UNITED INDIA INSURANCE COMPANY LIMITED
MICRO OFFICE, OPP KAPIL MUNI MAHILA COLLEGE, RAILWAY ROAD, KALAYAT DISTT KAITHAL
KAITHAL - 136117 HARYANA
PH: (01746) 260407 FAX: EMAIL:
PRIVATE CAR -
PACKAGE POLICY
POLICY NO.:1126823117P118216234
VEHICLE NO.:HR - 05 - AB - 8004
PERIOD OF INSURANCE
From 00:00 Hrs of 26/03/2018
To Midnight of 25/03/2019
Insured
MR ASHOK KUMAR DUA S/O SH SANT LAL
HNO 1616 SECTOR 7 U.E KARNAL
132001
KARNAL
HARYANA
CONTACT NUMBER: 9996019689 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.
Agent Name : YATIN HANS
Agent Code : AGN1012215
9354100800
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 : RAJ37112 @ 29/03/2019 2:48:14 PM
UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
PRIVATE CAR PACKAGE POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1126823117P118216234 Certificate Number 1126823117P118216234
Customer Id 23046650890
Name of the Issuing Office
MR ASHOK KUMAR DUA S/O SH SANT LAL Code 112682
Insured Address
Address of the HNO 1616 SECTOR 7 U.E KARNAL 132001 KARNAL MICRO OFFICE, OPP KAPIL MUNI MAHILA COLLEGE, RAILWAY
Insured HARYANA ROAD, KALAYAT Distt Kaithal 136117 KAITHAL HARYANA
Business/Occupation Others Telephone: 9996019689
Telephone (01746) 260407
Insured's Declared Value 235000
Period of Insurance From 00:00 Hrs of 26/03/2018 To Midnight of 25/03/2019
Particulars of Vehicle Insured
Registration No. Seating
Obsolete M a k e / Model Cubic
Trailer Engine No. Chassis No. Type of Body Year of Mfg including
Vehicle Vehicle Model Capacity
( if any) driver
Maruti
HR - 05 - AB - E1075266 Suzuki /
No C310870 Saloon 2010 1298 5
8004 SWIFT DZIRE
VXI
Registration Authority Geographical Area
HR05 KARNAL INDIA
Amount in words: Five thousand five hundred seven 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.
Limitations as to use Premium: 4,667.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 420.00
a) Hire or Reward SGST(9%): 420.00
b) Carriage of Goods (other than samples or personal luggage) Stamp Duty: 1.00
c) Organized Racing Total (Rounded Off) : 5,507.00
d) Pace Making
Receipt Number : 10111268217118682699
e) Speed Testing and Reliability Trails
Receipt Date: 18/03/2018
f) Use in connection with Motor Trade
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGN1012215
Under Section II-I (i) Death or bodily injury in respect of any one YATIN HANS
accident; As per Motor Vehicles Act 1988 Direct Business:
Under Section II-I (ii) Damage to third party property in respect of Development Officer Code:
any one claim or series of claims arising out of one event:
750000
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 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: 18/03/2018
Policy No: 1126823117P118216234
PRIVATE CAR PACKAGE POLICY
Policy No. 1126823117P118216234 Previous Policy No. 835153
Customer Id 23046650890
Insured Details Name MR ASHOK KUMAR DUA S/O SH SANT LAL
Fax: 0
Tel (O) 9996019689 Tel (R)
Mobile: 9996019689
Email
Business / Occupation Others
Period of Insurance From 00:00 Hrs of 26/03/2018 To Midnight of 25/03/2019
C o-Insurance Type
Particulars of Vehicle Insured
Registration No. Obsolete Engine No. Chassis M a k e / Model Model Year of Type of Cubic Seating including
Vehicle Trailer Vehicle No. Mfg Body Capacity driver
( if
any)
HR - 05 - AB - Maruti Suzuki / SWIFT
No C310870 2010 Saloon 1298 5
8004 E1075266 DZIRE VXI
Insured's Declared Value
For Vehicle For Trailer Non Electrical Accessories Electrical/Electronic Accessories CNG Unit LPG Unit Total Value
235000 0 0 0 0 0 235000
Registration
Auto Association Membership No. Geographical Area Extension
Authority
HR05 KARNAL INDIA
Amount in words: Five thousand five hundred seven rupees only
Persons or classes of persons entitled to drive 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.
Limitations as to use
The Policy covers use of the Vehicle for any purpose other than
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage)
c) Organized Racing
d) Pace Making
e) Speed Testing and Reliability Trails
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 / caused 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: 200000
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein/ attached hereto 22,28
Imposed Excess 0
Voluntary Excess 0
Compulsory Excess 1000
SCHEDULE OF PREMIUM (IN )
OWN DAMAGE LIABILITY
Basic premium on Vehicle and Accessories
B. Basic - T P 2,863.00
A. Basic - OD 3,307.44
Total 2,863.00
Total 3,307.44
Add :
Less : Compulsory PA for Owner Driver 100.00
No Claim Bonus 50% 1,653.72 LL to Paid Driver IMT 28 50.00
Sub Total (Deductions) 1,653.72
Sub Total (Additions) 150.00
Gross OD(A) 1,654.00
Gross TP(B) 3,013.00
Gross OD & TP:
4,667.00
(A) + (B)
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 : T h e 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 THE INSURED. SEE THE CLAUSE HEADED "AVOIDANCE OF CERTAIN TERMS AND R I G H T O F
RECOVERY" . FOR LEGAL INTERPRETATION, ENGLISH VERSION WILL HOLD GOOD.
Premium 4,667.00Receipt Agency/Broker Code: AGN1012215
Number 10111268217118682699 YATIN HANS
CGST(9%): 420.00 Receipt 18/03/2018Direct Business:
SGST(9%): 420.00 Date
DebitNote
Stamp Duty 1.00 Development Officer Code:
Number
Document
Total (Rounded Off) 5,507.00
Date
Instrument Details:
Mode Of Cheque Cheque Branch Branch
Bank Name Amount Cheque Signatory MICR No
Payment Number Date Name Code
PUNJAB NATIONAL MR ASHOK KUMAR DUA S/O
CHEQUE 747312 18/03/2018 KARNAL 1024 5,507.00 132024108
BANK SH SANT LAL
Customer GST/UIN No.: Office GST No.: 06AAACU5552C1ZN
SAC Code: 9971 Invoice No. & Date: 3117I118216234 & 18/03/2018
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: 18/03/2018
IN WITNESS WHEREOF, this policy has been signed at MO KALAYAT 112682 on this 18th day of March 2018.
For and On behalf of
United India Insurance Co. Ltd.
Affix Policy
Stamp here.
Duly Constituted Attorney:
Underwritten By - YATHAN87 ( DIRECT AGENT )
