UNITED INDIA INSURANCE COMPANY LIMITED
CITY BRANCH OFFICE NO.1, JOS TRUST BUILDING CHITTOOR ROAD,
ERNAKULAM - 682035 KERALA
PH: (484) 2355668,2355693 FAX: EMAIL:
MOTORCYCLE / SCOOTER
LIABILITY ONLY POLICY
POLICY NO.:1002033117P116144364
VEHICLE NO.:KL - 05 - AD - 0336
PERIOD OF INSURANCE
From 00:00 Hrs of 10/02/2018
To Midnight of 09/02/2019
Insured
MR RAJESH THANKACHAN
VETTIKKATHUNDATHIL HOUSE,VETTIMUKAL P,ETTUMANOOR
686631
KOTTAYAM
KERALA
Agent Name : VIDYA M
Agent Code : AGN0000602
9895999080
Mobile/Landline Number/Email :
[email protected]
LET US JOIN THE FIGHT AGAINST CORRUPTION.
PLEASE TAKE THE PLEDGE AT https://pledge.cvc.nic.in
For any Information, Service Requests, Claim intimation and Grievances please write to [email protected]
REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014
Website: http://www.uiic.co.in
Printed By : CUSTOMER @ 09/02/2018 5:53:35 PM
UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1002033117P116144364 Certificate Number 1002033117P116144364
Customer Id 23045018540 Issuing Office Address Code 100203
Name of the CITY BRANCH OFFICE NO.1, JOS TRUST BUILDING
MR RAJESH THANKACHAN
Insured CHITTOOR ROAD,
Address of the VETTIKKATHUNDATHIL HOUSE,VETTIMUKAL 682035
Insured P,ETTUMANOOR ERNAKULAM
KERALA
686631 Telephone (484) 2355668,2355693
KOTTAYAM
KERALA
Business/Occupation None Telephone :
Effective date of commencement of Insurance for the purpose of Act from 00:00 Hrs on 10/02/2018
Date of Expiry of the Insurance Midnight on 09/02/2019
Particulars of Vehicle Insured
Obsolete Seating
Engine
Registration No. Obsolete Chassis No. M a k e / Model Year of Mfg Type Of Body Cubic Capacity including
No.
Vehicle driver
KL - 05 - AD - HERO HONDA / Passion Solo with
No 02386 02192 2011 97 2
0336 Pro Self Cast Pillion
Registration Authority Geographical Area
KL05 KOTTAYAM INDIA
Amount in words: Nine hundred eight 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: 770.00
The policy does not cover use for: CGST(9%): 69.00
a) Hire or Reward SGST(9%): 69.00
b) Carriage Goods (other than samples or personal luggage) Stamp Duty: 1.00
c) Organized Racing
Total(Rounded off): 908.00
d) Pace Making
Receipt Number : 10110020317116521108
e) Speed Testing and Reliability Trials
f) Use in connection with Motor Trade Receipt Date: 09/02/2018
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGN0000602
Under Section II-I (i) Death or bodily injury in respect of any one VIDYA M
accident; As per Motor Vehicles Act 1988 Direct Business:
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: Dev Officer :
100000 /-
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 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: 09/02/2018
PolicyNo.: 1002033117P116144364
MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY
SCHEDULE
Policy No. 1002033117P116144364 Previous Policy No.
Customer Id 23045018540
Name MR RAJESH THANKACHAN
Insured Details Tel (O): Tel (R) Fax:
Email: Mobile:
Business / Occupation None
Period of Insurance From 00:00 Hrs of 10/02/2018 To Midnight of 09/02/2019
C o-Insurance Type
Particulars of Vehicle Insured
Obsolete Seating
Engine
Registration No. Obsolete Chassis No. M a k e / Model Year of Mfg Type Of Body Cubic Capacity including
No.
Vehicle Side Car
KL - 05 - AD - HERO HONDA / Passion Solo with
No 02386 02192 2011 97 2
0336 Pro Self Cast Pillion
Registration Authority Auto Association Membership No. Geographical Area Extension
KL05 KOTTAYAM INDIA
Motor Vehicle in case of a Motorised Two wheeler is deemed to include a side car attached to it.
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
The policy covers use of the Vehicle for any purpose other than
a) Hire or Reward
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing
d) Pace Making
e) Speed Testing and Reliability Trials
f) Use in connection with Motor Trade
Limits of Liability As narrated in the Certificate of Insurance attached herewith.
EXCLUSIONS :
1) Any accidental loss or damage or Liability / cause4d or sustained or incurrred 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 any expense whatsoever resulting or arising there from or
any consequential loss.
4) Any liability of whatsoever nature directly or indirectly caused by or constituted to or by or 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 proximatley or remotely occasioned by contributed to, by or traceable to
or arising out of or in connection with war, invasion, 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 consequence of any of the said
occurrences or nay consequence thereof and in default of such proof, the Company shall not be liable to make any payment in respect of
such a claim.
Personal Accident covers for Owner-Driver CSI: 100000
PolicyNo.: 1002033117P116144364
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein / attached hereto
SCHEDULE OF PREMIUM (IN )
B. Basic TP 720.00
Total 720.00
Add :
Compulsory PA for Owner Driver 50.00
Sub Total (Additions) 50.00
Gross TP(B) 770.00
Total Liability Premium 770.00
AMOUNT IN WORDS: Nine hundred eight rupees only
TERMS AND 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 UIIC website : www.uiic.co.in
DISCLAIMER :
The Policy stands cancelled or void in the event of Cheque Dishonor. The Company may cancel the policy by sending 7 days notice in
case of any fraud or misrepresentation, non-disclosure 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 Vehicles Act, 1988 is recoverable from
t h e I n s u r e d . S e e t h e c l a u s e h e a d e d "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For Legal interpretation, English
version will hold good.
Agency/Broker AGN0000602
Receipt
Premium: 770.00 10110020317116521108 C o d e :
Number :
VIDYA M
CGST(9%): 69.00 Receipt Date : 09/02/2018Direct Business:
SGST(9%): 69.00
DebitNote Developement
Stamp Duty: 1.00
Number : Officer Code:
Document
Total: 908.00 Cover Note No.:
Date :
Cover Note Date:
Customer GST No.: Office GST No.: 32AAACU5552C1ZS
SAC Code: 9971 Invoice No. & Date: 3117I116144364 & 09/02/2018
Amount Subject to Reverse Charges-NIL
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 of Proposal and Declaration: 09/02/2018
IN WITNESS WHEREOF, this policy has been signed at BO 1 ERNAKULAM 100203 on this 09th day of February 2018.
For and On behalf of
United India Insurance Co. Ltd.
Affix Policy
Stamp here.
Duly Constituted Attorney:
Underwritten By - AJE38377 ( BO UW CUM CASHIER )
This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
