UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
PRIVATE CAR-PACKAGE
UIN: IRDAN545RP0047V01199900
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1918003121P106199845 Certificate Number 1918003121P106199845
Customer Id 1775058308 Issuing Office Address Code 191800
Name of the Insured MISS MISS.VINITA TRIPATHI 131/11 ZONE 2 M.P.NAGAR BHOPAL
19, DWARKAPURI, KOTRA ROAD, BHOPAL DIST BHOPAL, MADHYA
PRADESH 462011
BHOPAL
Address of the Insured MADHYA PRADESH
BHOPAL
462003
MADHYA PRADESH Telephone (755) 2559208
Business/Occupation Others Telephone:

Insured's Declared Value 107100

Period of Insurance From 00:00 Hrs of 25/09/2021 To Midnight of 24/09/2022

Particulars of Vehicle Insured
Registration No.
Cubic Seating including
Trailer Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle Capacity/KW driver
(if any)
MARUTI SUZUKI
MP - 04 - CA - / WAGON R(1999
No F10DN4268360 MA3EED81S00444552 - 2006) LX BS- HATCHBACK 2006 1061 5
5594
III

Registration Authority Geographical Area Financier

MP04 BHOPAL INDIA
Amount in words: Five thousand nine hundred seventeen 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
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 Premium: 5,015.00

The policy covers use of the vehicle for any purpose other than CGST(9%): 451.00
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage) SGST(9%): 451.00
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total (Rounded Off) : 5,917.00
e) Speed Testing and Reliability Trails
Receipt Number : 10119180021106640883
f) Use in connection with Motor Trade
Receipt Date: 24/09/2021
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGI0040699
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor RAKESH AGRAWAL , Mobile: 9827254180
Vehicles Act 1988 Dealer Name/Code:
Under Section II-I (ii) Damage to third party property in respect of any one claim or series of
claims arising out of one event 750000 Direct Business:
Development Officer Code: 20426
NITIN VAIDYA
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 22,29
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance For and On behalf of
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988. United India Insurance Co. Ltd.

Duly Constituted Attorney:

Date of Issue: 24/09/2021

Amount Subject to Reverse Charges-NIL
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.

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Fri, Sep 24, 2021 09:07:35 IST
Location: United India Insurance Company Ltd
1/2 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - PRIVATE CAR PACKAGE(UIN: IRDAN545RP0047V01199900) POLICY SCHEDULE
Policy Number :1918003121P106199845 Previous Policy No :1918003120P106816467
Geographical Area :India(A) Insurance Start Date & Time :25/09/2021 00:00 (hours)
Insured Name/ID : MISS MISS.VINITA TRIPATHI/1775058308 Insurance expiry Date & Time :24/09/2022 midnight
Insured address : Policy Issuing Office Address :
19, DWARKAPURI, KOTRA ROAD, BHOPAL DIST BHOPAL, MADHYA PRADESH 131/11 ZONE 2 M.P.NAGAR BHOPAL ,GST No.:- 23AAACU5552C1ZR
City: BHOPAL District: BHOPAL City: BHOPAL District: BHOPAL
State: MADHYA PRADESH Pincode: 462003 State: MADHYA PRADESH Pincode: 462011
Telephone: Mobile: 9179993081 Telephone:(755) 2559208
Business Channel Code:AGI0040699 Business Channel Sub Code:
Dealer Name: Agent Name:RAKESH AGRAWAL
Dealer Code: Land Line No.: ,Mobile:9827254180
VEHICLE DETAILS
Registration Number MP - 04 - CA - 5594 Obsolete Vehicle & Engine No & F10DN4268360 Year Of Manufacture 2006
Number Vehicle Weight(Kg.)
RTA Name MP04 BHOPAL Chassis Number MA3EED81S00444552 Cubic Capacity/KW 1061
MARUTI SUZUKI & WAGON R(1999 -
Registration Date 25/09/2006 Vehicle Make & Model Type Of Body HATCHBACK
2006) LX BS-III
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
107100 0 0 0 0 0 107100 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
22,29
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 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 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
1500000 Compulsory 1000 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 5,015.00
Basic premium on Vehicle and Accessories B. Basic - TP 3,221.00
CGST(9%) 451.00
A. Basic - OD 2,938.82 Total 3,221.00
SGST(9%) 451.00
Total 2,938.82
TOTAL PAYABLE PREMIUM 5,917.00
Add :
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00
SAC Code 997134
Less : IMT 29 Legal Liability to Employees of 3121I106199845 &
50.00 Invoice No & Date
Insured 24/09/2021
No Claim Bonus 50% 1,469.41 Receipt Number 10119180021106640883
Sub Total (Deductions) 1,469.41 Receipt Date 24/09/2021
Sub Total (Additions) 325.00 Receipt Amount 5,917.00
Payment Mode
Gross OD(A) 1,469.00 Paying Party MISS MISS.VINITA
Gross TP(B) 3,546.00
TRIPATHI
Gross OD & TP:
5,015.00
(A) + (B)

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.

Date & Signature of Proposal:24/09/2021

In Witness Whereof this policy has been signed at DO 4 BHOPAL 191800 on this 24th day of September,2021

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 106.79.239.195
Issuing Agent: RAKESH AGRAWAL Printed By : CUSTOMER @ 24/09/2021 9:07:31 AM Agent User Name: RAKAGR00
Underwritten By - RAKAGR00 ( INDIVIDUAL AGENT
Agent Location: 191800
ATTACHED TO DEVELOPMENT OFFICER )

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

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