UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE CUM INSURANCE POLICY SCHEDULE

LE(FORM 51 OF CENTRAL
MOTOR VEHICLE RULES
1989)
Policy No. 1124813118P114761981 Certificate Number 1124813118P114764291
Customer Id 23060273686 Issuing Office Address Code 112481
Name of the MR. RAKESH KUMAR S/0 MR. JAGDISH CHAND MICRO OFFICE,SHOP NO.19, MOHALI ,ROAD,MAIN MARKET, SAS NAGAR MOHALI
Insured
HOUSE NO - 1699, PACCA BAGH LEHRI SHAH MANDIR 160055
ROAD , RUPNAGAR , PUNJAB M
Address of the O
Insured 14 H
00 A
01 L
I

P
U
N
J
A
B
Business/Occupatio None Telephone: Telephone (836)0101378
n
Insured's Declared Value 0
Period of Insurance From 00:00 Hrs of 13/07/2019 To Midnight of 12/07/2020
Particulars of Vehicle Insured
Registration No.
Cubic Seating
Trai Obsolete Engine No. Chassis Make/Model Type of Body Year of Mfg
Vehi Capacit including
ler Vehicle No.
cle y driver
(if
any
)
(HERO M )
10/2012
PB - 12–R-6072 N 00993 9K059 SOLO 201 - 2
o 47 2

Registration Geographical Area Financier

Authority
PB-12- (ROPAR INDIA
SDM)
N/A
Amount in words: One thousand nine hundred rupees only
Persons or classes of persons entitled to drive
Any person including Insured provided that a person hold an effective driving licence at the time of 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 Vehicle Rule, 1989.

Limitations as to use Premium:

The policy covers use of the vehicle for any purpose other than IGST(18%): 1331.
• Hire or Reward 00
• Carriage of Goods (other than samples or personal luggage) 203.00
• Organized Racing
Stamp Duty: 1.00
• Pace Making
• Speed Testing and Reliability Trails Total (Rounded Off) :
Receipt Number : 119.0________
• Use in connection with Motor Trade
0
Receipt Date: 13/07/2019
DebitNote Number:
 Document Date:

Limits of Liability Agency/Broker Code: AGD0117003

Under Section II-I (i) Death or bodily injury in respect of any one accident; As SANJEEV KUMAR
per Motor Vehicles Act 1988 Dealer Name/Code:
Under Section II-I (ii) Damage to third party property in respect of any one claim
or series Direct Business:
of claims arising out of one event 750000 Development Officer Code:

Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 28
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance For and On behal
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988.
Unite
d India Insurance Co. Ltd.

Duly Constituted Attorney:

Date of Issue: 13/07/2019
Amount Subject to Reverse Charges-NIL
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.
LET US JOIN THE FIGHT AGAINST
CORRUPTION.
PLEASE TAKE THE PLEDGE AT
https://pledge.cvc.nic.in

MOTOR INSURANCE - CERTIFICATE CUM INSURANCE POLICY SCHEDULE

Policy Number :1124813118P114761981 Previous Policy No ; 60039547214
:Geographical Area :India(A) Insurance Start Date & Time :13/07/2019
MICRO OFFICE,SHOP NO.19, MOHALI ,ROAD,MAIN MARKET, SAS NAGAR

MOHALI

160055
MOHALI PUNJAB City: District: MOHALI
State: PUNJAB Pincode: 160055
Telephone:(836) 0101378
Business Channel Code:AGD0117003 Business Channel Sub Code:
Dealer Name: Agent Name:SANJEEV KUMAR
Dealer Code: Land Line No.: ,Mobile:8360101378
VEHICLE DETAILS
Registration Number PB 12 R 6072 Obsolete Vehicle & No & 00993 Year Of Manufacture 2012
Engine Number Vehicle Weight(Kg.)
RTA Name PB12 RUPNAGAR Chassis Number 9K05947 Cubic Capacity

HERO (M)
Registration Date 24/10/2012 Vehicle Make & Model Type Of Body
10/2012 SOLO
AA Membership Geographical Extension Seating 2
Number Capacity(Including
Driver)
INSURED DECLARED VALUE )
Co-
Vehicle Trailer Electrical/Electronic Non Electrical COMPULSARY PA LPG Total Insurance
Accessories Accessories Kit Details

27000 0 552 0 50 0 0 100%

OTHER DETAILS
Unique
Financier Policy Subject to IMT Applicable Addon- Reference
Endorsements covers/Services
Code
28
N/A N/A N/A
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.
EXCLUSIONS:(1)Any accidental Loss Or Damage and/or liabilty 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 and/or liability directly or indirectly or proximately or remotely occasioned by or 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 consequences 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( ) DEDUCTIBLES (Under
Section I)( )
Owner Driver
0 Compulsory 50 Imposed 0 Voluntary 0
CSI
(Under
Section IV)
SCHEDULE OF )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL
PREMIUM
Premium(A+B) 359.00+ 769.00
B. Basic - TP
IGST(18%)
1,850.00 203 • 00

Gross OD(A) TOTAL

0.00 1,850.00
TOTAL PAYABLE PREMIUM 1128.00
Stamp Duty 1.00
Add :
SAC Code 9971

LL to Paid Driver IMT 28

50.00 3118I114761981 &
Invoice No & Date
13/07/2019

Receipt Number 10111248118115458143

Sub Total (Additions)
Receipt Date 12/02/2019
50.00
Receipt Amount 1331.00
Gross TP(B) Payment Mode CASH
1128.00
Paying Party SANJEEV KUMAR S/O SH
Total Liability Premium
SURAJ KUMAR
1331.00

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 United India Insurance company Offices and on Website www.uiic.co.in
DISCLAIMER:The policy stands Cancelled or void in the event of Cheque Dishonored.The company may cancel the policy by sending 7 days notice in case of
fraud,misrepresentation,nondisclosure of material fact or non co- operation of the insured.
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 fom 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 United India Insurance Co. Immediately to arrange spot survey.
Anti Money Laundering Clause:-In the event of a claim under the policy exceeding 1 lakh or a claim for refund of premium exceeding 1 lakh, the insured will comply with the
provisions of AML policy of the company. The AML policy is available in all our operating offices as well as Company's web site.

Date & Signature of Proposal:12/07/2019

In Witness Whereof this policy has been signed at MO BALTANA 112481 on this 12th day of February ,2019

Affix Policy Stamp

IP Address: 110.225.215.80

For United India Insurance Company Limited

Duly Constituted Attorneys

Issuing Agent: SANJEEV KUMAR Printed By : PAPRAM00 @ 13/07/2019 1:45:14 PM Agent User Name: PAPRAM00
Agent Location: 112481 Underwritten By - PAPRAM00 ( DIRECT AGENT )