UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - PACKAGE POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 0318033118P105064724 Certificate Number 0318033118P105064724
Customer Id 23051475957 Issuing Office Address Code 031803
MR SK SAIFUL SUCHA SINGH BLDG
Name of the Insured
PUNJABI MORE G T ROAD PO SEARSOL RAJBARI, RANIGUNJ BARDHAMAN, BARDHAMAN,
PALASHBONI, GOGLA, FARIDPUR
WEST BENGAL
713358
Address of the Insured 713381
BARDDHAMAN
BARDDHAMAN
WEST BENGAL
WEST BENGAL
Telephone (342) 2445362
Business/Occupation None Telephone :
Effective date of commencement of Insurance for the purpose of Act from 15:30 Hrs Insured's Declared Value 55578
on 17/07/2018
Date of Expiry of the Insurance Midnight on 16/07/2019
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 driver
(if any)
JA06ERJGF51874 MBLJAR025JGF04384 HERO MOTOCORP / GLAMOUR Solo with
NEW No 2018 125 2
drum self cast Pillion
Registration Authority Geographical Area Financier
WB40 DURGAPUR INDIA L&T FINANCE LTD(DURGAPUR,BARDDHAMAN,WEST BENGAL-713216)
Amount in words: One thousand seven hundred twenty-nine 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: 1,465.00
The policy covers use of the vehicle for any purpose other than
CGST(9%): 132.00
a) Hire or Reward
b) Carriage Goods (other than samples or personal luggage) SGST(9%): 132.00
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 1,729.00
e) Speed Testing and Reliability Trials Receipt Number : 10103180318105263289
f) Use in connection with Motor Trade Receipt Date: 17/07/2018
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0003302
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor SUBRATA PAUL
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: 6000 /- Direct Business:
Development Officer Code:
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 7,20,22
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.
Date of Issue: 17/07/2018
Amount Subject to Reverse Charges-NIL
LET US JOIN THE FIGHT AGAINST CORRUPTION.
PLEASE TAKE THE PLEDGE AT [Link]
Duly Constituted Attorney
MOTOR INSURANCE - MOTORCYCLE / SCOOTER PACKAGE POLICY SCHEDULE
Policy Number :0318033118P105064724 Previous Policy No :
Geographical Area :India(A) Insurance Start Date & Time :17/07/2018 15:30 (hours)
Insured Name : MR SK SAIFUL Insurance expiry Date & Time :16/07/2019 midnight
Insured address : Policy Issuing Office Address :
PALASHBONI, GOGLA, FARIDPUR SUCHA SINGH BLDG PUNJABI MORE G T ROAD PO SEARSOL RAJBARI, RANIGUNJ BARDHAMAN,
City: BARDDHAMAN District: BARDDHAMAN BARDHAMAN, WEST BENGAL ,GST No.:- 19AAACU5552C1ZG
State: WEST BENGAL Pincode: 713381 City: BARDDHAMAN District: BARDDHAMAN
Telephone: Mobile: 8250254891 State: WEST BENGAL Pincode: 713358
Telephone:(342) 2445362
Business Channel Code: AGD0003302 Business Channel Sub Code:
Dealer Name: Agent Name:SUBRATA PAUL
Dealer Code: Land Line No: ,Mobile:9832213388
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number NEW No & JA06ERJGF51874 2018
Number Manufacture
RTA Name WB40 DURGAPUR Chassis Number MBLJAR025JGF04384 Cubic Capacity 125
HERO MOTOCORP &
Registration Date 17/07/2018 Vehicle Make & Model Type Of Body Solo with Pillion
GLAMOUR drum self cast
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
55578 0 0 0 0 0 55578 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
L&T FINANCE LTD(DURGAPUR,BARDDHAMAN,WEST BENGAL-713216) 7,20,22
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 [Link] 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
100000 Compulsory 100 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 1,465.00
Basic premium on Vehicle and Accessories B. Basic TP 720.00
CGST(9%) 132.00
A. Basic OD 745.19 Restricted TPPD Cover - 50.00 SGST(9%) 132.00
Total 745.19 Total 670.00 TOTAL PAYABLE PREMIUM 1,729.00
Stamp Duty 1.00
Add : SAC Code 9971
3118I105064724 &
Gross OD(A) 745.00 Compulsory PA for Owner Driver 50.00 Invoice No & Date
17/07/2018
Receipt Number 10103180318105263289
Receipt Date 17/07/2018
Sub Total (Additions) 50.00
Receipt Amount 1,729.00
Payment Mode CASH
Gross TP(B) 720.00 Paying Party MR SK SAIFUL
Gross OD & TP:
1,465.00
(A) + (B)
TERMS & CONDITIONS:As per the Indian Motor Tariff,personal copy of the same is available free of cost on [Link] the Indian Motor Tariff is also available and displayed at all United India Insurance company Offices
and on Website [Link]
DISCLAIMER:The policy stands Cancelled or void in the event of Cheque [Link] 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 [Link]
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 : 17/07/2018
In Witness Whereof this policy has been signed at BO RANIGUNJ 031803 on this 17th day of July ,2018
For United India Insurance Company Limited
Affix Policy
Stamp
Duly Constituted Attorneys
IP Address: [Link]
Issuing Agent: SUBRATA PAUL Printed By : SUBPAU00 @ 17/07/2018 [Link] PM Agent User Name: SUBPAU00
Agent Location: 031803 Underwritten By - SUBPAU00 ( DIRECT AGENT )
