MOTOR INSURANCE - PRIVATE CAR LIABILITY ONLY POLICY SCHEDULE

Policy Number :22140031190160078738 Previous Policy Number :

Geographical Area :India Insurance Start Date & Time :19-04-2019 00:00(hours)
Insured Name :Mr. ANNAMALAI VC Insurance Expiry Date & Time :18-04-2020 Midnight
Insured Address : Policy Issuing Office Address :

VPO: N SARAVANA KUMAR,27 SOUTH DO 14 GURGAON 4, NEW COLONY, ABOVE SBI,

MADAVILAGAM,THIRUBUVANAM GURGAON
City :KANCHIPURAM District :KANCHIPURAM City :GURGAON District :Gurgaon
State :TAMIL NADU Pincode :612103 State :HARYANA Pincode :122001
Mobile No :9788393560 Office Contact Details :0124 2310260 Email ID :pb.support@uiic.co.in
Email :deepangcthe@gmail.com Fax :0124 2300927 GSTIN :06AAACU5552C1ZN

Business Channel Code: NA Business Channel Sub Code: BRC0000907

Mobile No.: 18002585970 (Service) , 18002585881 (Claims) Agent Name : Policybazaar Insurance Web Aggregator Pvt. Ltd
IRDA License Number: IRDAI/WBA21/15-06

VEHICLE DETAILS
Year of Manufacture Vehicle
Registration Number TN-21-AE-3220 Engine Number 475IDI03JQZP92250 2009
Weight(kg.)
TN21 TN21 KANCHIPURAM -
RTA Name Chassis Number MAT6001499PJ77997 Cubic Capacity / GVW 1405
631501
Registration Date 05/11/2009 Vehicle Make & Model TATA - INDICA - DL Type of Body -
AA Membership Name Seating Capacity 5 Geographical Extension

INSURED DECLARED VALUE (IN RUPEES)

Electrical /Electronic Non-Electrical Co-Insurance
Vehicle Trailer FiberGlass CNG Kit LPG Kit TOTAL
Accessories Accessories Details
0 0 0 0 0 0 0 0

OTHER DETAILS
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers

LIMITATIONS AS TO USE
The policy covers use of 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 (f)
Reliability Trials (g) Any purpose in connection with motor trade.
DRIVER:
Any person including insured: Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license.Provided also that the
person holding an effective learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY :
Under Section II-1(i) of the policy Death of or bodily injury Such amount as is necessary to meet the requirement of the Motor Vehicles Act,1988

Under Section II-1(ii) of the policy Damage to Third Party Property Rs.6000

OTHER DETAILS
EXCLUSIONS: (1) Any accidental loss or damage and/or liability 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 or liability directly or indirectly or proximately or
remotely occasioned by 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 consequence 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 (In Rupees) DEDUCTIBLES (Under Section I) (In Rupees)
Owner- Driver (Under section IV) 0 Compulsory 0.0 Imposed 0 Voluntary 0.0

SCHEDULE OF PREMIUM (IN RUPEES)

A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
Total Own Damage 0 Basic TP Liability 2,763.00 Package Premium 2,763.00
PA Owner Driver 0.00 GST @18.00% 497.00
Sub Total (Additions) 0.00 TOTAL PAYABLE PREMIUM 3,260.00
Sub Total (Deductions) 0 Stamp Duty Rs. 1
Total 2,763.00 Receipt Date 18/04/2019
Receipt Amount 3,260.00
Payment Mode Online
Paying Party ANNAMALAI VC

CHEQUE DETAIL
Cheque Number Cheque Date Bank Name Branch Name Branch Code Cheque Signatory MICR No
PG7682712 18/04/2019 910815968323 ANNAMALAI VC

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 http://uiic.co.in/sites/default/files/uploads/downloadcenter/IndianMotorTariff.pdf.
For terms and conditions for add on covers go to : http://uiic.co.in/sites/default/files/uploads/downloadcenter/motor_additional_covers.pdf
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, non disclosure 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 from 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. Date & Signature of Proposal: 18/04/2019 00:00:00.0
In Witness whereof this Policy has been signed at GURGAON this day of , Date
For United India Insurance Company Limited

CONSOLIDATED STAMP DUTY PAID VIDE

GRN NO. 32325721 DTD 28/12/2017 AND
CERT. NO. 780 DTD 28/12/2017 ISSUED BY
TREASURY OFFICER, GURGAON
Duly Constituted Attorneys
IP Address: 117.202.252.85
Print Date: 18/04/2019 03:17:32hours
United India Insurance Company Ltd : IRDA Reg: No : 545
Underwritten by Policy Bazaar on 18-04-2019 03:17:32hours
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

Claims Settlement Procedure for Policies issued by M/S Policybazaar Insurance Web Aggregator Private Ltd.

Our Company has signed an agreement for Online Sale of Insurance Policies with M/S Policybazaar Insurance Web Aggregator Private Ltd.
Policy will be issued by DO 14, Gurgaon (Office Code 221400) under DR02, Delhi

The claims will be processed and paid by OD Service Hub, RO 2 Delhi only (220091)

All operating Offices are hereby informed that with reference to our Circular Ref'. no. HO:MOT:OD:CIR:02:17 Dated 13.06.2017 on receipt of
intimation for claim on policy where Policybazaar Insurance Web Aggregator Pvt. Ltd. is the intermediary, the following steps to be followed-:
Confirmation of Policy details from GC Core at local office by entering policy number.
Immediate appointment of the surveyor of the eligible category as per estimate of loss and as per Company guidelines. Wherever spot or re-
inspection survey is required to be done the same may be arranged. In case of Fire/Theft/TP injury/ Death, immediate investigation to be arranged.
Scanned copy of Claim Intimation, Details of Estimate of loss and Surveyor/lnvestigator Details to be mailed to the following email id:

email - pbclaim.uiic@gmail.com & pb.claims@uiic.co.in

Once Loss assessment is completed, the surveyor should send the survey report with all enclosures (a) to (h) mentioned below by email in a "pdf'
format to the above mentioned email Ids. Thereafter the following to be sent by speed post/registered post at the address mentioned below:
All the documents relating to the claim like:
a) Claim Intimation
b) Estimates
c) Survey reports ( Spot, Final, Re-inspection)
d) Bills / Cash Memos, Receipts
e) Vehicular Documents, FIR details, Fire brigade report
f) Investigation report
g) NEFT details
h) Previous policy copy / Pre-inspection report details to be collected from insured in case of old vehicle whereas, in case of new
vehicle, copy of purchase invoice.

Address of Servicing Office:

Motor OD Service Hub

United India Insurance Co, Ltd
1st Floor, CORE IV
SCOPE Minar, Laxmi Nagar Distt. Centre
Delhi- 1 10092
Phone - 011- 22526229

In case of any further clarifications, the operating offices may contact DROII Service Hub In Charge. The above mentioned instructions to be
implemented with immediate effect.