UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTOR INSURANCE - GCV PUBLIC CARRIER OTHER THAN 3 WHEELER PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1104003124P118688711 Certificate Number 1104003124P118688711
Customer Id 23390617218 Issuing Office Address Code 110400
Name of the Insured MR KAMAL DEEP SINGH DIVISIONAL OFFICE-1,PLOT NO.4, 2ND FLOOR, OPPOSITE PLA SHOPPING CENTRE,MALL ROAD,
S/O SH BALBIR SINGH R/O BUDHSHALI TEH SIWANI BHIWANI

Address of the Insured 127021 125001

BHIWANI HISAR
HARYANA HARYANA
Business/Occupation None Mobile No.- ******0058 Telephone (1662) 232523,(1662) 225264
Effective date of commencement of Insurance for the purpose of Act from 00:00 Hrs Insured's Declared Value 325000
on 21/02/2025
Date of Expiry of the Insurance Midnight on 20/02/2026
Particulars of Vehicle Insured
Registration No.
Obsolete HP/Cubic
Trailer Engine No. Chassis No. Make/Model Type of Body Year of Mfg GVW
Vehicle Vehicle Capacity
(if any)
Tata Motors /
MAT559009MVH37386 2 DOOR STEEL 1510
HR - 66 - B - 8761 No 275MPFI02HYXK25614 TATA ACE GOLD 2021 694
SHELL
P CX LD 2021
Registration Authority Geographical Area Financier Public / Private
HR66 NARNAUL INDIA EQUITAS SMALL FINANCE BANK LTD(AMBALA,AMBALA,HARYANA-133001) Public
Amount in words: Nineteen thousand five hundred sixty 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: 17,392.00
The policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or CGST-Others(9%): 121.00
such a carriage falling under Subsection 3 of Section 66 of the Motor Vehicles Act, 1988.
SGST-Others(9%): 121.00
The policy does not cover use for:
a) Organized Racing CGST-Basic TP(6%): 963.00
b) Pace Making SGST-Basic TP(6%): 963.00
c) Reliability Trials Stamp Duty: 1.00
d) Speed Testing Total(Rounded Off): 19,560.00
Receipt Number: 10111040024122011281
Receipt Date: 20/02/2025
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: UIIP1104007888
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor RAVINDER KUMAR , Mobile:
Vehicles Act 1988 7206000069
Under Section II-I (ii) Damage to third party property in respect of any one claim or series of Dealer Name/Code:
claims arising out of one event: 750000 /-
Direct Business: BD28452
BDIS Code:
PANKAJ GUPTA
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 7,21,23,28
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988.
Date of Issue: 20/02/2025 For and On behalf of
Amount Subject to Reverse Charges-NIL United India Insurance Co. Ltd.
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.

IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE
IGNORE IF ALREADY UPDATED.
The genuineness of the policy can be verified
through "Verify Your Policy" link at
www.uiic.co.in.
Duly Constituted Attorney

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 MOTOR INSURANCE - GCV PUBLIC CARRIER OTHER THAN 3 WHEELER PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY SCHEDULE
Policy Number :1104003124P118688711 Previous Policy Number :
Geographical Area : India(A) Insurance Start Date & Time :21/02/2025 00:00 (hours)
Insured Name/ID : MR KAMAL DEEP SINGH/23390617218 Insurance expiry Date & Time :20/02/2026 midnight
Insured address : Policy Issuing Office Address :
S/O SH BALBIR SINGH R/O BUDHSHALI TEH SIWANI BHIWANI DIVISIONAL OFFICE-1,PLOT NO.4, 2ND FLOOR, OPPOSITE PLA SHOPPING CENTRE,MALL ROAD, ,GST
City: BHIWANI District: BHIWANI No.:- 06AAACU5552C1ZN
State: HARYANA Pincode: 127021 City: HISAR District: HISAR
Telephone: Mobile: ******0058 State: HARYANA Pincode: 125001
Telephone:(1662) 232523,(1662) 225264
Business Channel Code:UIIP1104007888 Business Channel Sub Code:
Dealer Name: Agent Name: RAVINDER KUMAR
Dealer Code: Land Line No.: ,Mobile:7206000069
VEHICLE DETAILS
Registration Number HR - 66 - B - 8761 Obsolete Vehicle & No & MAT559009MVH37386 Gross vehicle 1510
Chassis Number Weight
Tata Motors / TATA ACE GOLD P
RTA Name HR66 NARNAUL Vehicle Make & Model Type Of Body 2 DOOR STEEL SHELL
CX LD 2021
AA Membership
Registration Date 18/10/2021 Cubic Capacity 694
Name
Engine Number 275MPFI02HYXK25614 Year Of Manufacture 2021 Geographical
Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
325000 0 0 0 0 0 325000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
EQUITAS SMALL FINANCE BANK LTD(AMBALA,AMBALA,HARYANA-133001) 7,21,23,28
PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE:As narrated in the certificate of insurance attached Name Of the CPA Nominee Relation Age Name of the Appointee
herewith. LEGAL HIER Father 70 NA
LIMITATIONS AS TO USE:As narrated in the certificate of insurance attached herewith.
LIMITS OF LIABILITY:As narrated in the certificate of insurance attached herewith.
EXCLUSIONS:(1)Any accidental Loss Or Damage and/or liabilty caused sustained or incurred 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 expense whatsoever resulting or arising there from or any consequential loss.(4)Any liability of whatsoever nature directly or indirectly caused by or contributed to or by 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 and/or liability directly or indirectly or proximately or remotely occasioned by or contributed to by or traceable
to or arising out of or in connection with war, invasion, the act of foreign enemies, hostilities or war like operations (whether before or after declaration of war), civil war, mutiny rebellion, military or usurped power or by any
direct or indirect consequences of any of the said occurrences or any consequences thereof and in default of such proof, the Company shall not be liable to make any payment in respect of such a claim.

PA Cover CSI ( ) DEDUCTIBLES (Under Section I) ( )

Owner Driver
1500000 Compulsory 500 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 17,392.00
Basic premium on Vehicle and Accessories B. Basic - TP 16,049.00
CGST-Others(9%) 121.00
A. Basic - OD 841.42 Total 16,049.00
SGST-Others(9%) 121.00
Total 841.42
CGST-Basic TP(6%) 963.00
Add :
SGST-Basic TP(6%) 963.00
Compulsory PA for Owner Driver 275.00
Add : TOTAL PAYABLE PREMIUM 19,560.00
LL to Paid Driver IMT 28 100.00
Cover for lamps, tyres, tubes etc 126.21 Stamp Duty 1.00
SAC Code 997134
Sub Total (Additions) 126.21 Sub Total (Additions) 375.00 3124I118688711 &
Invoice No & Date
20/02/2025
Receipt Number 10111040024122011281
Gross TP(B) 16,424.00 Receipt Date 20/02/2025
Gross OD(A) 968.00
Receipt Amount 19,560.00
Gross OD & TP:
17,392.00 Payment Mode
(A) + (B)
Paying Party MR KAMAL DEEP SINGH
TERMS & 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 Website www.uiic.co.in
DISCLAIMER:The policy stands Cancelled or void in the event of Cheque Dishonored.The company may cancel the policy by sending 7 days notice in case of fraud,misrepresentation,nondisclosure 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 Vehicle Act, 1988 is recoverable fom the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".For Legal interpretation, English Version will hold good.In
case of accident the insured must inform United India Insurance Co. Immediately to arrange spot survey.
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 & Signature of Proposal : 21/02/2025

In Witness Whereof this policy has been signed at DO HISSAR 110400 on this 20th day of February ,2025

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.200.254.53
Issuing Agent: RAVINDER KUMAR Printed By : RAVKUM90 @ 20/02/2025 8:13:02 PM Agent User Name: RAVKUM90
Agent Location: 110400 Underwritten By - RAVKUM90 ( POSP )

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