UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - PACKAGE
UIN: IRDAN545RP0222V01200708
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1419003120P108896991 Certificate Number 1419003120P108896991
Customer Id 23014126471 Issuing Office Address Code 141900
PLOT NO. 1, RADHAMANI GRANDEUR, ABOVE CANARA BANK,
Name of the Insured MR VISHNU SINGH S/O NAND SINGH
OPP. JDA NURSERY PARK, SIKAR ROAD, JAIPUR
PLOT NO.338, GANESH NAGAR VISTAR, DHAKSHIN MUKHI BALAJI
302039
KE PICHE , KARDHANI, KALWAR ROAD,
JAIPUR
Address of the Insured RAJASTHAN
302012
JAIPUR Telephone (141) 2333170,(141) 2333493
RAJASTHAN
Business/Occupation None Telephone :
Insured's Declared Value 111000

Period of Insurance From 00:00 Hrs of 07/11/2020 To Midnight of 06/11/2021

Particulars of Vehicle Insured
Registration No.
Trailer Cubic Seating including
Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle (if Capacity/KW driver
any)
RJ - 14 - HD - U5S5F0FC097507 ME3U5S5F1FC044930 Royal Enfield / CLASSIC DESERT Solo with Pillion
No 2015 500 2
0500 STORM EFI
Registration Authority Geographical Area Financier
RJ14 JAIPUR INDIA HDFC BANK LTD.(JAIPUR,JAIPUR,RAJASTHAN-302001)
Amount in words: Four thousand eight hundred twenty-five rupees only
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 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: 4,089.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 368.00
a) Hire or Reward
SGST(9%): 368.00
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 4,825.00
e) Speed Testing and Reliability Trials Receipt Number : 10114190020109443830
f) Use in connection with Motor Trade Receipt Date: 06/11/2020
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGN0007964
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor RAJ KUMAR PAREEK , Mobile:
Vehicles Act 1988 9352750945
Under Section II-I (ii) Damage to third party property in respect of any one claim or series of Dealer Name/Code:
claims arising out of one event: 100000 /-
Direct Business:
Development Officer Code:
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 7,22
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988. For and On behalf of
Date of Issue: 06/11/2020 United India Insurance Co. Ltd.
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.
Duly Constituted Attorney
 MOTOR INSURANCE - MOTORCYCLE / SCOOTER - PACKAGE(UIN: IRDAN545RP0222V01200708) POLICY SCHEDULE
Policy Number :1419003120P108896991 Previous Policy No :1419003117P100840060
Geographical Area :India(A) Insurance Start Date & Time :07/11/2020 00:00 (hours)
: MR VISHNU SINGH S/O NAND
Insured Name/ID Insurance expiry Date & Time :06/11/2021 midnight
SINGH/23014126471
Insured address : Policy Issuing Office Address :
PLOT NO.338, GANESH NAGAR VISTAR, DHAKSHIN MUKHI BALAJI KE PICHE , PLOT NO. 1, RADHAMANI GRANDEUR, ABOVE CANARA BANK, OPP. JDA NURSERY PARK, SIKAR ROAD,
KARDHANI, KALWAR ROAD, JAIPUR ,GST No.:- 08AAACU5552C1ZJ
City: JAIPUR District: JAIPUR City: JAIPUR District: JAIPUR
State: RAJASTHAN Pincode: 302012 State: RAJASTHAN Pincode: 302039
Telephone: Mobile: Telephone:(141) 2333170,(141) 2333493
Business Channel Code: AGN0007964 Business Channel Sub Code:
Dealer Name: Agent Name:RAJ KUMAR PAREEK
Dealer Code: Land Line No: ,Mobile:9352750945
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number RJ - 14 - HD - 0500 No & U5S5F0FC097507 2015
Number Manufacture
RTA Name RJ14 JAIPUR Chassis Number ME3U5S5F1FC044930 Cubic Capacity/KW 500
Royal Enfield & CLASSIC
Registration Date 06/04/2015 Vehicle Make & Model Type Of Body Solo with Pillion
DESERT STORM EFI
Seating Capacity(Including Geographical
AA Membership Number 2
SideCar) Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer/Sidecar Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
111000 0 0 0 0 0 111000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
HDFC BANK LTD.(JAIPUR,JAIPUR,RAJASTHAN-302001) 7,22
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 warlike 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 100 Imposed 500 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 4,089.00
Basic premium on Vehicle and Accessories B. Basic TP 2,323.00
CGST(9%) 368.00
A. Basic OD 1,491.38 Total 2,323.00 SGST(9%) 368.00
Total 1,491.38 TOTAL PAYABLE PREMIUM 4,825.00
Add :
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00 SAC Code 9971
3120I108896991 &
Invoice No & Date
06/11/2020
Gross OD(A) 1,491.00 Sub Total (Additions) 275.00 Receipt Number 10114190020109443830
Receipt Date 06/11/2020
Receipt Amount 4,825.00
Gross TP(B) 2,598.00 Payment Mode CASH
Gross OD & TP: MR VISHNU SINGH S/O
4,089.00 Paying Party
(A) + (B) NAND SINGH

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 : 06/11/2020

In Witness Whereof this policy has been signed at DO 4 JAIPUR 141900 on this 06th day of November ,2020

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.3.103
Issuing Agent: RAJ KUMAR PAREEK Printed By : CUSTOMER @ 07/11/2020 8:51:35 AM Agent User Name: NAR42081
Agent Location: 141900 Underwritten By - NAR42081 ( DO UNDERWRITER )

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