liability to employees -
0
l-2
(+) Geographical Area Extension - (+) Geographical Area Extension -
320.00
(-) Vol. Excess Discount - (+) PA to owner driver
-Ju -
12
(-) Auto. Assoc Discount - (+) PA to unnamed PAX -
on
(-) Anti-theft Discount - (-) Discount For Limited As per MV Act -
s
(-) Other Discount - (+) Bi-fuel kit Loading -
ur
(-) NCB Discount (+) RSA Protect
Ho
(+) Nil Depreciation - TP Total (Rounded Off) 3,431.00
:45
(+) Nil Depreciation Plus - OD Total (Rounded Off)
:37
(+) NCB Protect - TOTAL PREMIUM 3,431.00
17
(+) Engine Protect - GST 618.00
m
(+) Invoice Protect - NET PAYABLE 4,049.00
fro
(+) Consumables Protect - Collection Number :45050681250000004865 dated 12-Jul-2025
ly
On
OD Total (Rounded Off) Subject to IMT Endorsement No. 7,24,25
Excess : Compulsory: Rs. 0 Imposed: Rs. 0 Voluntary: Rs. 0
y
ilit
Limitation as to use : The Policy covers use of the 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 and Reliability Trials (f) Use in connection with Motor Trade
b
Lia
Drivers Clause : Any person including Insured Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from holding or obtaining such a
licence. Provided also that the person holding an effective Learner's Licence may also drive the vehicle and such a person satisfies the requirements of Rule 3 of Central Motor
Vehicles Rules, 1989 as amended from time to time.
ar
Limits of Liability Clause: Under section 1(i) Such amount as is necessary to meet the requirements of the motor vehicle act 1988 as amended from time to time.
Ye
Under section 1(ii) Damage to third party property is Upto Rs. 7,50,000 .
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
1
appearing in the certificate in order to comply with the Motor Vehicles Act,1988 as amended from time to time is recoverable from the insured .See the clause headed
56
"AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For legal interpretation, English version will hold good.
UIN : IRDAN058RP0034V01100001
29
HYPOTHECATION : HDFC BANK LIMITED
00
Prev Policy : Not Available
60
NOTE : Warranted that in case of dishonour of the premium cheque, this document stands automatically cancelled 'AB-INITIO'.
67
Policy stamp to be defaced at the respective policy servicing office.
25
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.
31
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.
06
Policy Details
05
45
Authorised Signatory
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For & On behalf of
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NIC/UBPORTAL/9800011628 12/07/2025 09:04 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]
