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EXIT PRINT

GOODS CARRYING PACKAGE POLICY

POLICY SCHEDULE CUM TAX INVOICE
CERTIFICATE CUM POLICY NUMBER:USGI/POSWEB/0198459/00/000
INVOICE NUMBER : WEB231519096144

INTERMEDIARY INVICTUS INSURANCE BROKING SERVICES PRIVATE LIMITED

NAME
INTERMEDIARY 201396572528 PHONE 9999578671 E-MAIL anuj.d@turtlemint.com SUB NA
CODE NO. CODE
POLICY/INVOICE ISSUED DATE 08/02/2019
INSURED NAME OM PRAKASH MANUAL COVERNOTE NUMBER PSID171255
PROPOSER S/O KALLU RAM REGISTRATION DATE 01/01/2015
ADDRESS/PLACE H NO 1640, WARD NO- 15, SEHATPUR, SURYA
OF SUPPLY COLONY RTO ZONE C
FARIDABAD
FARIDABAD - HARYANA (9) CUSTOMER ID NA
PIN - 121001
NOMINEE NAME
MOBILE NO - 9837043462
PERIOD OF FROM 17:01 OF 08/02/2019 RELATIONSHIP WITH PROPOSER
INSURANCE TO MIDNIGHT OF 07/02/2020
FINANCIAL HYPOTHECATED /INDUSIND BANK LTD /. EIA ACCOUNT NO. NA
INTEREST
POLICY NOIDA BRANCH, 1st Floor, Shop No 9 & 10 Block - A - 15, Sector 44, NOIDA, UTTAR PRADESH, STATE CODE - 9, PIN - 201301,
ISSUANCE GSTIN- 09AAACU8917F1Z4
OFFICE
PARTICULARS OF VEHICLE INSURED
REGISTRATION CHASSIS ENGINE MAKE MODEL BODY CUBIC MFG GVW CARRYING
NUMBER NUMBER NUMBER TYPE CAPACITY YEAR CAPACITY
HR-38-V-0694 M7910 207749 ASHOK ECOMET OPEN 5759 2015 15500 3
LEYLAND 1214.
PUC Number PUC Center
NA NA
INSURED'S DECLARED VALUE (Rs.)
VEHICLE TRAILER TRAILER CHASSIS NON-ELEC ELECTRICAL/ELECTRONIC CNG LPG TOTAL
IDV IDV NUMBER ACCESSORIES ACCESSORIES KIT KIT VALUE
900000.00 0.00 0 0.00 0.00 0.00 0.00 900000.00
SCHEDULE OF PREMIUM (AMOUNT IN Rs.)
OWN DAMAGE (A) LIABILITY (B1)
Basic Own Damage 16479.00 Basic Third Party Liability 32367.00
Total Basic Own Damage 0.00
Detariff Discount Amount 13183.00 LIABILITY COVERS (B2)
Basic OD after Discount\Loading 3296.00 Add:
Adverse Claim Loading 0 Legal Liability Cleaner/Conductor/Coolies 100.00
Total Own Damage Premium 3296.00 PA to Owner-Driver 225.00
Paid Driver 50.00
Sub Total (Additions) : 375.00
NET PREMIUM OD(A) + TP(B2) 3671.00 Basic TP(B1) 32367.00
IGST (18%) 660.78 IGST (12%) 3884.04
TOTAL OD(A) + TP(B2) (INCLUDING GST) 4331.78 TOTAL TP(B1) (INCLUDING GST) 36251.04
TOTAL PREMIUM (INCLUDING GST) 40583.00
C0MPULSORY DEDUCTIBLE 1000.00
For No Claim Bonus (NCB) No Claim Bonus will only be allowed if the policy is renewed within 90 days of the expiry date of the previous year. The insured is entitled for a No Claim Bonus on the Own
Damage Section of the policy, if no claim is made or pending during the preceding year(s).
DRIVER (Persons or classes of persons entitled to drive): Any person including insured: Provided that a person holds an effective driving licence at the time of the accident and is not disqualified from
holding or obtaining such a licence Provided also that the person holding an effective learner's license may also drive the vehicle when not used for the transport of passengers/ goods at the time of the
accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules 1989.
LIMITATIONS AS TO USE: The Policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage falling under Sub Section (3) of Section 66 of the Motor
Vehicles Act, 1988. The Policy covers use of the vehicle for any purpose other than (1)Organised racing (2) Pace making (3) Speed testing (4) Reliability trails (5)Use whilst drawing a trailer except the
towing (other than for reward) of any one disabled mechanically propelled vehicle.
LIMITS OF LIABILITY: a) Under Section II- 1 (i) of the Policy- Death or bodily injury-such amount as is necessary to meet the requirements of the Motor Vehicle Act 1988 b) Under Section II- 1(ii) of the
Policy-Damage to Third Party Property-in respect of any one claim or series of claims arising out of one event (Rs. 6000/- OR Rs. 7.5 Lakhs as may be applicable). P.A. Cover under Section III for Owner -
Driver (CSI).
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"
SUBJECT TO IMT ENDORSEMENT NOS. AND MEMORANDUM PRINTED HEREIN / ATTACHED HERETO : 7,15,21,28,40
PREMIUM COLLECTION DETAILS: - [Collection No / Amount / ReceiptDate] NA
DISCLAIMER: For USGIC renewal policies, the policy wordings including terms and conditions were sent with the first year policy. The same policy wordings stands correct with no changes. You can also
refer the wordings at our website www.universalsompo.com. Policy is valid subject to Realization of Cheque. We accept premium only via legally recognized modes except for cash. If our representatives
request you to pay in cash, kindly report it to us.

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CLAIMS DISCLAIMER: In the unfortunate event of any loss or damage to the insured property resulting into a claim on this policy, please intimate the mishap IMMEDIATELY to our Call Centre at Toll Free
Numbers on 1-800-22-4030 (for MTNL/BSNL users) or 1-800-200-4030 (other users) or on chargeable numbers at +91-22-27639800 / +91-22-39133700. Email at contactclaims@universalsompo.com.
Please note that no delay should be allowed to occur in notifying a claim on the policy as the same may prejudice liability.

I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X,XI of M.V.Act 1988.
FOR UNIVERSAL SOMPO GENERAL
INSURANCE CO. LTD.

IRDAI UIN NO: IRDAN134P0009V01200809

SAC CODE : 997134

USGI IRDAI REGISTRATION NO: 134

In Witness whereof this Policy has been signed at Mumbai in lieu of covernote No. PSID171255

DULY CONSTITUTED ATTORNEY(S)

Consolidated stamp duty Rs 0.50 paid towards Insurance policy stamp vide receipt no. 30056201 dated 19/01/2017 of General Stamp Office Mumbai.
In case of any discrepancy, complaint or grievance, please feel free to contact us within 15 days of receipt of the Policy. Universal Sompo General Insurance Co. Ltd. Express IT Park, Plot
No. EL - 94, T.T.C. Industrial Area, M.I.D.C., Mahape, Navi Mumbai- 400710 Toll Free Numbers: 1-800-22-4030 (for MTNL/BSNL users) or 1-800-200-4030 (other users) Landline Numbers:
+91-22-27639800 / +91-22-39133700(Local Charges Apply). E-mail Address: contactus@universalsompo.com. Fax Number: 022-39171419 Note: Please include your policy number for
any communication with us.

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