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National Insurance Company Limited

3, Middleton Street, Post Box No. 9229, Kolkata - 700 071

DUPLICATE SCHEDULE

Policy Issuing Office


24-Shiv Ganga Complex, Station Road, Mukhi No Dhal, Bavla, Dist: Ahmedabad, Gujarat, Pin : 382220
Tele : 02714 231661, 232519 Fax: 027
Dept : Fire
Standard Fire and Special Perils Policy
Dev. Officer: 41009

Policy No :

300102/11/13/3100000122
Insureds Name: K.C.C BANK.A/C OF SONALBEN VIPULBHAI
PATEL.
Address
: GROUND FLOOR-FLATE NO-M/44/157,
GOKUL APPARTMANT.SOLA ROAD. AT
NRANPURA. AHMEDABAD.
Dist. : Ahmedabad, Gujarat
Pin Code :380013

Agent Code: 886455


Agent Name: HITESHBHAI J. PRAJAPATI A.D.C., BANK,
11502
Agent Contact No: 9898749759

Policy Period : 02:47 hours on 31/05/2013 to midnight of 30/05/2023


Receipt date & No: 31/05/2013 ( 30010281130000000455 )
( RUPEES THREE THOUSAND SEVEN HUNDRED FIFTY ONLY

Net Premium: 3750


Mode of Payment:

Cash

Co-insurance Details : NIC 300102 : 100%


Risks Covered

Risk/Rate Block Basic Rate RSMD Excl STFI Excl Disc/Lo Claim Net Rate Sum Insured
Code No. No.
(PerMille) (PerMille) (PerMille) ad(%) Exp(%) (%0) (In Rupees)

Building:Stock(s)
/Content(s) :

1 / 01

01

The Risk Covered is/are as under :Srl


Risk
1

0.300
0.300

0.000
0.000

0.0000
0.0000

0.00 0.3000 15,00,000


0.00 0.3000 0

0.000
0.000

Description of Risk

Premium
(In Rupees)
450
0

Rate Applicable
.3

Dwellings

Description of Risk : BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOU
BOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE.
Add-On Description

Rate Applied

Sum Insured

Premium

.05

15,00,000

75.00

Earthquake (Fire and Shock)

Total Addon Premium :

75.00

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------The property is situated at :- BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR )
GUJ HOU BOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE. 382220
The Sum(s) Insured is/are as under:Sum Insured
Escl
Escalation
Srl Description of Property
(%)
Premium(Rs)
1 Building(s) Only
For and on behalf of
National Insurance Company Limited

In witness whereof the undersigned being authorised by and on behalf


of the company has/have herein to set his/their hands.
CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58

Duly Constituted Attorney (s)

NNP-RPP-24/08/2015 12:50:32-3-1 30010210000010 - 6.9.0.0


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National Insurance Company Limited


3, Middleton Street, Post Box No. 9229, Kolkata - 700 071

DUPLICATE SCHEDULE
1

BUILDING WITH PLINTH AND FOUNDATION.


BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOU
BOARD.AT SOLA ROAD. AT NARANPURA.
AHMEDABAD. AND BUILDING USE FOR DWELLING
PURPOSE.
Premium For 1 Year :

Less
Add

Rs.525.00
Rs.5,250
Rs.2,250
Rs.3,750
Rs.464
Rs.4214

Policy Premium :
Long Term Discount
50% :
Net Premium :
Service Tax 12.36%:
Total :

Total Sum Insured(In Figures) :

Rs.15,00,000
Non-AOG Excess(%)

Total Sum Insured


(in words): Rupees Fifteen Lakh Only
STFI Rate Charged :

0.00

15,00,000

AOG Excess(%)

.05 Per Milli

Min Excess for Non-AOG Perils(Rs.):

Min Excess for AOG Perils(Rs.):

EQ Rate Charged :

.05 Per Milli

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------The Insurance under this Policy is subject to


: 1.Agreed Bank
warranties & clauses (as per forms attached) & is : Condition no. 3(b) of the Policy is hereby deleted
extended to cover risks of (as per forms attached) :
Policies having Sum Insured up to INR 10 cr per location - 5% of claim amount subject to a minimum of Rs. 10,000/- .
Description of Risk : BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOU
BOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE.
ATTACHED TO AND FORMING PART OF POLICY NO. :

300102/11/13/3100000122

Sr. No. Description of Clauses


------- ------------------------------------------------------------------------------------------------------------------------1 Subject to Earthquake (Fire and Shock) Clause As Attached
NAME OF BANK/FINANCER :
Srl No. Financier Name
------- ----------------------------------------------1 Kalupur Commercial Co-Op Bank Ltd

Branch Name
BAVLA

Remarks/Special Conditions :
Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal.

For and on behalf of


National Insurance Company Limited

In witness whereof the undersigned being authorised by and on behalf


of the company has/have herein to set his/their hands.
CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58

Duly Constituted Attorney (s)

NNP-RPP-24/08/2015 12:50:32-3-1 30010210000010 - 6.9.0.0


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