UNITED INDIA INSURANCE COMPANY LIMITED

NEW NO. 768, OLD NO.1028, UNITED INDIA BUILDINGS AVANASHI ROAD, NEAR
DINATHANTHI OFFICE COIMBATORE, COIMBATORE, TAMIL NADU
COIMBATORE - 641018 TAMIL NADU
PH: (0422) 2211257,(0422) 2211513 FAX: (422) 2214536 EMAIL:

MOTORCYCLE / SCOOTER
PACKAGE POLICY
UIN: IRDAN545RP0222V01200708
POLICY NO.:1704003122P111546022
VEHICLE NO.:TN - 66 - U - 4414

PERIOD OF INSURANCE
From 00:00 Hrs of 09/03/2023
To Midnight of 08/03/2024

Insured
MR D KARTHIKEYAN
90, MGR NAGAR,
641110
COIMBATORE
TAMIL NADU
CONTACT NUMBER: 9362010201 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

LINK-K INSURANCE BROKER CO. PVT.

Agent Name :
LTD.
Agent Code : BRC0000063
9787774747 / (422) 2526024
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 : CUSTOMER @ 07/02/2023 5:49:39 PM

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 MOTORCYCLE / SCOOTER PACKAGE POLICY
UIN: IRDAN545RP0222V01200708
SCHEDULE
Policy No. 1704003122P111546022 Previous Policy No. 1704003121P111858488
Customer Id 23045783194
Name MR D KARTHIKEYAN
Tel (O): Tel (R) Fax:
Insured Details
Email:
Mobile: 9362010201
[email protected]
Business / Occupation Executive - Senior Level
Period of Insurance From 00:00 Hrs of 09/03/2023 To Midnight of 08/03/2024
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
SOLO
TN - 66 - U - 4414 PF5CH1201499 MD625PF55H1C01965
No TVS / SPORT BS 4 2017 WITH 110 2
PILLION
Insured's Declared Value
Electrical/Electronic
For Vehicle For Side Car Non Electrical Accessories CNG Unit LPG Unit Total Value
Accessories

21000 0 0 0 0 0 21000
Registration Authority Auto Association Membership No. Geographical Area Extension
2438~~TN66 COIMBATORE 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 Premium: 1,147.00
The policy covers use of the Vehicle for any purpose other than CGST(9%): 103.00
a) Hire or Reward SGST(9%): 103.00
b) Carriage of Goods (other than samples or personal luggage) Stamp Duty: 1.00
c) Organized Racing Total(Rounded Off): 1,353.00
d) Pace Making
e) Speed Testing and Reliability Trails Receipt Number :
10117040022113393096
f) Use in connection with Motor Trade
Receipt Date: 07/02/2023
Debit Note Number:
Document Date:
Amount in words: One thousand three hundred fifty-three rupees only
Limits of Liability Agency/Broker Code: BRC0000063
Under Section II-I (i) Death or bodily injury in respect of any one LINK-K INSURANCE BROKER
accident; As per Motor Vehicles Act 1988 CO. PVT. LTD.
Under Section II-I (ii) Damage to third party property in respect of Direct Business:
any one claim or series of claims arising out of one event: Dev Officer:
100000
Personal Accident covers for Owner-Driver CSI: 1500000
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein / attached hereto 16,22
Imposed Excess 0
Voluntary Excess 0
Compulsory Excess 100

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 SCHEDULE OF PREMIUM (IN )
OWN DAMAGE LIABILITY

Basic premium on Vehicle and Accessories B. Basic TP 714.00

A. Basic OD 125.66 Total 714.00
Total 125.66
Add :
Compulsory PA for Owner Driver 275.00
Add :
PA for Unnamed persons 70.00
Road Side Assistance 25.00

Sub Total (Additions) 25.00 Sub Total (Additions) 345.00

Less :
Gross TP(B) 1,059.00
No Claim Bonus 50% 62.83
Gross OD & TP:
1,147.00
Sub Total (Deductions) 62.83 (A) + (B)

Gross OD(A) 88.00

WARRANTED THAT IN CASE OF DISHONOUR OF PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED "AB-
INITIO".

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.

Customer GST/UIN No.: Office GST No.: 33AAACU5552C1ZQ

SAC Code: 997134 Invoice No. & Date: 3122I111546022 & 07/02/2023
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.
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.

For Roadside Assistance please contact- Roadzen Assistance India Limited, Regd. Office : 802-804, Vijaya Building, 17 Brakhamba
Road, New Delhi, Contact No. - 7042113114
Date of Proposal and Declaration: 07/02/2023
IN WITNESS WHEREOF, this policy has been signed at DO 4 COIMBATORE 170400 on this 07th day of February 2023.

For and On behalf of CONSOLIDATED

United India Insurance Co. Ltd. POLICY STAMP DUTY
PAID AS PER
TAMILNADU
GOVERNMENT GO
(RT) NO. 53 DATED
25/02/2022 FOR THE
PERIOD 01/04/2022
TO 31/03/2023.
Duly Constituted Attorney:
Underwritten By - SHA39337 ( DO UNDERWRITER )

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MOTORCYCLE / SCOOTER PACKAGE POLICY
UIN: IRDAN545RP0222V01200708

Whereas the Insured by a proposal and declaration dated as stated in the Schedule which shall be the basis of this contract and is
deemed to be incorporated herein has applied to the company for insurance hereinafter contained and has paid the premium mentioned
in the schedule as consideration for such insurance in respect of accident loss or damage occurring during the Period of Insurance.

(The term two wheeler referred to in this Tariff will include motor cycle/scooter / auto cycle or any other motorised two wheeled vehicle
mentioned in the Schedule.)

NOW THIS POLICY WITNESSETH:

That subject to the Terms Exceptions and Conditions contained herein or endorsed or otherwise expressed hereon.

SECTION - I : LOSS OF OR DAMAGE TO THE VEHICLE INSURED

The Company will indemnify the insured against loss or damage to the vehicle insured hereunder and/or its accessories whilst thereon
a) by fire explosion self ignition or lightning;
b) by burglary housebreaking or theft;
c) by riot and strike;
d) by earthquake (fire and shock damage);
e) by flood typhoon hurricane storm tempest inundation cyclone hailstorm frost;
f) by accidental external means;
g) by malicious act;
h) by terrorist activity;
i) whilst in transit by road rail inland- waterway lift elevator or air;
j) by landslide rockslide.

Subject to a deduction for depreciation at the rates mentioned below in respect of parts replaced :
1. For all rubber/ nylon/ plastic parts, tyres and tubes, batteries 50%
2. For fibre glass components 30%
3. For all parts made of glass Nil
4. Rate of depreciation for all other parts including wooden parts will be as per the following schedule :

% of % of
Age of Vehicle Age of Vehicle
Depreciation Depreciation
Exceeding 3 years but not exceeding 4
Not exceeding 6 months Nil 25%
years
Exceeding 6 months but not exceeding Exceeding 4 years but not exceeding 5
5% 35%
1 year years
Exceeding 1 year but not exceeding 2 Exceeding 5 year but not exceeding 10
10% 40%
years years
Exceeding 2 years but not exceeding 3
15% Exceeding 10 years 50%
years

5.Rate of Depreciation for Painting: In the case of painting, the depreciation rate of 50% shall be applied only on the material cost of total
painting charges. In case of consolidated bill for painting charges, the material component shall be considered as 25% of total painting
charges for the purpose of applying the depreciation.

The Company shall not be liable to make any payment in respect of :

(a) consequential loss, depreciation, wear and tear, mechanical or electrical breakdown failures or breakages.
(b) damage to tyres and Tubes unless the vehicle insured is damaged at the same time in which case the liability of the company shall
be limited to 50% of the cost of replacement.
(c) loss of or damage to accessories by burglary housebreaking or theft unless the vehicle is stolen at the same time
and
(d) any accidental loss or damage suffered whilst the insured or any person driving the vehicle with the knowledge and consent of the
insured is under the influence of intoxicating liquor or drugs.

In the event of the vehicle being disabled by reason of loss or damage covered under this Policy the Company will bear the reasonable
cost of protection and removal to the nearest repairer and of redelivery to the Insured but not exceeding in all Rs.300/- in respect of any
one accident.

The insured may authorise the repair of the vehicle necessitated by damage for which the Company may be liable under this Policy
provided that:-
(a) the estimated cost of such repair including replacements, if any, does not exceed Rs.150/-
(b) the Company is furnished forthwith a detailed estimate of the cost of repairs and
the insured shall give the Company every assistance to see that such repair is necessary and the charges are reasonable.

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SUM INSURED - INSURED'S DECLARED VALUE (IDV)
T h e Insured's Declared Value (IDV) of the vehicle will be deemed to be the 'SUM INSURED' for the purpose of this policy which is fixed at
the commencement of each policy period for the insured vehicle.

The IDV of the vehicle (and side car/accessories, if any, fitted to the vehicle) is to be fixed on the basis of the manufacturer's listed selling
price of the brand and model as the insured vehicle at the commencement of insurance/renewal and adjusted for depreciation (as per
schedule below).

The schedule of age-wise depreciation as shown below is applicable for the purpose of Total Loss/Constructive Total Loss (TL/CTL) claims
only.

THE SCHEDULE OF DEPRECIATION FOR FIXING IDV OF THE VEHICLE

AGE OF VEHICLE % OF DEPRECIATION FOR FIXING IDV

Not exceeding 6 months 5%
Exceeding 6 months but not exceeding 1 year 15%
Exceeding 1 year but not exceeding 2 years 20%
Exceeding 2 years but not exceeding 3 years 30%
Exceeding 3 years but not exceeding 4 years 40%
Exceeding 4 years but not exceeding 5 years 50%

IDV 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.

IDV shall be treated as the Market Value throughout the policy period without any further depreciation for the purpose of Total Loss (TL)
/Constructive Total Loss (CTL) claims.

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.

SECTION II - LIABILITY TO THIRD PARTIES

1 . Subject to the limits of liability as laid down in the Schedule hereto the Company will indemnify the insured in the event of an accident
caused by or arising out of the use of the insured vehicle against all sums which the insured shall become legally liable to pay in
respect of :-
(i) death of or bodily injury to any person including occupants carried in the insured vehicle ( provided such occupants are not carried
for hire or reward) but except so far as it is necessary to meet the requirements of Motor Vehicles Act, the Company shall not be
liable where such death or injury arises out of and in the course of the employment of such person by the insured,
(ii) damage to property other than property belonging to the insured or held in trust or in the custody or control of the insured.
Provided always that the Company shall not be liable in respect of death injury or damage caused or arising beyond the limits of any
carriageway or thoroughfare in connection with the bringing of the load to the vehicle for loading thereon or the taking away of the
load from the vehicle after unloading there from.
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 granted by this section to the insured, the Company will indemnify any
driver who is driving the vehicle on the insured's order or with insured's permission provided that such driver shall as though he/she
was 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.

AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY

Nothing in this Policy or any endorsement hereon shall affect the right of any person indemnified by this policy or any other person to
recover an amount under or by virtue of the Provisions of the Motor Vehicles Act. But the Insured shall repay to the Company all sums
paid by the Company which the Company would not have been liable to pay but for the said provision.

APPLICATION OF LIMITS OF INDEMNITY

In the event of any accident involving indemnity to more than one person any limitation by the terms of this Policy and/or of any
Endorsement thereon of the amount of any indemnity shall apply to the aggregate amount of indemnity to all persons indemnified and
such indemnity shall apply in priority to the insured

5 / 13
SECTION III - PERSONAL ACCIDENT COVER FOR OWNER-DRIVER

Name Of the Nominee Age Name of the Appointee(If Nominee is Minor) Relationship
DHAMOTHARA KANNAN NA Father

Subject otherwise to the terms exceptions conditions and limitations of this Policy, the Company undertakes to pay compensation as per
the following scale for bodily injury/ death sustained by the owner-driver of the vehicle indirect connection with the vehicle insured whilst
mounting into/dismounting from or traveling in the insured vehicle as a co-driver, caused by violent accidental external and visible means
which independent of any other cause shall within six calendar months of such injury result in:
Nature of injury Scale of compensation Nature of injury Scale of compensation
(iii) Loss of one limb or sight of one
(i) Death 100% 50%
eye
(ii) Loss of two limbs or sight of (iv) Permanent total disablement
two eyes or one limb and sight 100% from injuries other than named 100%
of one eye above
Provided always that
A) 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.
B) 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.
C ) Such compensation shall be payable directly to the insured or to his/her legal representatives whose receipt shall be the full discharge
in respect of the injury to the insured.
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

GENERAL EXCEPTIONS (Applicable to all sections of the Policy)

The Company shall not be liable in respect of :

1 . any accidental loss damage and/or liability caused sustained or incurred outside the Geographical Area.
2 . any claim arising out of any contractual liability.
3 . any accidental loss damage and/or liability caused sustained or incurred whilst the vehicle insured herein is
(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.
4 . (i) Any accident loss or damage to any property whatsoever or any loss or expense whatsoever resulting or arising there from or any
consequential loss
(ii) any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from ionising radiations or
contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the
purposes 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 and in the event of any claim hereunder the Insured shall prove that the accidental loss damage and/or liability
arose independently of and was in no way connected with or occasioned by or contributed to by or traceable to 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.

DEDUCTIBLE
The Company shall not be liable for each and every claim under Section -1 (loss of or damage to the vehicle insured) of this Policy in
respect of the deductible stated in the schedule.

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CONDITIONS

This Policy and the Schedule shall be read together and any word or expression to which a specific meaning has been attached in any part
of this Policy or of the Schedule shall bear the same meaning wherever it may appear.
1. Notice shall be given in writing to the Company immediately upon the occurrence of any accidental loss or damage and in the event
of any claim and thereafter the insured shall give all such information and assistance as the Company shall require. Every letter
claim writ summons and/or process or copy thereof 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 injury in respect of any occurrence which may give rise to a claim under this policy. In case of theft or other criminal
act which may be the subject of a claim under this Policy the insured shall give immediate notice to the police and co-operate with
the Company in securing the conviction of the offender.
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 damages 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.
3. The Company may at its own option repair reinstate or replace the vehicle or part thereof and/or its accessories or may pay in cash
the amount of the loss or damage and the liability of the Company shall not exceed:
(a) for total loss / constructive total loss of the vehicle - the Insured's Declared Value (IDV) of the vehicle (including accessories
thereon) as specified in the Schedule less the value of the wreck
(b) for partial losses, i.e. losses other than Total Loss/Constructive Total Loss of the vehicle - actual and reasonable costs of
repair and/or replacement of parts lost/damaged subject to depreciation as per limits specified.
4. The Insured shall take all reasonable steps to safeguard the vehicle from loss or damage and to maintain it in efficient condition
and the Company shall have at all times free and full access to examine the vehicle or any part thereof or any driver or employee
of the insured. In the event of any accident or breakdown, the vehicle shall not be left unattended without proper precautions being
taken to prevent further damage or loss and if the vehicle be driven before the necessary repairs are effected any extension of the
damage or any further damage to the vehicle shall be entirely at the insured's own risk.
5. The Company may at any time cancel the policy on grounds of misrepresentation, fraud. non-disclosure of material fact or non-
cooperation by the insured by sending seven days notice by recorded delivery to the insured at insured's last known address and in
such event will return to the insured the premium paid less the pro rata portion thereof for the period the Policy has been in force
or the policy may be cancelled at any time by the insured on seven days' notice by recorded delivery and provided no claim has
arisen during the currency of the policy, the insured shall be entitled to a return of premium less premium at the Company's Short
Period rates for the period the Policy has been in force. Return of the premium by the company will be subject to retention of the
minimum premium of Rs.100/- (or Rs.25/- in respect of vehicles specifically designed/modified for use by
blind/handicapped/mentally challenged persons). Where the ownership of the vehicle is transferred, the policy cannot be cancelled
unless evidence that the vehicle is insured elsewhere at least for Liability Only cover is produced and original Certificate of
Insurance is produced for cancellation.
6. If at the time of occurrence of an event that gives rise to any claim under this policy there is in existence any other insurance
covering the same liability, the Company shall not be liable to pay or contribute more than its ratable proportion of any
compensation, cost or expense.
7. If any dispute or difference shall arise as to the quantum to be paid under this policy (liability being otherwise admitted), such
difference shall independent of all other questions be referred to the decision of a sole arbitrator to be appointed in writing by the
parties to the dispute or if they cannot agree upon a single arbitrator within 30 days of any party invoking Arbitration, the same
shall be referred to a panel of three arbitrators comprising two arbitrators one to be appointed by each of the parties to the dispute
/ difference, and a third arbitrator to be appointed by such two arbitrators who shall act as the presiding arbitrator and Arbitration
shall be conducted under and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.
It is clearly agreed and understood that no difference or dispute shall be referable to Arbitration as hereinbefore provided, if the
Company has disputed or not accepted liability under or in respect of this policy.
It is hereby expressly stipulated and declared that it shall be condition precedent to any right of action or suit upon this policy that
the award by such arbitrator/ arbitrators of the amount of the loss or damage shall be first obtained.
It is also hereby further expressly agreed and declared that if the Company shall disclaim liability to the insured for any claim
hereunder and such claim shall not, within twelve calendar months from the date of such disclaimer have been made the subject
matter of a suit in a court of law, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter
be recoverable hereunder.
8. The due observance and fulfillment of the terms, conditions and endorsements of this Policy in so far as they relate to anything to
be done or complied with by the insured and the truth of the statements and answers in the said proposal shall be conditions
precedent to any liability of the Company to make any payment under this Policy.
9. In the event of the death of the sole insured, this policy will not immediately lapse but will remain valid for a period of three
months from the date of the death of insured or until the expiry of this policy (whichever is earlier). During the said period, legal
heir(s) of the insured to whom the custody and use of the Motor Vehicle passes may apply to have this Policy transferred to the
name(s) of the heir(s) or obtain a new insurance policy for the Motor Vehicle.
Where such legal heir(s) desire(s) to apply for transfer of this policy or obtain a new policy for the vehicle such heir(s) should make
an application to the Company accordingly within the aforesaid period. All such applications should be accompanied by:-
a ) Death Certificate in respect of the insured
b ) Proof of title to the vehicle
c) Original Policy

7 / 13
No Claim Bonus

The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if no claim is made or pending during the
preceding year(s), as per the following table:

Period of insurance % of NCB on OD premium

The preceding year 20%
Preceding Two consecutive years 25%
Preceding Three consecutive years 35%
Preceding Four consecutive years 45%
Preceding Five consecutive years 50%

No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.

NB 1:- In Liability with Fire and / or Theft Only policies NCB as above will be applicable only on the Fire and / or Theft component of the
premium.
2:- In Fire and / or Theft Only policies the insured is not entitled for NCB.

Road side Assistance (UIN. IRDAN545RP0222V01200708/A0007V01202122)

In consideration of the payment of an additional premium as specified and shown in the policy schedule, the Company hereby undertakes
to provide the Insured, upon his request, with a maximum of two claims related to any one or more of the following emergency assistance
services in any area where the Company through the network of the service provider:

1. Breakdown Support Over Phone:

In the event of minor mechanical errors/faults/non-functioning of the Insured's vehicle or any part thereof, the Company would provide
the Insured with telephonic assistance to come up with solutions for such minor mechanical errors/faults/non-functioning of the
Insured's vehicle.

2. On site Minor Repairs:

In the event of immobilization of the Covered Vehicle due to mechanical or electrical breakdown and as long as the said fault can be
repaired at the place of immobilization within a maximum time period of 45 minutes, Company will proceed with on-site repair of the
breakdown. Neither supply of parts; consumables and replacement elements; nor materials in general are included in this coverage.

3. Delivery of Duplicate Keys:

If the keys necessary to access or operate the Vehicle are lost or misplaced, the Customer may request urgent forwarding of another
set from his/her place of residence. Keys must be given by a person designated by the Customer to a designated representative of the
Company. Identity proof of the Customer shall be required for delivery of the keys. This service is applicable within a radius of 50 kms
from Customer's/Policyholder's registered address. In case such an incidence happens beyond 50 kms, the Company shall arrange for
sending the same through courier, wherever possible.

4. Locked/Lost Keys:

In case the keys of the covered vehicle are locked-in, the Company shall help the customer as much as possible to get keys out of the
vehicle. Any breakage of glass ofr door beading, if required shall be with prior approval of the customer and to their account. In case
the keys are lost, the Company shall transfer the vehicle to a nearest safe place. The customer shall have to arrange for a duplicate
set on their own cost and efforts(unless it can be covered under 'Loss of Keys Add On Cover'). To avoid misuse, this service shall be
highly restricted and only provided on customer furnishing valid identification documents.

5. Flat Tyre Support:

In the event of the Insured's vehicle being immobilized due to a flat tyre, the Company would be assist the Insured by:
a)Organizing for a vehicle technician to replace the flat tyre with the spare stepney tyre of the vehicle at the location of breakdown or in
the event of repairs not being possible at the place of breakdown
b)By arranging to take the flat tyre to the nearest place of repair and delivering the tyre back to the place of breakdown & attaching it
to the Insured's vehicle.
Provided always that any expenses on material/spare parts parts and any other incidental costs, if required while carrying out the
repairs, would be borne by the Insured and the expenses on labour cost and conveyancecost, in relation to point (a) and (b) above,
would be borne by the Company.

6. Battery Jumpstart:

In the event of immobilization of the Covered vehicle due to rundown battery, the Company will assist the Customer by organinzing for
a Vehicle technician to jump start the Vehicle with appropiate means. If the run-down battery has to be replaced with a new battery, the
cost of such battery replacement and any costs to obtain the battery will have to be borne by the Customer.

7. Services Fuel Delivery:

In the event if the Covered Vehicle runs out of fuel the Company will deliver agrred quantity of fuel (petrol and Diesel only) maximum
up to 5 liters. This service is applicable within a radius of 50 km from nearest fuel bunk(petrol bunk). Amount of fuel should be borne
by customer.

8. Wrong Fuelling

In the event if fuel tank of the Covered Vehicle is filled with the wrong fuel, the Company will bear the cost of emptying it with approved
technicians. In case this service is not feasible, the vehicle will be transferred to the nearest delaership location.

9. Towing for Mechanical, Electrical Breakdown one way up to maximum distance of 25 km:

In event that Covered Vehicle is immobilized due to the breakdown or accident and "On-site" repair is not possible, the Company will
arrange for transfer of the Covered Vehicle to the nearest workshop or Customer Preffered Workshop one way up to maximum distance
of 25 km.

8 / 13
 10. Towing for Accidental Breakdown one way up:

In event that Covered Vehicle is immobilized due to Accidental breakdown, the Company will arrange for transfer of the Covered vehicle
to the nearest workshop one way up to maximum distance of 25 km. For accidental cases with frontal damage or cases where vehicle
cannot be loaded onto a flatbed, the vehicles shall be transferred to the nearest approved garage/workshop using suitable equipment.

11. Taxi benefit in case of major breakdown up to distance of 50km:

In the event that breakdown occurs, and the vehicle is transferred to the workshop, the Company shall help in providing local taxi to
the customer, wherever required and requested by the customer. This service is to enable the customer to accompany the vehicle to the
workshop or travel to the nearest convenient place up to 50 kms from Breakdown Location. These services are subject to availability in
that area.

12. Medical Assistance

In case of any medical problem arising due to breakdown or accident, the Company will provide contact details of the nearby
professionals in related field, in order to provide convenience to customers, especially the ones travelling outstation. In this area co. will
merely be a facilitator and will not be liable for quality of services. All monetary or other transactions will be directly between the
customer and service provider. Our role will end as soon as possible we provide contact details to the customer. These services are
subject to availabilty in that area.

13. Arrangement of Accommodation and Ticketing

In case there is a major breakdown, and breakdown, and stay provision needs to be made, the same will be arranged. The charges
have to be borne by the customer.

14. Extrication or Winching Services:

In the event of vehicle being stuck in ditch, pit or valley, the Company shall coordinate to provide facilities for Extrication or Winching
Services wherever possible. Cost to be borne by Customer. Any consequential damage during the process will be borne by the
Customer.

EXCLUSION

The Company would not be liable for:

1. Where the Insured Vehicle can be safely transferred on its own power to nearest dealer/workshop

2. Any accident, loss, damage, and/or liability caused, sustained or incurred whlist the Insured Vehicle is being used otherwise than in
accordance with the limitations as to use

3. Any consequential loss arising out of claims lodged under this Add On including but not restricted to.

4. Where a loss is covered inder Motor Insurance Policy or any other type of insurance policy with any other insurer or manufacturer's
warranty or recall campaign or under any other such packages at the same time.

5. Replacement cost of battery and/or any associated repair cost.

6. Cost of supply of parts or replacements elements or consumables.

7. Repair cost of tyre or replacement cost of any part of consumable at a third party workshop/repairer.

8. Any taxes, levy and expenses incurred in excess of the limit described under the plan incurred.

9. Loss of valuables and personal belongings kept in the Insured Vehicle.

10. Any loss or damage to the Insured Vehicle arising out of participation in a motor racing competition or trail runs.

11. Where it is proved that the benefit under this Add on is misused.

12. Any loss or damage caused due to pre-existing damages

13. Benefits under 'Taxi Benefits' and 'Accommodation Benefits' for occupants in excess of the seating capacity as per the registration
certificate of the Insured Vehicle

14. Additional cost incurred in towing the Insured Vehicle to a dealer/workshop after ther prescribed distance limit under this Add On

15. Services organized without Our prior consent for the varous assistance services

16. Mechanical and/or electrical breakdowns that require replacement of spare parts and/or specialized tools/equipments that are
usually available only in automotive workshops

17. General exclusions as applicable under section I(Loss of or damage to the vehicle insured) of the Policy are also applicable to this
Add-on Cover.

IMT ENDORSEMENTS : 16,22

IMT.16. Personal accident to unnamed passangers other than Insured and the paid driver and cleaner { For vehicles rated as Private
cars and Motorised two wheelers (not for hire or reward) with or without side car}

In consideration of the payment of an additional premium it is hereby understood and agreed that the insurer undertakes to pay
compensation on the scale provided below for bodily injuries hereinafter defined sustained by any passenger other than the insured
and/or the paid driver attendant or cleaner and/or a person in the employ of the insured coming within the scope of the Workmens
Compensation Act, 1923 and subsequent amendments of the said Act and engaged in and upon the service of the insured at the time

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such injury is sustained whilst mounting into, dismounting from or traveling in but not driving the insured motor car and caused by violent,
accidental, external and visible means which independently of any other cause shall within three calendar months of the occurrence of such
injury result in :

Details of Injury Scale of Compensation

i)Death 100%
ii) Loss of two limbs or sight of two eyes or one limb and sight of
100%
one eye
iii) Loss of one limb or sight of one eye 50%
iv) Permanent Total Disablement from injuries other than named
100%
above

Provided always that

(1) compensation shall be payable under only one of the items (i) to (iv) above in respect of any such person arising out of any one
occurrence and total liability of the insurer shall not in the aggregate exceed the sum of Rs. 100,000.00 during any one period of
insurance in respect of any such person.
(2) no compensation shall be payable in respect of death or 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.
(3) such compensation shall be payable only with the approval of the insured named in the policy and directly to the injured person or
his/her legal representative(s) whose receipt shall be a full discharge in respect of the injury of such person.
(4) not more than 2 persons/passengers are in the vehicle insured at the time of occurrence of such injury.
Subject otherwise to the terms exceptions conditions and limitations of this policy.
IMT.22. Compulsory Deductible (Applicable to Private Cars, three wheelers rated as private cars, all motorized two wheelers, taxis,
private car type vehicle plying for public/private hire, private type taxi let out on private hire)

Notwithstanding anything to the contrary contained in the policy it is hereby understood and agreed that the insured shall bear under
Section 1 of the policy in respect of each and every event (including event giving rise to a total loss/constructive total loss) the first 100
(or any less expenditure which may be incurred) of any expenditure for which provision has been made under this policy and/or of any
expenditure by the insurer in the exercise of his discretion under Condition 3 of this policy.
If the expenditure incurred by the insurer shall include any amount for which the insured is responsible hereunder such amount shall be
repaid by the insured to the insurer forthwith.
For the purpose of this Endorsement the expression "event" shall mean an event or series of events arising out of one cause in
connection with the vehicle insured in respect of which indemnity is provided under this policy.
Subject otherwise to the terms conditions limitations and exceptions of this Policy.

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Claim Procedure

• Inform the insures immediately, quoting policy no. to enable them to arrange for a survey.
• Inform the police about the accident, if third part injury/property damage is/are also involved.
• Note the names and addresses of witnesses present at the time of accident.
• Submit an estimate of repairs to your insuring office or the nearest office of the Insuring Company.
• Do not undertake the repairs till the insurers approve the estimate of the cost of repairs/replacements.
• Give any additional information, if available. That helps the insurers settle the claim faster.
• Please keep ready and present the following documents to the surveyor for verification when asked for:
(a) Driving License (b) R.C. Book
• In case of Commercial Vehicles, please keep ready
(a) Route Permit (b) Fitness Certificate (c) Badge (Taxi) also.
• After the repairs are over, you will have to sign a satisfaction certificate and submit to the repairs.

REDRESSAL OF GRIEVANCE

In case of any grievance the Insured Person may contact the company through:

Website: www.uiic.co.in
Toll free: 1800 425 333 33
E-mail: [email protected]
Courier: Customer Care Department, Head Office, United India Insurance Co. Ltd., 19, IV Lane, Nungambakkam High Road,
Chennai,Tamil Nadu- 600034

Insured Person may also approach the grievance cell at any of the Company's branches with the details of grievance.
If Insured Person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may contact the
grievance officer at [email protected]
For updated details of grievance officer, kindly refer the link https://uiic.co.in/en/customercare/grievance
If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also approach the office
of Insurance Ombudsman of the respective area/region for redressal of grievance as per Insurance Ombudsman Rules 2017.

The contact details of the Insurance Ombudsman offices have been provided as Annexure - 1.

Grievance may also be lodged at IRDAI Integrated Grievance Management System: https://igms.irda.gov.in

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 Annexure -1
The contact details of the Insurance Ombudsman offices are as below-
Areas of Jurisdiction Office of the Insurance Ombudsman
Gujarat, Dadra & Nagar Haveli, Daman and Diu Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak
Marg, Relief Road, Ahmedabad - 380 001. Tel No: 079 - 25501201/02/05/06.
Email: [email protected]
Karnataka Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru - 560 078.
Tel.: 080 - 26652048 / 26652049 Email: [email protected]
Madhya Pradesh and Chhattisgarh Office of the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya
Nagar, Opp. Airtel Office, Near New Market, Bhopal - 462 003. Tel.: 0755 - 2769201
/ 2769202 Fax: 0755 - 2769203 Email: [email protected]
Odisha Office of the Insurance Ombudsman, 62, Forest park, Bhubneshwar - 751 009.
Tel.: 0674 - 2596461 /2596455 Fax: 0674 - 2596429 Email:
[email protected]
Punjab , Haryana, Himachal Pradesh, Jammu a n d Office of the Insurance Ombudsman, S.C.O. No. 101, 102 & 103, 2nd Floor, Batra
Kashmir, UT of Chandigarh Building, Sector 17 - D, Chandigarh - 160 017. Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274 Email: [email protected]
Tamil Nadu, UT-Pondicherry Town and Karaikal (which Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna
are part of UT of Pondicherry) Salai, Teynampet, CHENNAI - 600 018. Tel.: 044 - 24333668 / 24335284 Fax: 044
- 24333664 Email: [email protected]
Delhi Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali
Road, New Delhi - 110 002. Tel.: 011 - 23232481/2321350 4. Email:
[email protected]
Assam , Meghalaya, Manipur, Mizoram, Arunachal Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Nr. Panbazar over
Pradesh, Nagaland and Tripura bridge, S.S. Road, Guwahati - 781001 (ASSAM). Tel.: 0361 - 2632204 / 2602205.
Email: [email protected]
Andhra Pradesh, Telangana and UT of Yanam - a part Office of the Insurance Ombudsman, 6-2-46, 1st floor, "Moin Court", Lane Opp.
of the UT of Pondicherry Saleem Function Palace, A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.:
040 - 67504123 / 23312122. Fax: 040 - 23376599 Email:
[email protected]
Rajasthan Office of the Insurance Ombudsman, Jeevan Nidhi - II Bldg., Gr. Floor, Bhawani
Singh Marg, Jaipur - 302 005. Tel.: 0141 - 2740363 Email:
[email protected]
Kerala , UT of (a) Lakshadweep, (b) Mahe - a part of Office of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg., Opp. Cochin
UT of Pondicherry Shipyard, M. G. Road, Ernakulam - 682 015. Tel.: 0484 - 2358759 / 2359338 Fax:
0484 - 2359336 Email: [email protected]
West Bengal, UT of Andaman and Nicobar Islands, Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 4th Floor, 4, C.R.
Sikkim Avenue, KOLKATA - 700 072. Tel.: 033 - 22124339 / 22124340 Fax : 033 -
22124341 Email: [email protected]
Districts of Uttar Pradesh: Laitpur, Jhansi, Mahoba, Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal
Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Kishore Road, Hazratganj, Lucknow - 226 001. Tel.: 0522 - 2231330 / 2231331.
Sonbhadra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Fax: 0522 - 2231310 Email: [email protected]
Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur,
Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
Gonda, Faizabad, Amethi, Kaushambi, Balrampur,
Basti, Ambedkarnagar, Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh, Kushinagar, Gorakhpur,
Deoria, Mau, Ghazipur, Chandauli, Ballia,
Sidharathnagar.
Goa, Mumbai Metropolitan Region excluding Navi Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road,
Mumbai & Thane Santacruz (W), Mumbai - 400 054. Tel.: 022 - 26106552 / 26106960 Fax: 022 -
26106052 Email: [email protected]
State of Uttarakhand and the following Districts of Uttar Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road,
Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301. Tel.: 0120-
Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, 2514250 / 2514252 / 2514253 Email: [email protected]
Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya,
Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam
Buddha Nagar, Ghaziabad, Hardoi, Shahjahanpur,
Hapur, Shamli, Rampur, Kasganj, Sambhal, Amroha,
Hathras, Kanshiramnagar, Saharanpur
Bihar, Jharkhand. Office of the Insurance Ombudsman, 1st Floor, Kalpana Arcade Building, Bazar
Samiti Road, Bahadurpur, Patna 800 006. Tel.: 0612-2680952. Email:
[email protected]
Maharashtra, Area of Navi Mumbai and Thane Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s.
excluding Mumbai Metropolitan Region 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune - 411 030. Tel.: 020-41312555.
Email: [email protected]
The updated details of Insurance Ombudsman are also available at:
ºIRDAI website: https://www.irdai.gov.in/
ºGeneral Insurance Council website: https://www.gicouncil.in/
ºOur Company Website: https://uiic.co.in/
ºFrom any of the offices of our Company.

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 UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER PACKAGE POLICY
UIN: IRDAN545RP0222V01200708
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1704003122P111546022 Certificate Number 1704003122P111546022
Customer Id 23045783194 Issuing Office Address Code 170400
Name of the Insured MR D KARTHIKEYAN NEW NO. 768, OLD NO.1028, UNITED INDIA BUILDINGS
90, MGR NAGAR, AVANASHI ROAD, NEAR DINATHANTHI OFFICE COIMBATORE,
COIMBATORE, TAMIL NADU
Address of the Insured 641110 641018
COIMBATORE COIMBATORE
TAMIL NADU TAMIL NADU
Executive - Telephone (0422) 2211257,(0422) 2211513
Business/Occupation Mobile No.- 9362010201
Senior Level

Insured's Declared Value 21000

Period of Insurance From 00:00 Hrs of 09/03/2023 To Midnight of 08/03/2024

Particulars of Vehicle Insured
Registration
No. Seating
Obsolete Type of Year of Cubic
Trailer Engine No. Chassis No. Make/ Model including
Vehicle Body Mfg Capacity/KW
Vehicle ( if driver
any)
TN - SOLO
66 - U No TVS / SPORT BS 4 WITH 2017 110 2
PF5CH1201499 MD625PF55H1C01965
- 4414 PILLION
Registration Authority Geographical Area
2438~~TN66 COIMBATORE INDIA
Amount in words: One thousand three hundred fifty-three 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: 1,147.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 103.00
a) Hire or Reward SGST(9%): 103.00
b) Carriage of Goods (other than samples or personal luggage) Stamp Duty: 1.00
c) Organized Racing Total(Rounded Off): 1,353.00
d) Pace Making
e) Speed Testing and Reliability Trails Receipt Number :
10117040022113393096
f) Use in connection with Motor Trade
Receipt Date: 07/02/2023
Debit Note Number:
Document Date:
Limits of Liability Agency/Broker Code: BRC0000063
Under Section II-I (i) Death or bodily injury in respect of any one LINK-K INSURANCE BROKER
accident; As per Motor Vehicles Act 1988 CO. PVT. LTD.
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 Code:
100000 /-
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 16,22
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: 07/02/2023

Duly Constituted Attorney

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

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