MOTOR INSURANCE - PRIVATE CAR LIABILITY ONLY POLICY SCHEDULE

Policy Number :22300031230160251514 Previous Policy Number :ABC123

Geographical Area :India Insurance Start Date & Time :08-06-2023 00:00(hours)
Insured Name :Mr. SACHIN D TAPASE Insurance Expiry Date & Time :07-06-2024 Midnight
Insured Address : Policy Issuing Office Address :

VPO: Quater no C3/25 ramtek road utkarsh nagar ntpc Divisional Office-30 (Gurugram) Unit no: 34,35,6A,6B,Ground Floor,
township tahsil mouda nagpur Vipul Trade Centre, Sector-48, Sohna Road,
City :NAGPUR District :NAGPUR City :Gurugram District :Gurugram
State :MAHARASHTRA Pincode :441104 State :Haryana Pincode :122001
Mobile No :7588691217 Office Contact Details :7338829307 Email ID :[email protected]
Email :[email protected] Fax : GSTIN :06AAACU5552C1ZN

Business Channel Code: NA Business Channel Sub Code: BRC0001039

Mobile No.: 18002585970 (Service) Agent Name : Policybazaar Insurance Broker Pvt. Ltd
IRDA License Number: IRDAI/WBA21/15-06

VEHICLE DETAILS
Year of Manufacture Vehicle
Registration Number CG-12-D-7230 Engine Number B73482 2007
Weight(kg.)
RTA Name CG12 CG12 KORBA Chassis Number 236711 Cubic Capacity / GVW 1298
Registration Date 05/07/2007 Vehicle Make & Model MARUTI - SWIFT - VXI Type of Body -
AA Membership Name Seating Capacity 5 Geographical Extension

INSURED DECLARED VALUE (IN RUPEES)

Electrical /Electronic Non-Electrical Co-Insurance
Vehicle Trailer FiberGlass CNG Kit LPG Kit TOTAL
Accessories Accessories Details
0 0 0 0 0 0 0 0

OTHER DETAILS
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers

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.

OTHER DETAILS
EXCLUSIONS: (1) Any accidental loss or 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 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 or liability directly or indirectly or proximately or
remotely occasioned by 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 consequence 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 (In Rupees) DEDUCTIBLES (Under Section I) (In Rupees)
Owner- Driver (Under section IV) 0 Compulsory 0.0 Imposed 0 Voluntary 0.0

SCHEDULE OF PREMIUM (IN RUPEES)

A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
Total Own Damage 0 Basic TP Liability 3,416.00 Package Premium 3,716.00
PA Owner Driver 0.00 GST @18.00% 669.00
PA for Unnamed persons 250.00 TOTAL PAYABLE PREMIUM 4,385.00
LL to Paid Driver IMT 28 50.00 Stamp Duty Rs. 1
Sub Total (Additions) 300.00 Receipt Date 07/06/2023
Sub Total (Deductions) 0 Receipt Amount 4,385.00
Total 3,716.00 Payment Mode Online
Paying Party SACHIN D TAPASE

CHEQUE DETAIL
Cheque Number Cheque Date Bank Name Branch Name Branch Code Cheque Signatory MICR No
PB72178300 07/06/2023 IGAPRUPKN9 SACHIN D TAPASE

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 http://uiic.co.in/sites/default/files/uploads/downloadcenter/IndianMotorTariff.pdf.
For terms and conditions for add on covers go to : http://uiic.co.in/sites/default/files/uploads/downloadcenter/motor_additional_covers.pdf
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, non disclosure 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 from 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. Date & Signature of Proposal: 07/06/2023 00:00:00.0
In Witness whereof this Policy has been signed at GURGAON this day of , Date
For United India Insurance Company Limited

CONSOLIDATED STAMP DUTY PAID VIDE

GRN NO. 32325721 DTD 28/12/2017 AND
CERT. NO. 780 DTD 28/12/2017 ISSUED BY
TREASURY OFFICER, GURGAON
Duly Constituted Attorneys
IP Address: 10.80.25.22
Print Date: 07/06/2023 09:02:12hours
United India Insurance Company Ltd : IRDA Reg: No : 545
Underwritten by Policy Bazaar on 07-06-2023 09:02:12hours
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
"IN CASE OF CLAIM KINDLY CONTACT OUR NEAREST LOCAL OFFICE".