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United India Issurance Co.

Ltd

P.B.No-313,GODOWN ROAD,NIZAMABAD 503001 220432,2219459 FAX:0846222859 POLICY No.:050700/341/11/01/00000732 VEHICLE NO.:AP-25-AB-2531 PERIOD OF INSURANCE FROM 00:00 Hrs on 03/12/2011 To Midnight on 02/12/2012

Insured K.SHIVAJI S/O K.VEERAIAH NAMDEVWADA, NIZAMABAD,ANDHRAPRADESH 503001

MOTORCYCLE/SCOOTER-PACAKAGE POLICY SCHEDULE


Policy number 050700/31/11/01/00000732 Name Insured Details Tel(o) Email Business/occupation Period of insurance co insurance Particulars of vehicle insured From 00:00 Hrs on 03/12/2011 To Midnight on 02/12/2012 SHIVAJI 9949516265 Tel (R) Fax Mobile

Registration number
AP-25-AB-2531

Engine no:
DHGBSF80182

Chassis no:
MD2DHDHZZSCF87185

Make:
BAJAJ

Year of Mfg:
2007

Cubic capacity:
100

seating capacity:
2

Insureds declared value:


For vehicle Rs. For side car Rs . For Non-Electrical accessories Rs. Electrical/Electronic accessories Rs. CNG/LPG Unit Rs. TOTAL Rs.

48,000
Registration Authority Not Required

0
Auto Assocn MemNo:

0
Geographical Area India

Nil

48,000
Extension NoExtn

Two wheelers shall be deemed to include a side car attached to it

Persons or class of persons entitled to drive :


Any person including Insured provided that a person driving holds an effective driving license at the time of accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an effective learners License may also drive the vehicle and such a person satisfies the requirement of Rule 3 of central motor vehicle Rule, 1989. Limitation as to use The policy covers use of the Vehicle for any purpose other than a) b) c) d) e) Hire or Reward Carriage of goods (other than samples or personal luggage) Organized racing Pace making Speed Testing and Reliability trials Use in connection with motor Trade Agency/Broker Code : M.PRAVEEN Dev. Officer Code : Cover Note No & Date 60 0 108 Premium : Rs 932.00 Service Tax : Rs 75.00 Stamp Duty : Rs 1.00 Total : Rs 1008.00 Receipt Number : 050700/81/11/0000001416 Receipt Date : 02/06/2011 Stax Regn No : AAACU5552CST001

f)

Limits of Liability :
Under Section-II-I (1) Death of or bodily injury in respect of any one accident: as per Motor vehicle Act 1988 Under Section-II-I (2) Damage to third party property in respect of any one claim or series of cliaims arising out of one event Rs 1,00,000.00 Contact: 9247821300 NA [email protected]

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