Document 656415486

MOTOR INSURANCE ‐ PRIVATE CAR PACKAGE POLICY SCHEDULE
Policy Number :22300031240160464309 Previous Policy Number :32020231236160001253

Geographical Area :India Insurance Start Date & Time :10‐05‐2024 00:00﴾hours﴿
Insured Name :Mr. RAHUL GAJBHIYE Insurance Expiry Date & Time :09‐05‐2025 Midnight
Insured Address : Policy Issuing Office Address :
VPO: S/O SHRI SHALIKRAM GAJBHIYE H N A‐97 NEAR SUYASH Divisional Office‐30 ﴾Gurugram﴿ Unit no: 34,35,6A,6B,Ground Floor,
HOSPITAL JANKI NAGAR CHUNABHATTI KOLAR ROAD Vipul Trade Centre, Sector‐48, Sohna Road,
City :BHOPAL District :BHOPAL City :Gurugram District :Gurugram
State :MADHYA PRADESH Pincode :460001 State :Haryana Pincode :122001
Mobile No :7987043427 Office Contact Details :7338829307 Email ID :pb.support@uiic.co.in
Email :helpful.insurance23@gmail.com Fax : GSTIN :06AAACU5552C1ZN
Business Channel Code: NA Business Channel Sub Code: BRC0001039

Mobile No.: 18002585970 ﴾Service﴿ Agent Name : Policybazaar Insurance Broker Pvt. Ltd
IRDA License Number: IRDAI/WBA21/15‐06
VEHICLE DETAILS
Year of Manufacture Vehicle
Registration Number MP‐04‐EA‐4447 Engine Number EULZL23280 2020
Weight﴾kg.﴿
RTA Name MP04 MP04 BHOPAL Chassis Number MA1NM2EU1L2L77813 Cubic Capacity / GVW 1497
Registration Date 04/02/2021 Vehicle Make & Model MAHINDRA AND MAHINDRA ‐ XUV300 ‐ W8 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
800,000.00 0 0 0 0 0.00 0.00 800,000.00 0.00
OTHER DETAILS
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers
AXIS BANK LTD. BHOPAL Nil depreciation without Excess
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.
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﴿ 15,00,000.00 Compulsory 1,000.00 Imposed 0 Voluntary 0.00
SCHEDULE OF PREMIUM ﴾IN RUPEES﴿

A‐OWN DAMAGE PREMIUM B‐LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
Basic Own Damage 25,528.00 Basic TP Liability 3,416.00 Package Premium 15,228.60
Nil Depreciation Premium 7,658.40 PA Owner Driver 275.00 GST @18.00% 2,741.00
Sub Total﴾Additions﴿ 7,658.40 LL to Paid Driver IMT 28 50.00 TOTAL PAYABLE PREMIUM 17,970.00
Sub Total ﴾Deductions﴿ 21,698.80 Sub Total ﴾Additions﴿ 325.00 Stamp Duty Rs. 1
Total 11,487.60 Sub Total ﴾Deductions﴿ 0 Receipt Date 09/05/2024
Total 3,741.00 Receipt Amount 17,970.00
Payment Mode Online
Paying Party RAHUL GAJBHIYE
CHEQUE DETAIL
Cheque Number Cheque Date Bank Name Branch Name Branch Code Cheque Signatory MICR No
PB93950877 09/05/2024 2413050239482 RAHUL GAJBHIYE
Europ Assistance India Private Limited, Address: 7th, Floor, Building No. 2, Star Hub, Near ITC Maratha Hotel, Sahar, Andheri East, Mumbai Suburban, Maharashtra, Contact No.‐18002102051
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: 09/05/2024 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: 10.82.5.67
Print Date: 09/05/2024 10:47:51hours
United India Insurance Company Ltd : IRDA Reg: No : 545
Underwritten by Policy Bazaar on 09‐05‐2024 10:47:51hours
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
"IN CASE OF CLAIM KINDLY CONTACT OUR NEAREST LOCAL OFFICE".

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MOTOR INSURANCE ‐ PRIVATE CAR PACKAGE POLICY SCHEDULE

Policy Number :22300031240160464309 Previous Policy Number :32020231236160001253

Business Channel Code: NA Business Channel Sub Code: BRC0001039

INSURED DECLARED VALUE ﴾IN RUPEES﴿

SCHEDULE OF PREMIUM ﴾IN RUPEES﴿

CONSOLIDATED STAMP DUTY PAID VIDE

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