THE NEW INDIA ASSURANCE CO. LTD. (Wholly owned by The Govt. of India) Pradhan Mantri Suraksha Bima Yogana(PMSBY) Group Personal Accident Insurance Scheme Customer ID : 8082711409 Master Policy Holder : CENTRAL BANK OF INDIA Master Policy Number : Insured's Details Insured Name Date of Birth : : PMYBY034151402000000 Issuing Office Details SIMMY SURESH Office Code 22/03/1982 Address : DO142400_MROII_DO (142400) : The New India Assurance Co Ltd , Jeevan Seva Building , 2nd Floor, S V Road, Santacruz West, Mumbai-400054 Account No. : Aadhar No. : PAN No. : 3216549872 Phone No. : 02224620363 / 02224620311 E-mail/Fax : niacs.113000@newindia.co.in / 02222612667 EANPS3134M S.Tax Regn. No. : AAACN4165CST178 NA Policy Details Certificate Number : NIACBI3216549872 Policy start Date : 01/05/2015 00:00:00 Previous Policy No. : Policy end Date : 31/05/2016 23:59:59 Name of assignee : Date of Proposal : 27/04/2015 Assignee Relationship : Premium 12.00 Service Tax 2.00 Frequency of Premium Total (Rs.) 14.00 ANNUAL NA NA Rupees (in words) Receipt No. & Date RUPEES FOURTEEN 42381500025/04/2015 Details of the coverages under the Policy: INDIVIDUAL Coverages Sum Assured Death Rs 2 Lakh Total and irrecoverable loss of both eyes or loss of use of both hands or feet or loss of sight of one eye and loss of use of hand or foot Total and irrecoverable loss of sight of one eyes or loss of use of one hand or foot Rs 2 Lakh Rs 1 Lakh This is to certify that the above member is covered under the scheme of insurance effected under the above master policy. Insurence benefits are available to the member subject to the conditions specified in the policy documents. This is a computer generated document and does not require any signature Note : 1) This certificate is primarily issued to create awareness about insurance affected in the life of the member. It does not confer any legal rights on the nominee/or any other person to claim the benefits under the policy. the benefits will be payable only to the authorised person specified in the policy and subject to the fulfilment of the conditions specified therein. 2) For informing about lodging of claims under the Scheme, please contact the bank. Policy No. :NIACBI3216549872 Document generated by Portal at 25/04/2015 00:00:00 hours. Regd. & Head Office: New India Assurance Bldg., 87 M.G.Road,Fort,Mumbai - 400 001. TOLL FREE No. 1 800 209 1415. For Redressal of your grievance, if any, you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3.Head office. In case, you are not satisfied with our own grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of Insurance Ombudsman, please visit our website http://newindia.co.in. PageNo.1
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