Office Copy

UNITED INDIA INSURANCE COMPANY LIMITED

19, SUDHA COMPLEX NEELA SOUTH STREET, NAGAPATTINAM, NAGAPATTINAM, TAMIL NADU
NAGAPATTINAM - 611001 TAMIL NADU
PH: (04365) 241569 FAX: EMAIL:

MICRO-INSURANCE PRODUCT-CATTLE INSURANCE POLICY

POLICY NO:0911014721P106327311
( DUPLICATE )

PERIOD OF INSURANCE
From 00:00 Hrs of 08/09/2021
To Midnight of 07/09/2022

Insured
MS TAMILNADU LIVESTOCK DEVELOPMENT AGENCY CHENNAI (NATIONAL
LIVESTOCK MISSION)
ADAH, NEARBY NEW BUS STANTD NAGAPATTINAM
611001
NAGAPATTINAM
TAMIL NADU
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name :
Agent Code :
Mobile/Landline Number/Email :

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 091101@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 : AMA45428 @ 28/09/2021 11:10:28 AM

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Tue, Sep 28, 2021 11:11:39 IST
Location: United India Insurance Company Ltd
1/5 Reason: Signing Policy for UIIC
Office Copy

MICRO-INSURANCE PRODUCT-CATTLE INSURANCE POLICY

WHEREAS the Insured named in the Schedule hereto has made to United India Insurance Company Limited(herein after called the
"Company", a proposal and declaration which shall be the basis of this contract and be deemed to be incorporated herein for the
Insurance hereinafter contained and has paid the premium stated herein.

THE COMPANY hereby agrees subject to the terms, provisions, conditions, contained herein or endorsed to otherwise expressed thereon
that if any animal described in the Schedule and belonging to the Insured shall die from any disease or accident (including fire and
lightning) contracted or occurring during the period of Insurance stated herein or any subsequent period in respect of which the insured
shall have paid and the Company shall have accepted the premium required for the renewal or extension thereof the Company will pay to
the Insured after receipt of proof of death satisfactory to the Company the loss which the Insured shall suffer by the death of such animal
not exceeding the Sum Insured in respect thereof as stated in the Schedule hereto or its Market value at the time of loss whichever is
less. However, the company's liability is restricted to 50% of Sum Insured or market value whichever is less if the animal prior to death
giving rise to a valid claim under the Policy is not pregnant or four months less of pregnancy or not in milk production.

Policy No. 0911014721P106327311

SCHEDULE

Policy No. 0911014721P106327311 Previous Policy No.

MS TAMILNADU LIVESTOCK DEVELOPMENT AGENCY
Name/ID CHENNAI (NATIONAL LIVESTOCK
MISSION)/ 23085793683
Insured Details
Tel (O): Tel (R) Fax:
Email Mobile:
Business / Occupation None Date of Declaration
Period of Insurance From 00:00 Hrs of 08/09/2021 To Midnight of 07/09/2022

Coinsurance UIIC 091101 : 100%

PREMIUM : Thirteen thousand six hundred eighty-five rupees only

Type of Cover: Named

DESCRIPTION OF ANIMALS INSURED

IDENTIFICATION Purpose Sum

Species/Breed Sex, Colour &
Sl. Name of the Animal's for
Indigenous/Cross Distinguishing Age Height Veterinarian Name Insured(
No. Owner/Borrower/Loanee Number(Ear which
breed/Exotic Marks )
Tag/Marks) Used
Female ,
GREYISH
1 VEMBAIYAN NATARAJAN 170252760528 Bovine/CBJY/Crossbreed WHITE , 3 MILCH DR.G.SIVASURIYAN 30000
GREYISH
WHITE
Female ,
GREYISH
2 GANDHIMATHI ANAND 170252760585 Bovine/CBJY/Crossbreed WHITE , 4 MILCH DR.G.SIVASURIYAN 25000
GREYISH
WHITE
Female ,
BLACKISH
BROWN WITH
3 ANBUSELVI RAJENDIRAN 170252760847 Bovine/CBJY/Crossbreed WHITE , 5 MILCH DR.G.SIVASURIYAN 25000
BLACKISH
BROWN WITH
WHITE
Female ,
GREYISH
4 CHITHRA VENGADASALAM 170252760530 Bovine/CBJY/Crossbreed WHITE , 7 MILCH DR.G.SIVASURIYAN 30000
GREYISH
WHITE
MANIKANDAN Female ,
5 170252760552 Bovine/CBJY/Crossbreed 8 MILCH DR.G.SIVASURIYAN 30000
KRISHANAMOORTHY FAWN , FAWN
Female ,
BROWN WITH
PRABHAKARAN
6 170251756447 Bovine/CBJY/Crossbreed WHITE , 5 MILCH DR.G.SIVASURIYAN 30000
NAMACHIVAYAM
BROWN WITH
WHITE
Female ,

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 MUTHULAKSHMI FAWN WITH
7 170251765973 Bovine/CBJY/Crossbreed 3 MILCH DR.G.SIVASURIYAN 25000
VELAYUTHAM BLACK , FAWN
WITH BLACK
Female ,
8 SREEPAN VEERASAMY 170251766112 Bovine/CBJY/Crossbreed WHITE , 3 MILCH DR.G.SIVASURIYAN 30000
WHITE
Female ,
RAJAKUMARI
9 170252222850 Bovine/CBJY/Crossbreed BROWN , 6 MILCH DR.G.SIVASURIYAN 30000
ULAGANATHAN
BROWN
Female ,
LIGHT BROWN
RAJAKUMARI
10 170252768753 Bovine/CBJY/Crossbreed WHITE , 3 MILCH DR.G.SIVASURIYAN 30000
ULAGANATHAN
LIGHT BROWN
WHITE
Female ,
RAJAKUMARI
11 170252768844 Bovine/CBJY/Crossbreed FAWN BLACK , 3 MILCH DR.G.SIVASURIYAN 30000
ULAGANATHAN
FAWN BLACK
Female ,
BLACK WITH
RAMAMIRTHAM
12 170251756323 Bovine/CBJY/Crossbreed BROWN , 3 MILCH DR.G.SIVASURIYAN 25000
MURUGESAN
BLACK WITH
BROWN
Female ,
BLACK WITH
13 TAMILARASN RANGASAMI 170251756493 Bovine/CBJY/Crossbreed 5 MILCH DR.G.SIVASURIYAN 25000
GREY , BLACK
WITH GREY
Female ,
14 TAMILARASN RANGASAMI 170251761035 Bovine/CBJY/Crossbreed BLACK , 3 MILCH DR.G.SIVASURIYAN 30000
BLACK
Female ,
GREYISH
15 ANNAMALAI GOVINDHAN 170251756607 Bovine/CBJY/Crossbreed WHITE , 3 MILCH DR.G.SIVASURIYAN 25000
GREYISH
WHITE
Female ,
GREYISH
16 ANNAMALAI GOVINDHAN 170251756128 Bovine/CBJY/Crossbreed BLACK , 2 MILCH DR.G.SIVASURIYAN 25000
GREYISH
BLACK
Female ,
GRYISH
17 ANNAMALAI GOVINDHAN 170251756254 Bovine/CBJY/Crossbreed BLACK , 2 MILCH DR.G.SIVASURIYAN 25000
GRYISH
BLACK
Female ,
GREYISH
VEERAMANI
18 170251756653 Bovine/CBJY/Crossbreed WHITE , 5 MILCH DR.G.SIVASURIYAN 25000
BALAKRISHNAN
GREYISH
WHITE
Female ,
BROWNISH
VEERAMANI
19 170251756048 Bovine/CBJY/Crossbreed BLACK WHITE 5 MILCH DR.G.SIVASURIYAN 25000
BALAKRISHNAN
, BROWNISH
BLACK WHITE
Female ,
VEERAPANDIYAN
20 170251756083 Bovine/CBJY/Crossbreed GREY BLACK , 6 MILCH DR.G.SIVASURIYAN 30000
ANNASAMI
GREY BLACK
Female ,
BLACK WITH
21 RENGASAMI RATHINAM 170251756196 Bovine/CBJY/Crossbreed WHITE , 4 MILCH DR.G.SIVASURIYAN 30000
BLACK WITH
WHITE
Female ,
GREYISH
22 DEVI BALAKRISHNAN 170251756094 Bovine/CBJY/Crossbreed BLACK , 5 MILCH DR.G.SIVASURIYAN 30000
GREYISH
BLACK
Female ,
BROWNISH
23 GANDHI 170251766203 Bovine/CBJY/Crossbreed BLACK , 3 MILCH DR.G.SIVASURIYAN 25000
BROWNISH
BLACK
Female ,
24 BASKAR MURUGAIYAN 170251763043 Bovine/CBJY/Crossbreed 5 MILCH DR.G.SIVASURIYAN 30000
FAWN , FAWN
Female ,
25 MURUGAIYAN VEDHAIYAN 170251763247 Bovine/CBJY/Crossbreed 3 MILCH DR.G.SIVASURIYAN 30000
FAWN , FAWN
Female ,
FAWN WITH
26 MURUGAIYAN VEDHAIYAN 170251765938 Bovine/CBJY/Crossbreed 5 MILCH DR.G.SIVASURIYAN 30000
WHITE , FAWN
WITH WHITE
Female ,
27 MURUGAIYAN VEDHAIYAN 170251762916 Bovine/CBJY/Crossbreed WHITE , 3 MILCH DR.G.SIVASURIYAN 30000
WHITE
Female ,
BROWNISH
28 RAJENDIRAN JAGANATHAN 170252231133 Bovine/CBJY/Crossbreed BLACK WHITE 4 MILCH DR.G.SIVASURIYAN 25000
, BROWNISH
BLACK WHITE

3/5
 Female ,
BROWNISH
29 RAJENDIRAN JAGANATHAN 170252231122 Bovine/CBJY/Crossbreed BLACK WHITE 3 MILCH DR.G.SIVASURIYAN 25000
, BROWNISH
BLACK WHITE

Tag should be surrendered at the time of claim,otherwise it will be treated as No claim.

In the event of death of animal/s covered under the policy, claim/s shall not be entertained unless the ear tag/s are surrendered to the
Company. In the event of loss of ear tag/s, it is the responsibility of the insured to give immediate notice to the Company and get the
animal retagged.
The Company is not liable to pay the claim in the event of death of insured animal due to disease occurring within 15 days from the
commencement of risk.
Total Sum Insured: 805000 Net Premium : 13,685.00
CGST(0%) : 0.00
SGST(0%) : 0.00
UTGST(0%) : 0.00
IGST(0%) : 0.00
Stamp Duty : 1.00
Total : 13,685.00
Receipt No. : 10109110121106774562
Receipt Date : 28/09/2021

Agency/Broker Code:
Dev.Officer Code:

Location of the farm or place where the animals are stabled: FOH
Special Conditions /exclusions: ,NO TAG NO CLAIM

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Office Copy

Customer GST/UIN No.: Office GST No.: 33AAACU5552C1ZQ

SAC Code: 997139 Invoice No. & Date: 4721I106327311 & 28/09/2021
Amount Subject to Reverse Charges-NIL

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: 08/09/2021

IN WITNESS WHEREOF,the undersigned being duly authorised has hereunto set his/her hand at BO NAGAPATTINAM 091101 on this 27th
day of September 2021 .

For and On behalf of CONSOLIDATED

United India Insurance Co. Ltd. STAMP DUTY PAID AS
PER TAMIL NADU
GOVERNMENT G.O.
(RT.) No.222 DATED
10.07.2020 FOR THE
PERIOD FROM
01.04.2021 TO
Duly Constituted Attorney(s)
30.09.2021
Underwritten By - AMA45428 ( BO UW CUM CASHIER )

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