UNITED INDIA INSURANCE COMPANY LIMITED

BRANCH OFFICE-080301, 5A, SARDAR PATEL MARG,

ALLAHABAD - 211001 UTTAR PRADESH
PH: (532) 2408500 FAX: EMAIL:

GCV PUBLIC CARRIER OTHER THAN 3 WHEELER

PACKAGE POLICY
UIN. IRDAN545RP0048V01199900
POLICY NO.:0803013124P107995886
VEHICLE NO.:UP - 70 - GT - 4592

PERIOD OF INSURANCE
From 00:00 Hrs of 31/08/2024
To Midnight of 30/08/2025

Insured
MR TAJMUL HUSAIN
HOLAGARH MOD SARAON ALLAHABAD
211003
ALLAHABAD
UTTAR PRADESH
CONTACT NUMBER: 9415669640 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name : SHYAM BABU DHURIA

Agent Code : AGD0121122
9918216958
Mobile/Landline Number/Email :
[email protected]

The genuineness of the policy can be verified through "Verify Your Policy" link at www.uiic.co.in.

For any Information, Service Requests, Claim intimation and Grievances please write to [email protected]

Download Customer App(www.uiic.co.in). REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014.
Website: http://www.uiic.co.in
Printed By : KRI43222 @ 30/08/2024 4:13:35 PM

This document is digitally signed

Signer: KALAIVENI SUBBIAH

Date: Fri, Aug 30, 2024 16:13:15 IST
Location: United India Insurance Company Ltd
1/5 Reason: Signing Policy for UIIC
 UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
GCV PUBLIC CARRIER OTHER THAN 3 WHEELER-PACKAGE POLICY
UIN. IRDAN545RP0048V01199900
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 0803013124P107995886 Certificate Number 0803013124P107995886
Customer Id 23338462007 Issuing Office Address Code 080301
Name of the Insured MR TAJMUL HUSAIN BRANCH OFFICE-080301, 5A, SARDAR PATEL MARG,
HOLAGARH MOD SARAON ALLAHABAD
211001
Address of the Insured 211003 ALLAHABAD
ALLAHABAD UTTAR PRADESH
UTTAR PRADESH Telephone (532) 2408500
Business/Occupation None Mobile No.- 9415669640
Effective date of commencement of Insurance for the purpose of Insured's Declared Value 1800000
Act from 00:00 Hrs on 31/08/2024
Date of Expiry of the Insurance Midnight on 30/08/2025
Particulars of Vehicle Insured
Registration No.
Obsolete Type of Year HP/Cubic
Trailer Engine No. Chassis No. Make/Model GVW
Vehicle Vehicle Body of Mfg Capacity
(if any)
Tata Motors
/ SIGNA
ISBE5.91804081F63704461 MAT541093J1F20038
UP - 70 - GT - 4592 No 3718 Open 2018 5883 42000
SIGNA Gvw
42000
Registration Public / Private
Geographical Area
Authority Financier Name Branch Agreement Type
INDIA Nepal Bhutan
UP70 ALLAHABAD TATA MOTORS FINANCE LTD ALLAHABAD Hypothecation Public
Bangladesh
Amount in words: Fifty-two thousand three hundred eighty-five rupees only
Persons or classes of persons entitled to drive:-
Any person including insured :
Provided that a person driving hold an effective driving license at the time of the accident and is not disqualified from holding or obtaining
such a license.
Provided also that the person holding an effective Learner's license may also drive the vehicle when not used for the transport of goods at
the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 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: 52,385.00
The policy covers use only under a permit within the meaning of CGST-Others(9%): 733.00
Motor Vehicles Act,1988 or such a carriage falling under Subsection SGST-Others(9%): 733.00
3 of Section 66 of the Motor Vehicles Act, 1988. CGST-Basic TP(6%): 2,655.00
The policy does not cover use for: SGST-Basic TP(6%): 2,655.00
a) Organized Racing Stamp Duty: 1.00
b) Pace Making
Total(Rounded Off): 59,161.00
c) Reliability Trials
d) Speed Testing Receipt Number : 10108030124108848459
Receipt Date: 30/08/2024
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0121122
Under Section II-I (i) Death or bodily injury in respect of any one SHYAM BABU DHURIA
accident; As per Motor Vehicles Act 1988 Direct Business:
Under Section II-I (ii) Damage to third party property in respect of BDIS Code: BD26173
any one claim or series of claims arising out of one event: R K SRIVASTAVA
750000 /-
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 1,7,21,23,28
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.
Date of Issue: 27/08/2024

Duly Constituted Attorney

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 PolicyNo.: 0803013124P107995886

GCV PUBLIC CARRIER OTHER THAN 3 WHEELER-PACKAGE POLICY

UIN. IRDAN545RP0048V01199900
SCHEDULE
Policy No. 0803013124P107995886 Previous Policy No. 2243023120242670
Customer Id 23338462007
Name MR TAJMUL HUSAIN
Insured Details Tel (O): 9415669640 Tel (R) Fax:
Email: [email protected] Mobile: 9415669640
Business / Occupation None
Period of Insurance From 00:00 Hrs of 31/08/2024 To Midnight of 30/08/2025
Co-Insurance Type

Particulars of Vehicle Insured

Registration No.
Obsolete
Trailer Engine No. Chassis No. Make/Model Year of Mfg
Vehicle Vehicle
(if any)
Tata Motors /
ISBE5.91804081F63704461 MAT541093J1F20038 SIGNA 3718
UP - 70 - GT - 4592 No 2018
SIGNA Gvw
42000
HP/Cubic
Type of Body GVW Public/Private
Capacity
Open 5883 42000 Public
Insured's Declared Value
Electrical/Electronic Total
For Vehicle For Trailer Non Electrical Accessories CNG Unit LPG Unit
Accessories Value

1800000 0 0 0 0 0 1800000
Registration Authority Auto Association Membership No. Geographical Area Extension
UP70 ALLAHABAD INDIA Nepal Bhutan Bangladesh
Amount in words: Fifty-nine thousand one hundred sixty-one rupees only
Persons or classes of persons entitled to drive:-
Any person including insured :
Provided that a person driving hold an effective driving license at the time of the accident and is not disqualified from holding or obtaining
such a license.
Provided also that the person holding an effective Learner's license may also drive the vehicle when not used for the transport of goods at
the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

Limitations as to use
The policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or such a carriage falling under Subsection 3 of
Section 66 of the Motor Vehicles Act, 1988.
The policy does not cover use for:
a) Organized Racing
b) Pace Making
c) Reliability Trials
d) Speed Testing

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 any consequence thereof and in default of such proof, the Company shall not be liable to make any payment in respect of
such a claim.
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein / attached hereto 1,7,21,23,28

Imposed Excess 0 Financier Name Branch Agreement Type

Voluntary Excess 0
TATA MOTORS FINANCE LTD ALLAHABAD Hypothecation
Compulsory Excess 1500

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 PolicyNo.: 0803013124P107995886

SCHEDULE OF PREMIUM (IN )

OWN DAMAGE LIABILITY

Basic premium on Vehicle and Accessories B. Basic - TP 44,242.00

A. Basic - OD 7,992.00 Total 44,242.00
Total 7,992.00
Add :
Add : LL to Paid Driver IMT 28 350.00
Geographical Extension - OD 400.00 Geographical Extension - TP 100.00

Add :
Sub Total (Additions) 450.00
Cover for lamps, tyres, tubes etc 1,198.80

Sub Total (Additions) 1,598.80 Gross TP(B) 44,692.00

Gross OD & TP:
52,385.00
Less : (A) + (B)
No Claim Bonus 25% 2,397.70
Sub Total (Deductions) 2,397.70

Additional Towing Charge

500.00
(SI: 10000/-)
Sub Total (Additions) 500.00

Gross OD(A) 7,693.00

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 the
Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY". For Legal interpretation, English version
will hold good.
In the event of accident, the Insured should inform United India Insurance Co. immediately to arrange spot survey.

Agency/Broker AGD0121122
Receipt Code:
Premium: 52,385.00 10108030124108848459
Number : SHYAM BABU
DHURIA
CGST-Others(9%): 733.00 Receipt Date : 30/08/2024 Direct Business:
SGST-Others(9%): 733.00
CGST-Basic TP(6%): 2,655.00
SGST-Basic TP(6%): 2,655.00
DebitNote BDIS Code: BD26173
Stamp Duty: 1.00
Number : R K SRIVASTAVA
Document
Total (Rounded Off): 59,161.00
Date :

Customer GST/UIN No.: Office GST No.: 09AAACU5552C1ZH

SAC Code: 997134 Invoice No. & Date: 3124I107995886 & 30/08/2024
Amount Subject to Reverse Charges-NIL

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.
Note:-With reference to IRDAI circular no IRDAI/NL/CIR/MOTP/170/10/2018 dated 09/10/2018 and as per the declaration given in
the proposal form by owner driver Compulsory Personal Accident (CPA) cover is removed, since he/she is not holding a valid driving
license.

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 https://pledge.cvc.nic.in.

Date of Proposal and Declaration:27/08/2024

IN WITNESS WHEREOF, this policy has been signed at BO 1 ALLAHABAD 080301 on this 27th day of August 2024
For and On behalf of
United India Insurance Co. Ltd.

Affix Policy
Stamp here.

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Duly Constituted Attorney:
Underwritten By - KRI43222 ( BO UNDERWRITER )
Warranty:Warranted that at no time the Gross Laden Weight of the Vehicle exceeds the Gross Vehicle Weight mentioned in the schedule
of the policy.

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