UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1311003124P112979020 Certificate Number 1311003124P112979020
Customer Id Issuing Office Address Code 131100
23362480882
2ND FLOOR, RANI SATI SADAN
Name of the Insured MR SANIDUL ISLAM
MOTILAL NEHRU ROAD, PANBAZAR, GUWAHATI
S D W NUR HUSSAIN VILL 1 NO MANDIA WARDLANI PO MANDIA
781001
PS BAGHBAR BARPETA ASSAM
KAMRUP
Address of the Insured ASSAM
781308
Telephone (361) 2548664
BARPETA
ASSAM
Business/Occupation Others Mobile No.- 9365366695
Insured's Declared Value 0

Period of Insurance From 17:48 Hrs of 15/11/2024 To Midnight of 14/11/2025

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)
AS - 15 - Q - U3S5C2KL682583 ME3U3S5C2KL612950 Royal Enfield / THUNDER BIRD X Solo with Pillion
No 2019 350 2
8896 350 THUNDERBIRD X 350
Registration Authority Geographical Area Financier
AS15 BARPETA INDIA
Amount in words: One thousand nine hundred thirty-seven 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.
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 Premium: 1,641.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 148.00
a) Hire or Reward
SGST(9%): 148.00
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 1,937.00
e) Speed Testing and Reliability Trials Receipt Number : 10113110024115230771
f) Use in connection with Motor Trade Receipt Date: 15/11/2024
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0056098
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor MD NASIR UDDIN , Mobile:
Vehicles Act 1988 9101575734
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: BAS21995
EMF Code:
PARAMANANDA GOSWAMI
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.
Date of Issue: 15/11/2024
For and On behalf of
Amount Subject to Reverse Charges-NIL
United India Insurance Co. Ltd.
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.

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
[Link].
Duly Constituted Attorney

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 MOTOR INSURANCE - MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY SCHEDULE
Policy Number :1311003124P112979020 Previous Policy No :
Geographical Area :India(A) Insurance Start Date & Time :15/11/2024 17:48 (hours)
Insured Name/ID : MR SANIDUL ISLAM/23362480882 Insurance expiry Date & Time :14/11/2025 midnight
Insured address : Policy Issuing Office Address :
S D W NUR HUSSAIN VILL 1 NO MANDIA WARDLANI PO MANDIA PS BAGHBAR 2ND FLOOR, RANI SATI SADAN MOTILAL NEHRU ROAD, PANBAZAR, GUWAHATI ,GST No.:-
BARPETA ASSAM 18AAACU5552C1ZI
City: BARPETA District: BARPETA City: KAMRUP District: KAMRUP
State: ASSAM Pincode: 781308 State: ASSAM Pincode: 781001
Telephone: Mobile: 9365366695 Telephone:(361) 2548664
Business Channel Code: AGD0056098 Business Channel Sub Code:
Dealer Name: Agent Name:MD NASIR UDDIN
Dealer Code: Land Line No: ,Mobile:9101575734
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number AS - 15 - Q - 8896 No & U3S5C2KL682583 2019
Number Manufacture
RTA Name AS15 BARPETA Chassis Number ME3U3S5C2KL612950 Cubic Capacity/KW 350
Royal Enfield & THUNDER
Registration Date 30/11/2019 Vehicle Make & Model BIRD X 350 Type Of Body Solo with Pillion
THUNDERBIRD X 350
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. Name Of the CPA Nominee Relation Age Name of the Appointee
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. NUR HUSSAIN Father NA
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
1500000 Compulsory 100 Imposed 0 Voluntary 0
(Under Section III)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 1,641.00
B. Basic TP 1,366.00
CGST(9%) 148.00
Total 1,366.00 SGST(9%) 148.00
Gross OD(A) 0.00 TOTAL PAYABLE PREMIUM 1,937.00
Add :
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00 SAC Code 997134
3124I112979020 &
Invoice No & Date
15/11/2024
Sub Total (Additions) 275.00 Receipt Number 10113110024115230771
Receipt Date 15/11/2024
Receipt Amount 1,937.00
Gross TP(B) 1,641.00 Payment Mode
Total Liability Premium 1,641.00 Paying Party MR SANIDUL ISLAM

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.

LET US JOIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT [Link]

Date & Signature of Proposal : 15/11/2024

In Witness Whereof this policy has been signed at DO FANCYBAZAR 131100 on this 15th day of November ,2024

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: [Link]
Issuing Agent: MD NASIR UDDIN Printed By : CUSTOMER @ 15/11/2024 [Link] PM Agent User Name: MDMUDD00
Agent Location: 131100 Underwritten By - MDMUDD00 ( 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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