UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTOR INSURANCE - GCV PUBLIC CARRIER OTHER THAN 3 WHEELER PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 2019043121P102776054 Certificate Number 2019043121P102776054
Customer Id 23066230310 Issuing Office Address Code 201904
Name of the Insured MR KRISHAN SINGLA ABOVE BANK OF BARODA,THANDI SARAK,MALERKOTLA
S/O SH GOURI SHANKER W NO 2 JANTA NAGAR DHURI
148023
Address of the Insured 148024 SANGRUR
SANGRUR PUNJAB
PUNJAB Telephone (1675) 251568
Businessman/Industrialist
Business/Occupation Tel:
Small Scale
Effective date of commencement of Insurance for the purpose of Act from 00:00 Hrs Insured's Declared Value 1300000
on 25/06/2021
Date of Expiry of the Insurance Midnight on 24/06/2022
Particulars of Vehicle Insured
Registration No.
Obsolete HP/Cubic
Trailer Engine No. Chassis No. Make/Model Type of Body Year of Mfg GVW
Vehicle Vehicle Capacity
(if any)
Tata Motors /
MAT466401A2E12879 35000
PB - 13 - W - 8897 Yes 6BTAA5901E62883430 3118 TRUCK - Open 2010 5883
GVW35000
Registration Authority Geographical Area Financier Public / Private
PB13 SANGRUR INDIA Public
Amount in words: Fifty-three thousand one hundred sixty-seven 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.
Limitations as to use Premium: 47,245.00
The policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or CGST-Others(9%): 379.00
such a carriage falling under Subsection 3 of Section 66 of the Motor Vehicles Act, 1988.
SGST-Others(9%): 379.00
The policy does not cover use for:
a) Organized Racing CGST-Basic TP(6%): 2,582.00
b) Pace Making SGST-Basic TP(6%): 2,582.00
c) Reliability Trials Stamp Duty: 1.00
d) Speed Testing
Total(Rounded Off): 53,167.00
Receipt Number: 10120190421102828550
Receipt Date: 24/06/2021
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0108847
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor INDERJIT SINGH , Mobile:
Vehicles Act 1988 9464982850
Under Section II-I (ii) Damage to third party property in respect of any one claim or series of Dealer Name/Code:
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 21,23,28
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: 24/06/2021 For and On behalf of
Note:-With reference to IRDAI circular no IRDAI/NL/CIR/MOTP/170/10/2018 dated 09/10/2018 and as
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 license.

Amount Subject to Reverse Charges-NIL

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.
Duly Constituted Attorney

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Wed, Jun 30, 2021 12:35:08 IST
Location: United India Insurance Company Ltd
1/3 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - GCV PUBLIC CARRIER OTHER THAN 3 WHEELER PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY SCHEDULE
Policy Number :2019043121P102776054 Previous Policy Number :2019043120P103208669
Geographical Area : India(A) Insurance Start Date & Time :25/06/2021 00:00 (hours)
Insured Name/ID : MR KRISHAN SINGLA/23066230310 Insurance expiry Date & Time :24/06/2022 midnight
Insured address : Policy Issuing Office Address :
S/O SH GOURI SHANKER W NO 2 JANTA NAGAR DHURI ABOVE BANK OF BARODA,THANDI SARAK,MALERKOTLA ,GST No.:- 03AAACU5552C1ZT
City: SANGRUR District: SANGRUR City: SANGRUR District: SANGRUR
State: PUNJAB Pincode: 148024 State: PUNJAB Pincode: 148023
Telephone: Mobile: 9417224508 Telephone:(1675) 251568
Business Channel Code:AGD0108847 Business Channel Sub Code:
Dealer Name: Agent Name: INDERJIT SINGH
Dealer Code: Land Line No.:1675 251568,Mobile:9464982850
VEHICLE DETAILS
Registration Number PB - 13 - W - 8897 Obsolete Vehicle & Yes & MAT466401A2E12879 Gross vehicle 35000
Chassis Number Weight
Tata Motors / 3118 TRUCK -
RTA Name PB13 SANGRUR Vehicle Make & Model Type Of Body Open
GVW35000
AA Membership
Registration Date 19/06/2010 Cubic Capacity 5883
Name
Engine Number 6BTAA5901E62883430 Year Of Manufacture 2010 Geographical
Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
1300000 0 0 0 0 0 1300000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
21,23,28
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 1500 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 47,245.00
Basic premium on Vehicle and Accessories B. Basic - TP 43,037.00
CGST-Others(9%) 379.00
A. Basic - OD 4,464.90 Total 43,037.00
SGST-Others(9%) 379.00
Total 4,464.90 CGST-Basic TP(6%)
Add : 2,582.00
SGST-Basic TP(6%) 2,582.00
LL to Paid Driver IMT 28 100.00
Add : TOTAL PAYABLE PREMIUM 53,167.00
Cover for lamps, tyres, tubes etc 669.74 Stamp Duty 1.00
Sub Total (Additions) 100.00
SAC Code 997134
Sub Total (Additions) 669.74 3121I102776054 &
Invoice No & Date
25/06/2021
Gross TP(B) 43,137.00 Receipt Number 10120190421102828550
Less :
Gross OD & TP: Receipt Date 24/06/2021
No Claim Bonus 20% 1,026.93 47,245.00
(A) + (B) Receipt Amount 53,167.00
Sub Total (Deductions) 1,026.93 Payment Mode CHEQUE
Paying Party MR KRISHAN SINGLA

Gross OD(A) 4,108.00

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 : 25/06/2021

In Witness Whereof this policy has been signed at BO MALERKOTLA 201904 on this 24th day of June ,2021

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 103.41.25.223

2/3
Issuing Agent: INDERJIT SINGH Printed By : CUSTOMER @ 30/06/2021 12:35:26 PM Agent User Name: VAR28590
Underwritten By - VAR28590 ( BO UW CUM CASHIER ) ,
Agent Location: 201904
Approved By - HIT29514(RO UNDERWRITER)

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

3/3