UNITED INDIA INSURANCE COMPANY LIMITED

NEW MARKET,P.O PANCHGRAM DIST.HAILAKANDI,ASSAM

HAILAKANDI - 788802 ASSAM
PH: (3844) 273036 FAX: EMAIL:

PRIVATE CAR
LIABILITY ONLY POLICY
POLICY NO.:1305093124P119608335
VEHICLE NO.:AS - 12 - J - 2430

PERIOD OF INSURANCE
From 11:05 Hrs of 07/03/2025
To Midnight of 06/03/2026

Insured
MR BIMAL CHETRY
P/A VILL TARAJULI MAZKHUTI UDALGURI

784505
SONITPUR
ASSAM
CONTACT NUMBER: ******0879 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

POSP Name : SUSMITA GHOSH

POSP Code : UIIP1305099469
Mobile/Landline Number/Email : 8876317970
PAN : DBJPG7906Q

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 : CUSTOMER @ 07/03/2025 11:49:47 AM

This document is digitally signed

Signer: DS UNITED INDIA INSURANCE CO LTD 1

Date: Fri, Mar 7, 2025 11:49:52 IST
Location: United India Insurance Company Ltd
1/7 Reason: Signing Policy for UIIC by Harmeet Singh Chahal
 UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
PRIVATE CAR
LIABILITY ONLY POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)

Policy No. 1305093124P119608335 Certificate Number 1305093124P119608335

Customer Id 23396912341 Issuing Office
Code 130509
Name of the Insured MR BIMAL CHETRY Address
Address of the P/A VILL TARAJULI MAZKHUTI UDALGURI NEW MARKET,P.O PANCHGRAM DIST.HAILAKANDI,ASSAM 788802
Insured 784505 SONITPUR ASSAM HAILAKANDI ASSAM
Business/Occupation Others Mobile No.- ******0879
Telephone (3844) 273036

Period of Insurance From 11:05 Hrs of 07/03/2025 To Midnight of 06/03/2026

Particulars of Vehicle Insured
Registration No. Seating
Obsolete Type of Year of Cubic
Trailer Engine No. Chassis No. Make/ Model including
Vehicle Vehicle Body Mfg Capacity/KW
( if any) driver
MARUTI
SUZUKI /
AS - 12 - J - OMNI(1992 -
No F8BIN4491782 MA3EVB11S01367162 Saloon 2012 796 8
2430 2010) 8
SEATER BS
III
Registration Authority Geographical Area
AS12 SONITPUR INDIA
Amount in words: Two thousand five hundred thirty 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.
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: 2,144.00
The policy covers use only under a permit within the meaning of CGST(9%): 193.00
Motor Vehicles Act, 1988 or such a carriage falling under Subsection SGST(9%): 193.00
3 of Section 66 of the Motor Vehicles Act, 1988. Stamp Duty: 1.00
The policy does not cover use for: Total (Rounded Off): 2,530.00
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage) Receipt Number :
10113050924123327661
c) Organized Racing
Receipt Date: 07/03/2025
d) Pace Making
DebitNote Number:
e) Speed Testing and Reliability Trails
f) Use in connection with Motor Trade Document Date:
Limits of Liability POSP Code: UIIP1305099469
Under Section II-I (i) Death or bodily injury in respect of any one SUSMITA GHOSH
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 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: 07/03/2025 Duly Constituted Attorney:

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 PRIVATE CAR
LIABILITY ONLY POLICY
SCHEDULE

Policy No. 1305093124P119608335 Previous Policy No.

Customer Id 23396912341
Name MR BIMAL CHETRY
Fax:
Insured Details Tel (O) Tel (R)
Mobile: ******0879
Email *****************@GMAIL.COM
Business / Occupation Others
Period of Insurance From 11:05 Hrs of 07/03/2025 To Midnight of 06/03/2026
Co-Insurance Type

Particulars of Vehicle Insured

Registration No. Seating
Obsolete Type of Year of Cubic
Trailer Engine No. Chassis No. Make/ Model including
Vehicle Vehicle Body Mfg Capacity/KW
( if any) driver
MARUTI
SUZUKI /
AS - 12 - J - OMNI(1992 -
No F8BIN4491782 MA3EVB11S01367162 Saloon 2012 796 8
2430 2010) 8
SEATER BS
III
Registration
Auto Association Membership No. Geographical Area Extension
Authority
AS12 SONITPUR INDIA
Amount in words: Two thousand five hundred thirty 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
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) 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 may consequence thereof and in default of such proof, the Company shall not be liable to make any payment in respect of
such a claim.

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This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein/ attached hereto 28

SCHEDULE OF PREMIUM (IN )

B. Basic - TP 2,094.00
Total 2,094.00

Add :
LL to Paid Driver IMT 28 50.00

Sub Total (Additions) 50.00

Gross TP(B) 2,144.00

Total Liability Premium 2,144.00

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.

Premium: 2,144.00Receipt Number 10113050924123327661 POSP Code: UIIP1305099469

SUSMITA GHOSH
CGST(9%): 193.00 Receipt Date 07/03/2025Direct Business:
SGST(9%): 193.00
Stamp Duty: 1.00 DebitNote Number Development Officer Code:
Total (Rounded
2,530.00Document Date
Off):

Customer GST/UIN No.: Office GST No.: 18AAACU5552C1ZI

SAC Code: 997134 Invoice No. & Date: 3124I119608335 & 07/03/2025
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: 07/03/2025

IN WITNESS WHEREOF, this policy has been signed at BO PANCHGRAM 130509 on this 07th day of March 2025.

For and On behalf of

United India Insurance Co. Ltd.

Affix Policy
Stamp here.

Duly Constituted Attorney:

Underwritten By - SUSGHO99 ( POSP )

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 CUSTOMER INFORMATION SHEET
This document provides only key information about your policy. Please refer to Policy document for detailed terms and conditions
Sl No Title Description Policy Clause
1 Product Name Private Car Liability only policy Policy Schedule
Unique Identification
2. Number (UIN) allotted by UIN : IRDAN545RP0043V01199900 Policy Schedule
IRDAI
Section I : Liability to Third Parties
Structure Basis of Sum
3. Section II : Personal Accident Cover for Owner-driver (applicable only Policy Schedule
Insured (IDV)
if opted by the Insured in the policy) - Benefit based
Section I :Motor Third Party Liability - Covers Liability towards Third
Party Death/Injury and Third Party Property Damage

4. Interests Insured Section II : Motor Personal Accident driver (applicable only if opted Policy Schedule
by the Insured in the policy) - covers for accidental death, bodily
injuries, and physical disabilities (temporary and permanent) of the
Owner/driver of the Insured vehicle.
5. Sum Insured / Motor
Insured Declared Value Liability to Third Party
Section: Liability to Third Party
Scope Section
For Third Party Death / bodily injury/Third Party Property Damage
Personal Accident Cover
Section - Personal Accident Cover For Owner-Driver (if Opted and
for Owner-Driver Section
shown in the Policy Schedule): Benefit payment up to 15 Lakhs
(Death and Permanent
basis
Total Disablement)

6 Policy Coverage 1. Section - Liability to Third Party Section:Subject to the Limit of Liability to Third Party
liability as laid down in the schedule hereto, the Company will Section
indemnify the insured in the event of accident caused by or arising
out of the use of the Motor Vehicle anywhere in India against all
sums including claimant's costs and expenses which the insured
shall become legally liable to pay in respect of
i) death of or bodily injury to any person so far as it is necessary
to meet the requirements of the Motor Vehicles Act.
ii) damage to property other than property belonging to the
insured or held in trust or in the custody or control of the insured up
to the limit specified in the schedule.
2. The Company will pay all costs and expenses incurred with its
written consent.
3. In terms of and subject to the limitations of the indemnity which
is granted by this policy to the insured, the Company will indemnify
any driver who is driving the Motor Vehicle on the insured's order or
with insured's permission provided that such driver shall as though
he/she were the insured observe fulfill and be subject to the terms
exceptions and conditions of this policy in so far as they apply.
4. In the event of the death of any person entitled to indemnity
under this policy the Company will in respect of the liability incurred
by such person indemnify his/her personal representative in terms
of and subject to the limitations of this Policy provided that such
personal representative shall as though such representative was the
insured observe fulfill and be subject to the terms exceptions and
conditions of this Policy in so far as they apply.
5. The Company may at its own option
A) arrange for representation at any Inquest or Fatal Inquiry in
respect of any death which may be the subject of indemnity under
this Policy and
B) undertake the defence of proceedings in any Court of Law in
respect of any act or alleged offence causing or relating to any event
which may be the subject of indemnity under this Policy.

Section - Compulsory Personal Accident (CPA) Subject otherwise to Personal Accident Cover
the terms exceptions conditions and limitations of this Policy, the for Owner-Driver
Company undertakes to pay compensation as per the following scale Section(Death and
for bodily injury/ death sustained by the owner-driver of the vehicle Permanent Total
in direct connection with the vehicle insured or whilst mounting Disablement)
into/dismounting from or traveling in the insured vehicle as a co-
driver, caused by violent, accidental, external and visible means
which independently of any other cause shall within six calendar
months of such injury result in

Details
Scale of Details of Scale of
of
compensation injury compensation
injury
(iii) Loss of
(i) one limb or
100% 50%
Death sight of one
eye
(ii)
Loss of

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 two
(iv)
limbs
Permanent
or
total
sight
disablement
of two
100% from 100%
eyes
injuries
or one
other than
limb
named
and
above
sight
of one
eye
Provided always that
1) the compensation shall be payable under only one of the items
(i) to (iv) above in respect of the owner-driver arising out of any one
occurrence and the total liability of the insurer shall not in the
aggregate exceed the sum as per schedule during any one period of
insurance.
2) No compensation shall be payable in respect of death or bodily
injury directly or indirectly wholly or in part arising or resulting from or
traceable to (a) intentional self injury suicide or attempted suicide
physical defect or infirmity or (b) an accident happening whilst such
person is under the influence of intoxicating liquor or drugs.
This cover is subject to
(a) the owner-driver is the registered owner of the vehicle insured
herein;
(b) the owner-driver is the insured named in this policy.
(c) the owner-driver holds an effective driving licence, in
accordance with the provisions of Rule 3 of the Central Motor
Vehicles Rules, 1989, at the time of the accident
7 Major Exclusions Major Exclusions are as shown below: General Exclusions
• The Company shall not be liable in respect of any claim arising
whilst the vehicle insured herein
a.being used otherwise than in accordance with the 'Limitations as to
Use'
or
b.being driven by or is for the purpose of being driven by him/her in
the charge of any person other than a Driver as stated in the Driver's
Clause.
•The Company shall not be liable in respect of any claim arising out
of any contractual liability.
•Except so far as is necessary to meet the requirements of the Motor
Vehicles Act, the Company shall not be liable in respect of death
arising out of and in the course of employment of a person in the
employment of the insured or in the employment of any person who
is indemnified under this policy or bodily injury sustained by such
person arising out of and in the course of such employment.

Detailed list of exclusions are as per policy schedule

8 Special Conditions and 1. Notice shall be given in writing to the Company immediately upon Conditions
Warranties the occurrence of any accident and in the event of any claim. Every
letter claim writ summons and/or process shall be forwarded to the
Company immediately on receipt by the insured. Notice shall also be
given in writing to the Company immediately the insured shall have
knowledge of any impending Prosecution Inquest or Fatal Inquiry in
respect of any accident which may give rise to a claim under this
Policy.
2. No admission, offer, promise, payment, or indemnity shall be
made or given by or on behalf of the insured without the written
consent of the Company which shall be entitled if it so desires to
take over and conduct in the name of the insured the defence or
settlement of any claim or to prosecute in the name of the insured
for its own benefit any claim for indemnity or otherwise and shall
have full discretion in the conduct of any proceedings or in the
settlement of any claim and the insured shall give all such
information and assistance as the Company may require. If the
Company shall make any payment in settlement of any claim and
such payment includes any amount not covered by this Policy the
insured shall repay to the Company the amount not so covered.
3. The insured shall take all reasonable steps to maintain the
insured vehicle in efficient condition and the company shall have at
all times free and full access to examine the insured vehicle or any
part thereof or any driver or employee of the insured.
In addition to above, detailed Conditions and Warranties are as
mentioned in the Policy

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9 Admissibility of Claim Claim should be notified immediately on the date of accident
through online intimation, email to the address mentioned in policy
or through any other means.
Due diligence should be taken by Insured upon occurrence of loss as
mentioned in conditions of the policy.
10 Policy service/ Claim • Please contact your Policy issuing office, details of which are
service mentioned in your Policy Schedule for any assistance in policy
• In case of accident, Online intimation of the claim can be given
through phone, online through mail to Agent or policy issuing office
or through portal. Details of the contact number and mail id are
mentioned in the policy.
The following are the Basic Claim documents to be submitted by the
insured:
Insured has to submit all the relevant documents at the time of
taking insurance. List of documents mentioned in the proposal form
should be submitted along-with the proposal.
Basic Documents to be submitted during proposal acceptance;
• Proposal form duly signed by Insured
• RC of the Insured vehicle/Invoice copy in case of new vehicle
• Pollution certificate
• KYC document of the Insured
• Bank details of the Insured
Basic Documents at the time of claim:
• Motor Claim Form -claim form may be downloaded from uiic.co.in
website
• Copy of Registration Certificate of the Insured vehicle if there is
change in ownership
• Copy of Driving License of person driving at the time of loss
Any other specific documents related to the claim
11 Cancellation a) The policyholder can cancel the policy at any time during the Conditions
term, by informing the insurer. In case the policyholder cancels the
policy, he/she is not required to give reasons for cancellation.
The insurer can cancel the policy only on grounds of established
fraud, by giving minimum notice of 7 days to the policy holder.
b) Under no circumstances can the insurer cancel the statutory Motor
Third Party Liability Insurance or any other compulsory insurance
mandated by law except in case of double insurance or total loss
c) The insurer shall -
i. Refund proportion of premium for unexpired policy period, If
the term of the policy is upto one year and there is no claim(s)
made during the policy period.
ii. Refund premium for the unexpired policy period, in respect of
the policy with the term more than one year and the risk coverage
for such policy years has not commenced.
d) In all cases minimum premium of Rs.100/- will be retained by the
insurer
12 Policy Servicing / • Details of company officials: Please contact your Policy issuing
Grievances Complaints office, details of which are mentioned in your Policy Schedule
• In case of any grievance, you may contact UIIC through:
• a.Website: www.uiic.co.in
• b.Toll Free Number: 1800 425 333 33
• c.E-Mail: [email protected]
• d.You may also approach the grievance cell at any of our branches
with details of the grievance
• Alternatively, you may lodge a complaint at the IRDAI Integrated
Grievance Management System (https://bimabharosa.irdai.gov.in/).
13 Obligations of the • Insured is at obligation to disclose all material information in the
Policyholder Proposal form.
• In the event of misrepresentation, mis-description or non-
disclosure of any material fact by the Insured, the Policy shall be
void
• Insured can contact our policy issuing office, details of which are
mentioned in the policy schedule.
(i)To intimate any change to the material information affecting the
policy.
(ii)Any change in the ownership of the vehicle, any kind of
modification in the vehicle/RC which might enhance the risk is
considered as material information and should be informed to
insurance company for necessary endorsement on policy.

Legal Disclaimer Note: The information must be read in conjunction with the policy document. In case of any conflict between the CIS and
the policy document, the terms and conditions mentioned in the policy shall prevail.

Declaration by the Policy Holder:

I have read the above and confirm having noted details

Place:
Date:
Signature of Policy Holder
*Duplicate copy has to be signed and submitted to the company.

This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

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