UNITED INDIA INSURANCE COMPANY LIMITED

. KARNAL KAITHAL ROAD, MAIN KAITHAL ROAD KAITHAL, KAITHAL, HARYANA

KAITHAL - 136027 HARYANA
PH: (01746) 222366,(01746) 234124 FAX: EMAIL:

PRIVATE CAR -
PACKAGE POLICY
UIN: IRDAN545RP0047V01199900
POLICY NO.:1107053124P114799132
VEHICLE NO.:HR - 12 - AC - 8263

PERIOD OF INSURANCE
From 23:00 Hrs of 18/12/2024
To Midnight of 17/12/2025

Insured
MR ANIL SAINI
S/O SH DAYA NAND SAINI, R/O 698/A/21 SUKHPURA CHOWK , GOHANA ROAD

124001
ROHTAK
HARYANA
CONTACT NUMBER: 9034950999 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name : PRITAM BISLA

Agent Code : AGN1034000
9034945099
Mobile/Landline Number/Email :
PRITAMBISLA321@GMAIL.COM

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 110705@uiic.co.in

Download Customer App(www.uiic.co.in). REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014.
Website: http://www.uiic.co.in
Printed By : CUSTOMER @ 18/12/2024 8:35:49 PM

This document is digitally signed

Signer: DS UNITED INDIA INSURANCE CO LTD 1

Date: Wed, Dec 18, 2024 20:35:52 IST
Location: United India Insurance Company Ltd
1/4 Reason: Signing Policy for UIIC by Harmeet Singh Chahal
 UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
PRIVATE CAR PACKAGE POLICY
UIN: IRDAN545RP0047V01199900
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1107053124P114799132 Certificate Number 1107053124P114799132
Customer Id 23122681359
Name of the Insured MR ANIL SAINI Issuing Office Address C o d e 110705
S/O SH DAYA NAND SAINI, R/O 698/A/21 . KARNAL KAITHAL ROAD, MAIN KAITHAL ROAD KAITHAL, KAITHAL,
Address of the Insured SUKHPURA CHOWK , GOHANA ROAD 124001 HARYANA 136027 KAITHAL HARYANA
ROHTAK HARYANA
Business/Occupation Others Mobile No.- 9034950999 Telephone (01746) 222366,(01746) 234124

Insured's Declared Value 145800

Period of Insurance From 23:00 Hrs of 18/12/2024 To Midnight of 17/12/2025
Particulars of Vehicle Insured
Registration No. Seating
Obsolete M a k e / Model Year of Cubic
Trailer Engine No. Chassis No. Type of Body including
Vehicle Vehicle Model Mfg Capacity/KW
( if any) driver
MARUTI
SUZUKI /
HR - 12 - AC - K10BN7762785 MA3EWDE1S00B01078
No WAGON R HATCHBACK 2016 998 5
8263
1.0(2010 - )
LXI
Registration Authority Geographical Area
HR12 ROHTAK INDIA
Amount in words: Three thousand seven hundred sixty-one 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: 3,187.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 287.00
a) Hire or Reward SGST(9%): 287.00
b) Carriage of Goods (other than samples or personal luggage) Stamp Duty: 1.00
c) Organized Racing Total (Rounded Off) : 3,761.00
d) Pace Making Receipt Number : 10111070524117358776
e) Speed Testing and Reliability Trails
Receipt Date: 18/12/2024
f) Use in connection with Motor Trade
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGN1034000
Under Section II-I (i) Death or bodily injury in respect of any one PRITAM BISLA
accident; As per Motor Vehicles Act 1988 Direct Business:
Under Section II-I (ii) Damage to third party property in respect of Development Officer Code:
any one claim or series of claims arising out of one event:
750000
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 22,28
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.

Duly Constituted Attorney:

Date of Issue: 18/12/2024

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 Policy No: 1107053124P114799132

PRIVATE CAR PACKAGE POLICY

UIN: IRDAN545RP0047V01199900

Policy No. 1107053124P114799132 Previous Policy No. 1112833123P109425916

Customer Id 23122681359
Insured Details Name MR ANIL SAINI
Fax: 0
Tel (O) 50000688 Tel (R)
Mobile: 9034950999
Email anupsihag@rocketmail.com
Business / Occupation Others
Period of Insurance From 23:00 Hrs of 18/12/2024 To Midnight of 17/12/2025
Co-Insurance Type
Particulars of Vehicle Insured
Registration No. Obsolete Engine No. Chassis No. M a k e / Model Model Year Type of Cubic Seating
Vehicle Trailer Vehicle of Mfg Body Capacity/KW including
( if driver
any)
HR - 12 - AC MARUTI SUZUKI / WAGON
No 2016 HATCHBACK 998 5
- 8263 K10BN7762785 MA3EWDE1S00B01078 R 1.0(2010 - ) LXI
Insured's Declared Value
For Vehicle For Trailer Non Electrical Accessories Electrical/Electronic Accessories CNG Unit LPG Unit Total Value

145800 0 0 0 0 0 145800
Registration
Auto Association Membership No. Geographical Area Extension
Authority
HR12 ROHTAK INDIA
Amount in words: Three thousand seven hundred sixty-one rupees only
Persons or classes of persons entitled to drive 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.
Limitations as to use
The Policy covers use of the Vehicle for any purpose other than
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage)
c) Organized Racing
d) Pace Making
e) Speed Testing and Reliability Trails
f) Use in connection with Motor Trade
Limits of Liability As narrated in the Certificate of Insurance attached herewith.
EXCLUSIONS :
1) Any accidental loss or damage or Liability / caused or sustained or incurrred 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 any expense whatsoever resulting or arising there from or any
consequential loss.
4) Any liability of whatsoever nature directly or indirectly caused by or constituted to or by or 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 proximatley or remotely occasioned by contributed to, by or traceable to
or arising out of or in connection with war, invasion, 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 consequence of any of the said
occurrences or nay consequence thereof and in default of such proof, the Company shall not be liable to make any payment in respect of
such a claim.
Personal Accident covers for Owner-Driver CSI: 1500000
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein/ attached hereto 22,28
Imposed Excess 0
Voluntary Excess 0
Compulsory Excess 1000

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 SCHEDULE OF PREMIUM (IN )
OWN DAMAGE LIABILITY

Basic premium on Vehicle and Accessories

B. Basic - TP 2,094.00
A. Basic - OD 1,395.74
Total 2,094.00
Total 1,395.74

Add :
Compulsory PA for Owner Driver 275.00
Less :
LL to Paid Driver IMT 28 50.00
No Claim Bonus 45% 628.08
Sub Total (Deductions) 628.08
Sub Total (Additions) 325.00

Gross OD(A) 768.00

Gross TP(B) 2,419.00
Gross OD & TP:
3,187.00
(A) + (B)

TERMS AND 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 UIIC website : www.uiic.co.in
Disclaimer : T h e Policy stands cancelled or void in the event of Cheque Dishonor. The Company may cancel the policy by sending 7 days
notice in case of any fraud or 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 M O T O R
VEHICLES ACT, 1988 IS RECOVERABLE FROM THE INSURED. SEE THE CLAUSE HEADED "AVOIDANCE OF CERTAIN TERMS AND R I G H T O F
RECOVERY" . FOR LEGAL INTERPRETATION, ENGLISH VERSION WILL HOLD GOOD.

Premium 3,187.00Receipt Agency/Broker Code: AGN1034000

Number 10111070524117358776 PRITAM BISLA
CGST(9%): 287.00 Receipt 18/12/2024Direct Business:
SGST(9%): 287.00 Date
DebitNote
Stamp Duty 1.00 Development Officer Code:
Number
Document
Total (Rounded Off) 3,761.00
Date

Customer GST/UIN No.: Office GST No.: 06AAACU5552C1ZN

SAC Code: 997134 Invoice No. & Date: 3124I114799132 & 18/12/2024
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.

Date of Proposal and Declaration: 18/12/2024

IN WITNESS WHEREOF, this policy has been signed at BO KAITHAL 110705 on this 18th day of December 2024.

For and On behalf of

United India Insurance Co. Ltd.

Affix Policy
Stamp here.

Duly Constituted Attorney:

Underwritten By - ANU28708 ( BO UNDERWRITER )

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

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