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 Insured MR. RAKESH KUMAR S/0 MR. JAGDISH CHAND MICRO OFFICE,SHOP NO.19, MOHALI ,ROAD,MAIN MARKET, SAS NA
HOUSE NO - 1699, PACCA BAGH LEHRI SHAH MANDIR ROAD , RUPNAGAR , PUNJAB
160055
Address of the Insured 140001
MOHALI

PUNJAB
Business/Occupation None Telephone: Telephone (836)0101378
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.
Trailer (if any) Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle C

Ca

(HERO M )
PB - 12–R-6072 No 00993 9K05947 SOLO 2012
10/2012

Registration Authority Geographical Area Financier

PB-12- (ROPAR SDM) INDIA
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 t
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%):

· Hire or Reward Stamp Duty:

Total (Rounded Off) :
· Carriage of Goods (other than samples or personal luggage) Receipt Number : 0
Receipt Date: 13/07/
· Organized Racing DebitNote Number:

· Pace Making Document Date:

· Speed Testing and Reliability Trails

· Use in connection with Motor Trade
Limits of Liability Agency/Broker Code: AGD011
SANJEEV KUMAR
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor Dealer Name/Code:

Vehicles Act 1988

Direct Business:
Under Section II-I (ii) Damage to third party property in respect of any one claim or series
Development Officer Code:
of claims arising out of one event 750000
 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 beha
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988. United India Insurance Co. L

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 00:00 (hours) Insured Name

: MR RAKESH KUMAR S/O SH JAGDISH CHAND Insurance expiry Date & Time

:12/07/2020 midnight Insured address :

Policy Issuing Office Address :

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 & Engine No & 00993 Year Of Manufacture 2012
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 Number Geographical Extension Seating Capacity(Including 2
Driver)
INSURED DECLARED VALUE )
Co
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories COMPULSARY PA LPG Kit Total Insur
Det

27000 0 552 0 50 0 0 100

OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference C
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 t
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 ou
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 damag
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
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 reb
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 res
of such a claim.
PA Cover CSI( ) DEDUCTIBLES (Under Section I)( )
Owner Driver CSI
0 Compulsory 50 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 359.00+ 7
B. Basic - TP
1,850.00 IGST(18%) 203
Gross OD(A) 0.00 TOTAL
1,850.00
·
TOTAL PAYABLE PREMIUM 11
Stamp Duty
Add :
SAC Code
LL to Paid Driver IMT 28
50.00 3118I114761
Invoice No & Date
13/07

Receipt Number 1011124811811545

Sub Total (Additions)
50.00 Receipt Date 12/02/
Receipt Amount 133
Gross TP(B) Payment Mode C
1128.00
Paying Party SANJEEV KUMAR S/O
Total Liability Premium
1331.00 SURAJ KUMAR

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 )