IMPORTANT RTANT

n case o an accident mvolvIng therd p8r Any claim under the ¢aliey should be
Enrtd immsdiatéi; but rot later than
3 y a'se t clainiwr: De prepudiced

UHTED INMDiR
UNITED INDIA INSURANCE cOMPANY LIMITED
NO.23, 1ST MAIN ROAD, 3RD BLOCK 3RD STAGE, BASAVESHWARANAGAR
BANGALORE 560079 KARNATAKA
PH: (94490) 40624 FAX: EMAIL:

MOTORCYCLE ScoOTER
PACKAGE POLICY
UIN: IRDAN545RP0222V01200708
POLICY NO.:0724813121P100925129
VEHICLE NO.:KA - 05 KK 3153

PERIOD OF INSURANCE
From 00:00 Hrs of 04/05/2021
To Midnight of 03/05/2022

Insured
MR GOUTHAM.D
# 58, 8TH CROSS, FREEDOM FIGHTER LAYOUT, LAGGERE, LBENGALURU
560058
BANGALORE
KARNATAKA
CONTACT NUMBER: 9844607508 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name
FOR CLAIM CONTACT
Agent Code
Mobile/Landline Number/Email SERVICE HUB"
: 0-2253 4037/4051
The genuineness of the policy can be verified through "Verify Your Policy" Iink at www.uiic.co.in.

For any Information, Service Requests, Claim intimation and Grievances please write to 072481@uiic.co.in

.... . *o************** **** .*********

D o w n l o a d C u s t o m e r A p p ( w w w . u i i c . c o . i n ) . REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014.

Website: htto://wwW.uiic.co.
Printed By : SHI31176 26/04/2021 1:39:22 PM

1:30 PM.
30AMtal
ouRS: i0:
&
This document is digitally signed

Signer: N MOHAN SANKAR

Date: Mon, Apr 26, 2021 183:35 ST
Location: United India I n s u c e ompany Ltd
Reason: Signing Policy tor
114
 PolicyNo.: 0724813121P100925129
OWN DAMAGE
SCHEDULEOF PREMIUM (IN
LIABILITY

Basic premium on Vehicle and Accessories B. Basic TP

A. Basic OD 1,193.00
413.44 Total 1,193.0
Total
413.44Add Compuisory PA for Owner Driver
Less : 275.00
No Claim Bonus 25%

sub Total (Deductions)

103.36 Sub Total (Additions) 275 .00

103.36
Gross TP(8) 1,468.00
Gross OD(A)
310.00 Gross OD & TP:
(A) +(B) 1,778.00
AMOUNT IN WORDS: Two thousand nincty-eight rupees
TERMS AND CONDITIONS
only

AS PER THE INDIAN MOTOR TARIFF. PERSONAL COPY

OF THE SAME 1S
OOR ARIF IS ALSO AVAILABLE AND DISPLAYED AVAILABLE FREE OF COST ON
AT ALL UNITED 1INDIA FURTHER, THE REQUEST.
www.uiIC.co.in INSURANCE COMPANY OFFICES AND ON UIIC WEBE INDIAN
DISCLAiMER THE POLICY STANDS
CANCELLED OR V0ID IN THE EVENT OF
EDNG 7 DAYS NOTICE IN CASE OF ANY FRAUD OR
OF THE INSURED. CHEQUE DISHONOR. THE COMPANY MAY
MISREPRESENTATION, S
NON-DISCLOSURE OF MATERIAL FACT OR NON-C0-OPERAIION CANCEL THE OL
IMPORTANT NOTICE
THE INSURED IS NOT INDEMNIFIED IF THE
PAYMENT MADE BY THE COMPANY 3Y REASON VEHICLE 1S USED OR DRIVEN
OTHERWISE THAN IN ACCORDANCE WITH
OF WIDER TERMS THIS SCHEDULE. ANY
VEHICLES ACT, 1988 IS APPEARING IN THE
RECOVERY". FOR LEGAL RECOVRABLE FROM THE INSURED. SEE THE CLAUSE HEADEDCERTIFICATE IN ORDER TO COMPLY
INTER?RETATION, ENGLISH VERSION WILL HOLD GOOD. "AV0IDANCE OF VITH_IHE
CERTAIN TERMS AND MOTOR
RIGHT OF
Premium:
T/O 1,778.0 OReceipt Number
CGST(9%): 160.00Receipt Date 1010724812110078394SAgency/Broker Code:
GST(9%):_ 60..oo 26/04/2021Direct Business:
tamp Duty:
.C0pebitNote Number pevelopment Officer
Total (Rounded Of):_
2,098.coDocument Date LOde:

Customer GST/UIN No.:

SAC Code: |office GST No.:
99712 | Invoice No. & Date: |29AAACU5552C1ZF
Amount Subject to Reveerse Charges-NIL 31211100925129 &25/04/2021
Anti Money
Laundering Clause:-in
1 lakh, the insured will
the event of a
cla im
under the
policy exceeding 1 lakh
comply with the provisions ot AML policy the or a claim for refund of premium
well as Company's web site. o company. h e AML
Policy is avallable in all our exceeding
operating offices as
LET US JoIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT
https://pledae.cvc.nic.in.
Date of Proposal and Declaration: 26/04/2021
IN WITNESS WHEREOF, this
pcy
has been signed at MO
BAsAVE SHWARNAGAR 072481 on this 26th day of April 2021.
For and On behalf of
United India Insurance

Affix Policy
. Stamp here.
i ° .

*****
Duly Constituted Attofne
NDIA
Underwritten By SHI31176 ( MO INCHARS I
MICROOFFL

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