UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 2909813121P101599897 Certificate Number 2909813121P101599897
Customer Id 23107967286 Issuing Office Address Code 290981
.
Name of the Insured MR ATAL KUMAR TRIKHA
OPP OLD BUS STAND, SURATGARH SURATGARH, SRIGANGANAGAR, RAJASTHAN
S/O MAHENDER KUMAR TRIKHA R/O WARD NO 15 NEAR
335804
GAUSHALA SURATGARH
GANGANAGAR
Address of the Insured RAJASTHAN
335804
GANGANAGAR Telephone (01509) 225115
RAJASTHAN
Business/Occupation Others Telephone :
Insured's Declared Value 0

Period of Insurance From 11:29 Hrs of 22/05/2021 To Midnight of 21/05/2022

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 - 13 - SX - HA11EPH4A03162 MBLHAR057H4A02934 HERO MOTOR CORP LTD / HF DLX
No SOLO 2017 100 2
8390 ALLOY HF DLX ALLOY
Registration Authority Geographical Area Financier
RJ13 SRI GANGANAGAR INDIA
Amount in words: One thousand two hundred eleven 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: 1,027.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 92.00
a) Hire or Reward
SGST(9%): 92.00
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 1,211.00
e) Speed Testing and Reliability Trials Receipt Number : 10129098121101542384
f) Use in connection with Motor Trade Receipt Date: 22/05/2021
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0084774
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor ASHWANI KUMAR OJHA , Mobile:
Vehicles Act 1988 9414381056
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
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: 22/05/2021 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

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Sat, May 22, 2021 11:37:21 IST
Location: United India Insurance Company Ltd
1/2 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY SCHEDULE
Policy Number :2909813121P101599897 Previous Policy No :
Geographical Area :India(A) Insurance Start Date & Time :22/05/2021 11:29 (hours)
Insured Name/ID : MR ATAL KUMAR TRIKHA/23107967286 Insurance expiry Date & Time :21/05/2022 midnight
Insured address : Policy Issuing Office Address :
S/O MAHENDER KUMAR TRIKHA R/O WARD NO 15 NEAR GAUSHALA SURATGARH . OPP OLD BUS STAND, SURATGARH SURATGARH, SRIGANGANAGAR, RAJASTHAN ,GST No.:-
08AAACU5552C1ZJ
City: GANGANAGAR District: GANGANAGAR City: GANGANAGAR District: GANGANAGAR
State: RAJASTHAN Pincode: 335804 State: RAJASTHAN Pincode: 335804
Telephone: Mobile: 9413543377 Telephone:(01509) 225115
Business Channel Code: AGD0084774 Business Channel Sub Code:
Dealer Name: Agent Name:ASHWANI KUMAR OJHA
Dealer Code: Land Line No: ,Mobile:9414381056
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number RJ - 13 - SX - 8390 No & HA11EPH4A03162 2017
Number Manufacture
RTA Name RJ13 SRI GANGANAGAR Chassis Number MBLHAR057H4A02934 Cubic Capacity/KW 100
HERO MOTOR CORP LTD
Registration Date 25/03/2017 Vehicle Make & Model & HF DLX ALLOY HF DLX Type Of Body SOLO
ALLOY
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
0 0 0 0 0 0 0 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code

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 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 1,027.00
B. Basic TP 752.00
CGST(9%) 92.00
Total 752.00 SGST(9%) 92.00
Gross OD(A) 0.00 TOTAL PAYABLE PREMIUM 1,211.00
Add :
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00 SAC Code 997134
3121I101599897 &
Invoice No & Date
22/05/2021
Sub Total (Additions) 275.00 Receipt Number 10129098121101542384
Receipt Date 22/05/2021
Receipt Amount 1,211.00
Gross TP(B) 1,027.00 PAYMENT GATEWAY -
Payment Mode
PAYTM
Total Liability Premium 1,027.00
Paying Party MR ATAL KUMAR TRIKHA

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 : 22/05/2021

In Witness Whereof this policy has been signed at MO SURATGARH 290981 on this 22nd day of May ,2021

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.90.240.24
Issuing Agent: ASHWANI KUMAR OJHA Printed By : CUSTOMER @ 22/05/2021 11:37:30 AM Agent User Name: ASHOJH00
Agent Location: 290981 Underwritten By - ASHOJH00 ( DIRECT AGENT )

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

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