UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - PACKAGE
UIN: IRDAN545RP0222V01200708
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1419003124P104495695 Certificate Number 1419003124P104495695
Customer Id Issuing Office Address Code 141900
23110199650
PLOT NO. 1, RADHAMANI GRANDEUR, ABOVE CANARA BANK,
Name of the Insured MR SHYAM SUNDER SHARMA
OPP. JDA NURSERY PARK, SIKAR ROAD, JAIPUR
39 VIJAAY SINGH PATHIK NAGAR NEAR BYE PASS KALWAR ROAD
302039
JHOTWARA JAIPUR
JAIPUR
Address of the Insured RAJASTHAN
302012
Telephone (141) 2333170,(141) 2333493
JAIPUR
RAJASTHAN
Business/Occupation Others Mobile No.- 9928053144
Insured's Declared Value 18687

Period of Insurance From 00:00 Hrs of 28/06/2024 To Midnight of 27/06/2025

Particulars of Vehicle Insured
Registration No.
Trailer Obsolete Vehicle Cubic Seating including
Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle (if Capacity/KW driver
any)
RJ - 14 - YH - HA10ACJ4F00141 MBLHAR184J4F00054 HERO MOTOCORP / PASSION PRO SOLO WITH
No 2018 100 2
6465 CAST SELF DISC I3S PILLION
Registration Authority Geographical Area Financier
RJ14 JAIPUR INDIA
Amount in words: One thousand three hundred thirty-eight 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: 1,134.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 102.00
a) Hire or Reward
SGST(9%): 102.00
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 1,338.00
e) Speed Testing and Reliability Trials Receipt Number : 10114190024104894154
f) Use in connection with Motor Trade Receipt Date: 27/06/2024
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0097560
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor KAILASH CHAND SHARMA , Mobile:
Vehicles Act 1988 9001462857
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: 100000 /-
Direct Business: BAS23426
Business Associate Code:
RAM SAHAY SHARMA
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 22
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: 27/06/2024
For and On behalf of
Amount Subject to Reverse Charges-NIL
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18
United India Insurance Co. Ltd.
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 - MOTORCYCLE / SCOOTER - PACKAGE(UIN: IRDAN545RP0222V01200708) POLICY SCHEDULE
Policy Number :1419003124P104495695 Previous Policy No :1419003123P103303825
Geographical Area :India(A) Insurance Start Date & Time :28/06/2024 00:00 (hours)
Insured Name/ID : MR SHYAM SUNDER SHARMA/23110199650 Insurance expiry Date & Time :27/06/2025 midnight
Insured address : Policy Issuing Office Address :
39 VIJAAY SINGH PATHIK NAGAR NEAR BYE PASS KALWAR ROAD JHOTWARA PLOT NO. 1, RADHAMANI GRANDEUR, ABOVE CANARA BANK, OPP. JDA NURSERY PARK, SIKAR ROAD,
JAIPUR JAIPUR ,GST No.:- 08AAACU5552C1ZJ
City: JAIPUR District: JAIPUR City: JAIPUR District: JAIPUR
State: RAJASTHAN Pincode: 302012 State: RAJASTHAN Pincode: 302039
Telephone: Mobile: 9928053144 Telephone:(141) 2333170,(141) 2333493
Business Channel Code: AGD0097560 Business Channel Sub Code:
Dealer Name: Agent Name:KAILASH CHAND SHARMA
Dealer Code: Land Line No: ,Mobile:9001462857
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number RJ - 14 - YH - 6465 No & HA10ACJ4F00141 2018
Number Manufacture
RTA Name RJ14 JAIPUR Chassis Number MBLHAR184J4F00054 Cubic Capacity/KW 100
HERO MOTOCORP &
Registration Date 26/06/2018 Vehicle Make & Model PASSION PRO CAST SELF Type Of Body SOLO WITH PILLION
DISC I3S
Seating Capacity(Including Geographical
AA Membership Number 2
SideCar) Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer/Sidecar Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
18687 0 0 0 0 0 18687 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
22
PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE:As narrated in the certificate of insurance attached herewith. Name Of the CPA Nominee Relation Age Name of the Appointee
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. SANJAY Son NA
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 warlike 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 CSI
1500000 Compulsory 100 Imposed 0 Voluntary 0
(Under Section III)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 1,134.00
Basic premium on Vehicle and Accessories B. Basic TP 714.00
CGST(9%) 102.00
A. Basic OD 263.11 Total 714.00 SGST(9%) 102.00
Total 263.11 TOTAL PAYABLE PREMIUM 1,338.00
Add :
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00 SAC Code 997134
3124I104495695 &
Less : Invoice No & Date
27/06/2024
No Claim Bonus 45% 118.40 Sub Total (Additions) 275.00 Receipt Number 10114190024104894154
Receipt Date 27/06/2024
Sub Total (Deductions) 118.40 Receipt Amount 1,338.00
Gross TP(B) 989.00 Payment Mode
Gross OD & TP: MR SHYAM SUNDER
Gross OD(A) 145.00 1,134.00 Paying Party
(A) + (B) SHARMA

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 : 27/06/2024

In Witness Whereof this policy has been signed at DO 4 JAIPUR 141900 on this 27th day of June ,2024

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.40.80
Issuing Agent: KAILASH CHAND SHARMA Printed By : CUSTOMER @ 27/06/2024 1:25:50 PM Agent User Name: KAISHA87
Agent Location: 141900 Underwritten By - KAISHA87 ( DIRECT AGENT )

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

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