MOTOR INSURANCE - PRIVATE CAR STANDALONE OWN DAMAGE(UIN: IRDAN545RP0001V01201920 ) POLICY SCHEDULE

Policy Number :2017013123P101337141 Previous Policy No :

Geographical Area :India(A) Insurance Start Date & Time :09/05/2023 00:00 (hours)
Insured Name/ID : MR BASANT KUMAR/23144333509 Insurance expiry Date & Time :08/05/2024 midnight
Insured address : Policy Issuing Office Address :
S/O RAM MEHER MAIN MARKET PAONTA SAHIB DISTT 22 NO. PHATAK, LEELA BHAWAN BHUPINDRA ROAD, LEELA BHAWAN MARKET, ,GST No.:-
City: SIRMAUR District: SIRMAUR 03AAACU5552C1ZT
State: HIMACHAL PRADESH Pincode: 173025 City: PATIALA District: PATIALA
Telephone: Mobile: 7043692772 State: PUNJAB Pincode: 147001
Telephone:(175) 2200697
MSIP Name/Code:BHAGAT AUTOMOBILES PRIVATE LIMITED / MISP001137 Business Channel Sub Code:

Designated Person Name :MR HARNARESH SINGH Land Line No.: ,Mobile:9876020945
VEHICLE DETAILS
Registration Number HP - 17 - G - 4691 Obsolete Vehicle & Engine No & DTB009726 Year Of Manufacture 2022
Number Vehicle Weight(Kg.)
RTA Name HP07 SHIMLA Chassis Number MEXH21CW7NT000481 Cubic Capacity/KW 999
VOLKSWAGEN & TAIGUN(2021 - )
Registration Date Vehicle Make & Model Type Of Body SUV
TOPLINE 1.0 TSI AT
AA Membership Number Geographical Extension Seating Capacity(Including 5
Driver)
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
1175000 0 0 0 0 0 1175000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
ICICI BANK LTD.(PATIALA,PATIALA,PUNJAB-147001) 7,10,22 Consumables Cover,Nil Depreciation Without
Excess
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
The policy covers use of the 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 and Reliability Trails
f) Use in connection with Motor Trade
EXCLUSIONS:(1)Any liability for death or injury to any passenger or third party or damage to property within or outside the vehicle caused by or arising out of use of the vehicle. (2)Any accidental Loss Or Damage and/or
liabilty caused sustained or incurred outside the geographical area.(3)Any claim arising out of any contractual liability.(4)Any accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting
or arising there from or any consequential loss.(5)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.(6)Any accidental loss or damage or liability directly or indirectly caused by or contributed to by or arising from
nuclear weapons material.(7)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 CSI
0 Compulsory 1000 Imposed 0 Voluntary 0
(Under Section IV)

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SCHEDULE OF PREMIUM( )
OWN DAMAGE PREMIUM TOTAL PREMIUM
Premium 20,732.00
Basic premium on Vehicle and Accessories
IGST(18%) 3,732.00
Basic - OD 12,733.56
TOTAL PAYABLE PREMIUM 24,464.00
Total 12,733.56 Stamp Duty 1.00
SAC Code 997134
Add : 3123I101337141 &
Invoice No & Date
08/05/2023
Nil Depreciation Without Excess 7,141.65 Receipt Number 10120170123101635753
Receipt Date 08/05/2023
Consumables Cover 1,175.00
Receipt Amount 24,464.00
Payment Mode
Sub Total (Additions) 8,316.65
Paying Party MR BASANT KUMAR

Less :

Anti-Theft Device Discount 318.34

Sub Total (Deductions) 318.34

Gross OD 20,732.00

Existing TP Policy Details :

Policy No Insurer Name Insurer Address Policy Start Date Policy End date
2017003122P100930878 UIIC DO PTA 29/04/2022 28/04/2025
WARRANTED THAT IN CASE OF CANCELLATION OF EXISTING TP POLICY UNDER ANY CIRCUMSTANCES, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED.
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.

LET US JOIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT https://pledge.cvc.nic.in.

Amount Subject to Reverse Charges-NIL

We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not
required to prepare an invoice in terms of the provisions of the said sub-rule.

IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.
The genuineness of the policy can be verified
through "Verify Your Policy" link at
www.uiic.co.in.

Date & Signature of Proposal:08/05/2023

In Witness Whereof this policy has been signed at BO PATIALA 201701 on this 08th day of May ,2023

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.40.80
BHAGAT AUTOMOBILES
Issuing MISP: Printed By : CUSTOMER @ 08/05/2023 4:55:38 PM MISP User Name: MAN37047
PRIVATE LIMITED
MISP Location: 201701 Underwritten By - MAN37047 ( BO UNDERWRITER )

This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

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