UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MISCELLANEOUS AND SPECIAL TYPE OF VEHICLES - LIABILITY ONLY POLICY

(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)

Policy No. 0512003119P101302350 Certificate Number 0512003119P101302350

Customer Id 1259907165 Issuing Office Address Code 051200
Name of the Insured  MR K. CHIRANJEEVI, HALL NO.7 & 8, PB NO.53, SRIDEVI COMPLEX,TILAK ROAD,TIRUPATI.
S/O K VENUNADHAM, 13-6-432/21/A, GUDIMALKAPUR, HYDERABAD
DIST CHITTOOR, ANDHRA PRADESH 517501
CHITTOOR
Address of the Insured
517501 ANDHRA PRADESH
CHITTOOR Telephone (0877) 2225778,(0877) 2225078 
ANDHRA PRADESH
Business/Occupation Others Telephone :  
Effective date of commencement of Insurance for the purpose Insured's Declared Value   0
of Act from   13:12   Hrs   on  24/04/2019
Date of Expiry of the Insurance Midnight on  23/04/2020

Particulars of Vehicle Insured

Registration No.
Type of Year of HP/Cubic
Trailer Obsolete Vehicle Engine No. Chassis No. Make/Model GVW
Vehicle Body Mfg Capacity
(if any)
Kartar Agro
Industries /
AP - 12 - B - 7621   No    4S73157 0003310 Maize Combine OPEN 1998 0 0
Harvester   Not 
Available

Registration Authority Geographical Area Financier Public / Private

Hyderabad West   INDIA               Not Applicable 
Amount in words: Seven thousand two hundred seventy-five 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.

Limitations as to use Premium: 6,165.00

The policy covers use only under a permit within the meaning of Motor Vehicles Act, 1988 or CGST(9%):   555.00 
such a carriage falling under Subsection 3 of Section 66 of the Motor Vehicles Act, 1988.
The policy does not cover use for: SGST(9%):   555.00 
a) Organized Racing Stamp Duty: 1.00
b) Pace Making Total(Rounded Off): 7,275.00
c) Reliability Trials
d) Speed Testing Receipt Number :   10105120019101566100
Receipt Date:   24/04/2019
DebitNote Number:  
Document Date:  
Limits of Liability Agency/Broker Code: AGD0015501
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor KRISHNA REDDY M  
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:
Development Officer Code:
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 28
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988.
Date of Issue: 24/04/2019
Note:-With reference to IRDAI circular no IRDAI/NL/CIR/MOTP/170/10/2018 dated 09/10/2018 and as For and On behalf of
per the declaration given in the proposal form by owner driver Compulsory Personal Accident (CPA) cover is United India Insurance Co. Ltd.
removed, since he/she is not holding a valid driving licence.
 

Amount Subject to Reverse Charges-NIL

IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE
IGNORE IF ALREADY UPDATED.
LET US JOIN THE FIGHT AGAINST CORRUPTION.
☞ PLEASE TAKE THE PLEDGE AT https://pledge.cvc.nic.in
Duly Constituted Attorney
 MOTOR INSURANCE - MISCELLANEOUS AND SPECIAL TYPE OF VEHICLES-LIABILITY ONLY POLICY SCHEDULE
Policy Number :0512003119P101302350 Previous Policy Number :0512003117P117872846  
Geographical Area : India(A) Insurance Start Date & Time :24/04/2019 13:12 (hours)
Insured Name : MR K. CHIRANJEEVI, Insurance expiry Date & Time :23/04/2020 midnight
Insured address :  Policy Issuing Office Address : 
S/O K VENUNADHAM, 13-6-432/21/A, GUDIMALKAPUR, HYDERABAD DIST HALL NO.7 & 8, PB NO.53, SRIDEVI COMPLEX,TILAK ROAD,TIRUPATI.   ,GST No.:- 37AAACU5552C1ZI
CHITTOOR, ANDHRA PRADESH    City: CHITTOOR  District: CHITTOOR 
City: CHITTOOR  District: CHITTOOR  State: ANDHRA PRADESH  Pincode: 517501 
State: ANDHRA PRADESH  Pincode: 517501  Telephone:(0877) 2225778,(0877) 2225078 
Telephone:  Mobile: 9849046335 
Business Channel Code:AGD0015501 Business Channel Sub Code:
Dealer Name: Agent Name: KRISHNA REDDY M  
Dealer Code: Land Line No.: ,Mobile:9441329983
VEHICLE DETAILS
Registration Number AP - 12 - B - 7621  Obsolete Vehicle & No & 0003310  Gross vehicle 0 
Chassis Number Weight
Kartar Agro Industries & Maize
RTA Name Hyderabad West  Vehicle Make & Model Combine Harvester   Not  Type Of Body OPEN 
Available
AA Membership
Registration Date 01/02/1998  Cubic Capacity 0   
Name
Engine Number 4S73157  Year Of Manufacture 1998 Geographical              
Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
0  0    0   0   0   0   0    100%  
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
  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
0  Compulsory 2000  Imposed 0  Voluntary 0 
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 6,165.00
B. Basic - TP 6,115.00
CGST(9%) 555.00
Gross OD(A) 0.00 Total 6,115.00
SGST(9%) 555.00
TOTAL PAYABLE PREMIUM 7,275.00
Add :
Stamp Duty 1.00
LL to Paid Driver IMT 28 50.00
SAC Code  9971
3119I101302350 &
Invoice No & Date
Sub Total (Additions) 50.00 24/04/2019
Receipt Number 10105120019101566100 
Receipt Date 24/04/2019 
Gross TP(B) 6,165.00
Receipt Amount 7,275.00 
Total Liability Premium 6,165.00 PAYMENT GATEWAY FOR
Payment Mode
CD 
Paying Party MR K. CHIRANJEEVI,
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.

Date & Signature of Proposal :  24/04/2019 
In Witness Whereof this policy has been signed at DO TIRUPATI 051200 on this 24th day of April ,2019

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.7.144
Issuing Agent: KRISHNA REDDY M  Printed By : CUSTOMER @ 24/04/2019 4:55:02 PM Agent User Name: KRIM002 
Agent Location: 051200  Underwritten By - KRIM002 ( DIRECT AGENT )

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