UNITED INDIA INSURANCE COMPANY LIMITED

ENDORSEMENT SCHEDULE
PRIVATE CAR PRIVATE CAR -
PACKAGE POLICY
UIN: IRDAN545RP0047V01199900

Policy Number 1510003122P109655765 Dept. Motor

Previous Policy
1510003120P110853317
Number
Endorsement Effective
Endorsement No. 1 24/01/2023
Date
Policy Start Date 24/01/2023 Policy Expiry Date 27/12/2023
Insured's Name MR JAMPANI SRIKANTH Issuing Office DO 2 VIJAYAWADA
Address S/O SHRI J VENKATARAO, 2-190, Office Address
DIVISIONAL OFFICE - 2, POST BOX NO.774, # 56-11-
INDIRA NAGAR 1,
4,
YANAMALAKUDURU, PENAMALURU
UPSTAIRS ANDHRA BANK,2ND FLOOR, BUNDAR ROAD,
MANDAL
PATAMATA
KRISHNA
KRISHNA
520010
520007
ANDHRA PRADESH
ANDHRA PRADESH
Telephone (0866) 2473257
Registration Number AP - 16 - BG - 2992
Endorsement Type Transfer of Insurance

SAC Code: 997134

Customer GST/UIN No.:
Office GST No.: 37AAACU5552C1ZI
Debit Note No. & Date: 22112611408D01 & 24/01/2023
Original Invoice No. & Date: 3122I109655765 & 26/12/2022
Amount Subject to Reverse Charges-NIL

We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said
sub-rule.

At the request of the Insured, it is hereby declared and agreed that the following items under the, within mentioned policy, has been
changed/allotted

An amount of 615 is charged and collected from the Insured towards recovery of NCB in consequence of settlement of claim/transfer of
vehicle/exceeding 90 days.
IMT 3 Transfer of Insurance

It is hereby understood and agreed that as from 24/01/2023 the interest in the policy is transferred to and vested in JAMPANI SRIKANTH
of ........... carrying on or engaged in the business or profession of Others who shall be deemed to be the insured and whose proposal
and declaration dated 24/01/2023 shall be deemed to be incorporated in and to be the basis of this contract.
Provided always that for the purpose of the No claim Bonus, no period during which the interest in this policy has been vested in any
previous Insured shall accrue to the benefit of new insured JAMPANI SRIKANTH as per this endorsement.
Subject otherwise to the terms exceptions conditions and limitations of this policy.

Business Associate / Agent KRISHNA PRASAD S / CH UPENDRA LOKESWARA RAO

Endorsement Premium : 521.00

Endorsement CGST(9%) : 47.00
Endorsement SGST(9%) : 47.00
Endorsement Stamp Duty : 0.00
Total Endorsement Premium : 615.00
For and on behalf of
United India Insurance Co. Ltd.

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Date : 24/01/2023 3:04:03 PM ( Duly Constituted Attorney(s) )

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 UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
PRIVATE CAR PRIVATE CAR -
PACKAGE POLICY
UIN: IRDAN545RP0047V01199900
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy 1510003122P109655765 / 1 Certificate Number 1510003122P109655765
No/Endorsement No
Customer Id 23197047661 Issuing Office Address C o d e 151000
Name of the Insured MR JAMPANI SRIKANTH
S/O SHRI J VENKATARAO, 2-190, INDIRA NAGAR DIVISIONAL OFFICE - 2, POST BOX NO.774, # 56-11-4,
1, YANAMALAKUDURU, PENAMALURU MANDAL UPSTAIRS ANDHRA BANK,2ND FLOOR, BUNDAR ROAD, PATAMATA
Address of the 520010
Insured 520007 KRISHNA
KRISHNA ANDHRA PRADESH
ANDHRA PRADESH Telephone (0866) 2473257
Mobile No.-
Business/Occupation Others
9291310414
Insured's Declared Value 125000
Period of Insurance From 15:00 Hrs of 24/01/2023 To Midnight of 27/12/2023
Particulars of Vehicle Insured
Registration No.
Year of Cubic Seating including
Trailer Engine No. Chassis No. Make/Model Type of Body
Vehicle Mfg Capacity/KW driver
(if any)
WAGON
AP 16 BG F10DN4423799 MA3EED81S00599555 R(2006 -
HATCHBACK 2007 1061 5
2992 2010) / DUO
LXI LPG
Registration
Geographical Area
Authority
AP16
INDIA
VIJAYAWADA
Amount in words: Six hundred fifteen 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.
Note:- The policy does not cover liability for death, bodily injury or damage as excluded insection 150 (2) (ii) and (iii); (b) and (c) of the
Motor Vehicles Act, 1988.
Limitations as to use Endorsement Premium: 521.00
The policy covers use of the vehicle for any purpose other than CGST(9%) : 47.00
a) Hire or Reward SGST(9%) : 47.00
b) Carriage of Goods (other than samples or personal luggage) Stamp Duty: 0.00
c) Organized Racing Total (Rounded Off) : 615.00
d) Pace Making Receipt Number : 10215100022106298198
e) Speed Testing and Reliability Trails
Receipt Date: 24/01/2023
f) Use in connection with Motor Trade
DebitNote Number:
Document Date:
Limits of Liability AGI0008238
Under Section II-I (i) Death or bodily injury in respect of any one Agency/Broker Code:
accident; As per Motor Vehicles Act 1988 CH UPENDRA LOKESWARA RAO
Under Section II-I (ii) Damage to third party property in respect of Direct Business: BAS25332
any one claim or series of claims arising out of one event: Business Associate Code:
KRISHNA PRASAD S
750000

Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 3,16,22,28
I/We hereby certify that the policy to which the certificate relates as well as For and On behalf of
the certificate of insurance are issued in accordance with provisions of United India Insurance Co. Ltd.
Chapter X & XI of M.V Act, 1988.

Duly Constituted Attorney:

Date of Issue: 24/01/2023

Printed By - UPERAO00 @ 24/01/2023 3:04:03 PM

Underwritten By - MAH48083 ( DO UNDERWRITER )

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