UNITED INDIA INSURANCE COMPANY LIMITED

M O K R PURAM , # 146 , 1ST FLOOR , V D CHANDRU BUILDING 4TH CROSS , 1ST MAIN , OPP
BANK OF BARODA , BESIDES DIVYA PRINTERS , K R PURAM ,
BANGALORE - 560036 KARNATAKA
PH: (080) 25618262,(080) 25610965 FAX: EMAIL:

MOTORCYCLE / SCOOTER
PACKAGE POLICY
UIN: IRDAN545RP0222V01200708
POLICY NO.:0725813125P105396850
VEHICLE NO.:KA - 05 - KJ - 1015

PERIOD OF INSURANCE
From 00:00 Hrs of 07/07/2025
To Midnight of 06/07/2026

Insured
MR K S ASHARANI
ST ANTHONY VILLAGE GROUND FLOOR M V EXTENSION KAVERI NAGAR 1ST MAIN 4TH CROSS
HOSKOTE
562114
BANGALORE RURAL
KARNATAKA
CONTACT NUMBER: ******3554 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name : AYULA MANJUNATHA

Agent Code : AGD0027178
9902949225
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 : SOM31096 @ 03/07/2025 3:50:47 PM

This document is digitally signed

Signer: DS UNITED INDIA INSURANCE CO LTD 1

Date: Thu, Jul 3, 2025 15:50:44 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
MOTORCYCLE / SCOOTER PACKAGE POLICY
UIN: IRDAN545RP0222V01200708
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 0725813125P105396850 Certificate Number 0725813125P105396850
Customer Id 23227090138 Issuing Office Address Code 072581
Name of the Insured MR K S ASHARANI M O K R PURAM , # 146 , 1ST FLOOR , V D CHANDRU BUILDING
ST ANTHONY VILLAGE GROUND FLOOR M V 4TH CROSS , 1ST MAIN , OPP BANK OF BARODA , BESIDES DIVYA
EXTENSION KAVERI NAGAR 1ST MAIN 4TH PRINTERS , K R PURAM ,
CROSS HOSKOTE 560036
Address of the Insured BANGALORE
562114 KARNATAKA
BANGALORE RURAL Telephone (080) 25618262,(080) 25610965
KARNATAKA
Business/Occupation Others Mobile No.- ******3554
Insured's Declared Value 24000
Period of Insurance From 00:00 Hrs of 07/07/2025 To Midnight of 06/07/2026
Particulars of Vehicle Insured
Seating
Obsolete Year of Type of Cubic
Registration No. Engine No. Chassis No. Make/ Model including
Vehicle Mfg Body Capacity/KW
driver
KA - 05 - KJ - AF211596123 MB8DP11ABJ8754515 Suzuki / Access Solo with
No 2018 125 2
1015 ACCESS Pillion
Registration Authority Geographical Area
KA05 JAYANAGAR - 560011 INDIA
Amount in words: One thousand fifteen 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: 861.00
CGST(9%): 77.00
The policy covers use of the vehicle for any purpose other than SGST(9%): 77.00
a) Hire or Reward Stamp Duty: 1.00
b) Carriage Goods (other than samples or personal luggage) Total(Rounded off): 1,015.00
c) Organized Racing
Receipt Number : 10107258125107120927
d) Pace Making
Receipt Date: 03/07/2025
e) Speed Testing and Reliability Trials
DebitNote Number:
f) Use in connection with Motor Trade
Document Date:
Limits of Liability Agency/Broker Code: AGD0027178
Under Section II-I (i) Death or bodily injury in respect of any one AYULA MANJUNATHA
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 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.
Date of Issue: 03/07/2025

Duly Constituted Attorney

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 PolicyNo.: 0725813125P105396850

MOTORCYCLE / SCOOTER PACKAGE POLICY

UIN: IRDAN545RP0222V01200708
SCHEDULE
Policy No. 0725813125P105396850 Previous Policy No. 0725813124P104951070
Customer Id 23227090138
Name MR K S ASHARANI
Insured Details Tel (O): Tel (R) Fax:
Email: ****@gmail.com Mobile: ******3554
Business / Occupation Others
Period of Insurance From 00:00 Hrs of 07/07/2025 To Midnight of 06/07/2026
Co-Insurance Type

Particulars of Vehicle Insured

Seating
Obsolete Year of Type of Cubic
Registration No. Engine No. Chassis No. Make/ Model including
Vehicle Mfg Body Capacity/KW
Side Car
KA - 05 - KJ - AF211596123 MB8DP11ABJ8754515 Suzuki / Access Solo with
No 2018 125 2
1015 ACCESS Pillion
Insured's Declared Value
Electrical/Electronic Total
For Vehicle For Side Car Non Electrical Accessories CNG Unit LPG Unit
Accessories Value

24000
24000 0 0 0 0 0
Registration Authority Auto Association Membership No. Geographical Area Extension
KA05 JAYANAGAR - 560011 INDIA
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 / 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.
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 100

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 PolicyNo.: 0725813125P105396850
SCHEDULE OF PREMIUM (IN )
OWN DAMAGE LIABILITY

Basic premium on Vehicle and Accessories

B. Basic TP 714.00
A. Basic OD 129.10
Total 714.00
Total 129.10
Add :
LL to Paid Driver IMT 28 50.00
Less :
No Claim Bonus 25% 32.28
Sub Total (Additions) 50.00
Sub Total (Deductions) 32.28

Gross TP(B) 764.00

Gross OD(A) 97.00
Gross OD & TP:
861.00
(A) + (B)

AMOUNT IN WORDS: One thousand fifteen 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 THE INSURED. SEE THE CLAUSE HEADED "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF
RECOVERY". FOR LEGAL INTERPRETATION, ENGLISH VERSION WILL HOLD GOOD.

Agency/Broker Code: AGD0027178

Premium: 861.00Receipt Number : 10107258125107120927
AYULA MANJUNATHA
CGST(9%): 77.00 Receipt Date : 03/07/2025Direct Business:
SGST(9%): 77.00
Development Officer
Stamp Duty: 1.00DebitNote Number :
Code:
Total (Rounded Off): 1,015.00Document Date :

Customer GST/UIN No.: Office GST No.: 29AAACU5552C1ZF

SAC Code: 997134 Invoice No. & Date: 3125I105396850 & 03/07/2025
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: 03/07/2025

IN WITNESS WHEREOF, this policy has been signed at MO K R PURAM 072581 on this 03rd day of July 2025.

For and On behalf of

United India Insurance Co. Ltd.

Affix Policy
Stamp here.

Duly Constituted Attorney:

Underwritten By - SOM31096 ( MO INCHARGE )

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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 Two Wheeler Package policy Policy Schedule
Unique Identification
2. Number (UIN) allotted by UIN : IRDAN545RP0222V01200708 Policy Schedule
IRDAI
Section I : Own Damage - Indemnity based
Structure Basis of Sum Section II : Liability to Third Parties
3. Policy Schedule
Insured (IDV) Section III : Personal Accident Cover for Owner-driver (applicable
only if opted by the Insured in the policy) - Benefit based
Section I : Motor Own Damage - Covers damages to vehicle
occurring due to perils listed in the policy
Section II : Motor Third Party Liability - Covers Liability towards Third
Party Death/Injury and Third Party Property Damage
4. Interests Insured Section III : 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 Section I - Loss of Or Damage To The Vehicle Insured: Section I - Loss of or
Insured Declared Value Damage To the Vehicle
Scope Insured

The IDV of the vehicle (and any fitted accessories) is based on the
manufacturer's listed selling price of the brand and model at the
start of insurance or renewal, adjusted for depreciation. For vehicles
over 5 years old and obsolete models, the IDV is determined by
agreement between the insurer and insured.
The insured vehicle shall be treated as a CTL if the aggregate cost
of retrieval and / or repair of the vehicle, subject to terms and
conditions of the policy, exceeds 75% of the IDV of the vehicle.
IDV depreciation schedule is as follows:
% of Depreciation
Age of Vehicle
for Fixing IDV
Not Exceeding 6 months 5%
Exceeding 6 months but not
15%
exceeding 1 year
Exceeding 1 year but not
20%
exceeding 2 years
Exceeding 2 years but not
30%
exceeding 3 years
Exceeding 3 years but not
40%
exceeding 4 years
Exceeding 4 years but not
50%
exceeding 5 years

DV of vehicles beyond 5 years of age and of obsolete models of the

vehicles (i.e. models which the manufacturers have discontinued to
manufacture) is to be determined on the basis of an understanding
between the insurer and the insured.

Section II - Liability to Third Party Section II - Liability to

For Third Party Death / bodily injury/ Third Party Property Damage Third Party

Section III - Personal

Section III - Personal Accident Cover For Owner-Driver (if Opted and Accident Cover for Owner-
shown in the Policy Schedule): Benefit payment up to 15 Lakhs basis Driver (Death and
Benefit payment up to 15 Lakhs basis Permanent Total
Disablement)
6 Policy Coverage Section I - Loss of or
Section I Loss of or damage to the vehicle insured
Damage To the Vehicle
List of perils covered are as per Policy schedule
Insured
Section II Legal Liability to Third parties (TP) for personal injury, Section II - Liability to
Death and property damage resulting from accident Third Party
Section III - Personal
Section III Compulsory Personal Accident (CPA) Cover for Owner- Accident Cover for Owner-
Driver resulting from accident (applicable only if opted by the Driver (Death and
Insured in the policy) Permanent Total
Disablement)

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7 Add-on covers available • Nil Depreciation without excess Add Ons Section
• Engine and Gear Box Protection - Standard & Platinum
• Return to Invoice
• Consumables
• Loss of Key
• RSA
• EMI protect
• RTR
*Addons which are Opted by the Insured and which are mentioned in
the policy are only applicable
8 Loss Participation Deductible applicable: Compulsory excess/Voluntary Policy Schedule
excess/Imposed excess
The Company shall not be liable for each and every claim under
Section - I (loss of or damage to the vehicle insured) of this Policy in
respect of the deductible stated in the schedule.
Compulsory Excess:
Deductible for Two wheeler : Rs.100/-

9 Major Exclusions Major Exclusions are as shown below: General Exclusions

• any accidental loss damage and/or liability caused sustained or
incurred outside the Geographical Area.
• any accidental loss damage and/or liability caused sustained or
incurred whilst the vehicle insured herein is
• being used otherwise than in accordance with the 'Limitations as
to Use'
or
• 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.
Detailed list of exclusions are as per policy schedule
10 Special Conditions and Conditions and warranties are as stated in policy Conditions
Warranties In case of Theft of vehicle, immediate notice should be given to
insurance company along-with FIR.
Notice should be given to RTO about the theft of vehicle and be
guided by claims dealing office to follow theft guidelines.
In case of Death of Registered Owner of vehicle, the policy will not
lapse immediately but will remain valid for 3 months from the date
of death of Registered Owner or expiry of the policy whichever is
earlier.
In addition to above, detailed Conditions and Warranties are as
mentioned in the Policy
11 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.
Claim will be indemnified in any one of the methods;
1. Repair basis - Indemnity with deduction for depreciation /excess
applicable-cashless or reimbursement to Insured
2. Total Loss/CTL basis- Based on the Net of Salvage loss/ Total loss
basis after deduction of Wreck value and Excess.

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12 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.
• Surveyor appointment will be done within 24hrs of receiving
intimation
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
• KYC documents if there is any change in ownership
• 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 accident
• FIR in case of TP Injury/Death Case/Theft claim
• NOC in case of theft claim
Any other specific documents related to the claim
13 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 -
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.
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
14 Policy Servicing/ Grievances • Details of company officials: Please contact your Policy issuing
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
e.You may lodge a complaint in our Inhouse Grievance portal -
UGMS Portal
Alternatively, you may lodge a complaint at the IRDAI Integrated
Grievance Management System (https://bimabharosa.irdai.gov.in/).
15 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 the details.

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

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