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MOTOR INSURANCE ‐ PRIVATE CAR LIABILITY ONLY POLICY SCHEDULE
Policy Number :22300031240161308259 Previous Policy Number :22300031230160805184
Geographical Area :India Insurance Start Date & Time :23‐12‐2024 00:00﴾hours﴿
Insured Name :Mr C JEYAKUMAR Insurance Expiry Date & Time :22‐12‐2025 Midnight
Insured Address : Policy Issuing Office Address :
14‐137/2, FLAT NO: 304 TIRUMALA ENCLAVE R S NAGAR, Divisional Office‐30 ﴾Gurugram﴿ Unit no: 34,35,6A,6B,Ground Floor,
MALKAJGIRI HYDERABAD 500047 Vipul Trade Centre, Sector‐48, Sohna Road,
City :HYDERABAD City :Gurugram District :Gurugram
State :ANDHRA PRADESH Pincode :500047 State :Haryana Pincode :122001
Mobile No :9030183045 GSTIN : Office Contact Details :0124‐2213170 Email ID :[Link]@[Link]
Email :jeyakumarcaleb@[Link] Fax : GSTIN :06AAACU5552C1ZN
Business Channel Code: NA Business Channel Sub Code: BRC0001039
M/S POLICYBAZAAR INSURANCE BROKERS PRIVATE
Mobile No.: 18002585970 ﴾Service﴿ , 18002585881 ﴾Claims﴿ Broker Name :
LIMITED
IRDA License Number: IRDA/ DB 797/ 19
VEHICLE DETAILS
Year of Manufacture Vehicle
Registration Number AP‐15‐AA‐4545 Engine Number L15A30051256 2005
Weight﴾kg.﴿
AP15 AP15 KARIMNAGAR /
RTA Name Chassis Number MAKGD852E5N227421 Cubic Capacity / GVW / KWH 1493
JAGTIAL / PEDDAPALLI
Registration Date 23/07/2005 Vehicle Make & Model HONDA ‐ CITY ‐ 1.5 GXI Type of Body ‐
AA Membership Name Seating Capacity 5 Geographical Extension
INSURED DECLARED VALUE ﴾IN RUPEES﴿
Electrical /Electronic Non‐Electrical Co‐Insurance
Vehicle Trailer FiberGlass CNG Kit LPG Kit TOTAL
Accessories Accessories Details
0 0 0 0 0 0 0 0
OTHER DETAILS
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers
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.
OTHER DETAILS
EXCLUSIONS: ﴾1﴿ Any accidental loss or damage and/or liability 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 or liability directly or indirectly or proximately or remotely occasioned
by 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 consequence 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 ﴾In Rupees﴿ DEDUCTIBLES ﴾Under Section I﴿ ﴾In Rupees﴿
Owner‐ Driver ﴾Under section IV﴿ 0 Compulsory 0.0 Imposed 0 Voluntary 0.0
SCHEDULE OF PREMIUM ﴾IN RUPEES﴿
A‐OWN DAMAGE PREMIUM B‐LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
Total Own Damage 0 Basic TP Liability 3,416.00 Package Premium 3,416.00
PA Owner Driver 0.00 GST @18.00% 615.00
Sub Total ﴾Additions﴿ 0.00 TOTAL PAYABLE PREMIUM 4,031.00
Sub Total ﴾Deductions﴿ 0 Stamp Duty Rs. 1
Total 3,416.00 Receipt Date 22/12/2024
Receipt Amount 4,031.00
Payment Mode Online
Paying Party C JEYAKUMAR
CHEQUE DETAIL
Cheque Number Cheque Date Bank Name Branch Name Branch Code Cheque Signatory MICR No
PB113122787 22/12/2024 435778043491 C JEYAKUMAR
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 [Link]
For terms and conditions for add on covers go to : [Link]
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. The policy is valid subject to the vehicle covered is already re‐registered or will be re‐registered as per the statutory requirement.
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 from 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. Date & Signature of Proposal: 22/12/2024 [Link].0
In Witness whereof this Policy has been signed at GURGAON this day of , Date
For United India Insurance Company Limited
CONSOLIDATED STAMP DUTY PAID VIDE
GRN NO. 75907349 DTD 31/03/2021
ISSUED BY TREASURY OFFICER, GURGAON
Duly Constituted Attorneys
IP Address: [Link]
Print Date: 22/12/2024 [Link]hours
United India Insurance Company Ltd : IRDA Reg: No : 545
Policy Schedule generated by Policy Bazaar on 22‐12‐2024 [Link]hours
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
"IN CASE OF CLAIM KINDLY CONTACT OUR NEAREST LOCAL OFFICE".
