UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
PRIVATE CAR-PACKAGE
UIN: IRDAN545RP0047V01199900
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1911013123P104158752 Certificate Number 1911013123P104158752
Customer Id 23229851813 Issuing Office Address Code 191101
Name of the Insured MR DEEPAK LODHA BRANCH OFFICE-191101, 34-A, INDRAPURI, RAISEN ROAD,
GRAM-GANGAHONI TEH-BIAORA RAJGARH
462021
Address of the Insured RAJGARH BHOPAL
465661 MADHYA PRADESH
MADHYA PRADESH
Business/Occupation Others Mobile No.- 9575222602 Telephone (755) 2580291

Insured's Declared Value 450000

Period of Insurance From 00:00 Hrs of 18/07/2023 To Midnight of 17/07/2024

Particulars of Vehicle Insured
Registration No.
Cubic Seating including
Trailer Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle Capacity/KW driver
(if any)
FORCE MOTORS /
MP - 08 - BA - TRAX TOOFAN
No D60016571 MC1D4DJA1GP055977 DELUXE(2020 - ) METAL TOP 2015 2596 11
1685
11 SEATER BS VI

Registration Authority Geographical Area Financier

MP08 GUNA INDIA
Amount in words: Fourteen thousand six hundred eighty-six rupees only
Persons or classes of persons entitled to drive
Any person including Insured provided that a person hold 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: 12,446.00
The policy covers use of the vehicle for any purpose other than
CGST(9%): 1,120.00
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage) SGST(9%): 1,120.00
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total (Rounded Off) : 14,686.00
e) Speed Testing and Reliability Trails
f) Use in connection with Motor Trade Receipt Number : 10119110123104924533
Receipt Date: 17/07/2023
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGN0003556
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor NEETU JAIN , Mobile: 8461955501
Vehicles Act 1988 Dealer Name/Code:
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 750000 Direct Business:
BDIS Code: BD28714
BADAL JAIN
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 16,22,28
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance For and On behalf of
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988. United India Insurance Co. Ltd.

Duly Constituted Attorney:

Date of Issue: 17/07/2023

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.

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.

This document is digitally signed

Signer: KALAIVENI SUBBIAH

Date: Wed, Sep 6, 2023 14:31:46 IST
Location: United India Insurance Company Ltd
1/3 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - PRIVATE CAR PACKAGE(UIN: IRDAN545RP0047V01199900) POLICY SCHEDULE
Policy Number :1911013123P104158752 Previous Policy No :PI14970575
Geographical Area :India(A) Insurance Start Date & Time :18/07/2023 00:00 (hours)
Insured Name/ID : MR DEEPAK LODHA/23229851813 Insurance expiry Date & Time :17/07/2024 midnight
Insured address : Policy Issuing Office Address :
GRAM-GANGAHONI TEH-BIAORA RAJGARH BRANCH OFFICE-191101, 34-A, INDRAPURI, RAISEN ROAD, ,GST No.:- 23AAACU5552C1ZR
City: RAJGARH District: RAJGARH City: BHOPAL District: BHOPAL
State: MADHYA PRADESH Pincode: 465661 State: MADHYA PRADESH Pincode: 462021
Telephone:9575222602 Mobile: 9575222602 Telephone:(755) 2580291
Business Channel Code:AGN0003556 Business Channel Sub Code:
Dealer Name: Agent Name:NEETU JAIN
Dealer Code: Land Line No.: ,Mobile:8461955501
VEHICLE DETAILS
Registration Number MP - 08 - BA - 1685 Obsolete Vehicle & Engine No & D60016571 Year Of Manufacture 2015
Number Vehicle Weight(Kg.)
RTA Name MP08 GUNA Chassis Number MC1D4DJA1GP055977 Cubic Capacity/KW 2596
FORCE MOTORS & TRAX TOOFAN
Registration Date 11/02/2016 Vehicle Make & Model Type Of Body METAL TOP
DELUXE(2020 - ) 11 SEATER BS VI
AA Membership Number Geographical Extension Seating Capacity(Including 11
Driver)
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
450000 0 0 0 0 0 450000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
16,22,28
PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE:As narrated in the certificate of insurance attached herewith.
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 CSI
1500000 Compulsory 2000 Imposed 0 Voluntary 0
(Under Section III)
SCHEDULE OF PREMIUM( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 12,446.00
Basic premium on Vehicle and Accessories B. Basic - TP 7,897.00
CGST(9%) 1,120.00
A. Basic - OD 3,948.75 Total 7,897.00
SGST(9%) 1,120.00
Total 3,948.75
TOTAL PAYABLE PREMIUM 14,686.00
Add :
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00
SAC Code 997134
PA for Unnamed persons 3123I104158752 &
Invoice No & Date
Gross OD(A) 3,949.00 (No of persons: 11, SI per occupant: 275.00 17/07/2023
50000/-) Receipt Number 10119110123104924533
Receipt Date 17/07/2023
LL to Paid Driver IMT 28 50.00
Receipt Amount 14,686.00
Payment Mode
Sub Total (Additions) 600.00 Paying Party MR DEEPAK LODHA

Gross TP(B) 8,497.00

Gross OD & TP:

12,446.00
(A) + (B)

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:17/07/2023

In Witness Whereof this policy has been signed at BO 2 BHOPAL 191101 on this 17th day of July ,2023

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.40.80
Issuing Agent: NEETU JAIN Printed By : CUSTOMER @ 06/09/2023 2:31:54 PM Agent User Name: NEEJAI93
Agent Location: 191101 Underwritten By - NEEJAI93 ( 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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