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:0911014721P106333801
( DUPLICATE )

PERIOD OF INSURANCE
From 00:00 Hrs of 22/09/2021
To Midnight of 21/09/2022

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 12:14:21 PM

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Tue, Sep 28, 2021 12:15:49 IST
Location: United India Insurance Company Ltd
1/8 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. 0911014721P106333801

SCHEDULE
Policy No. 0911014721P106333801 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 22/09/2021 To Midnight of 21/09/2022

Coinsurance UIIC 091101 : 100%

PREMIUM : Forty-eight thousand four hundred fifty rupees only

Type of Cover: Named

DESCRIPTION OF ANIMALS INSURED

IDENTIFICATION Purpose Sum

Species/Breed Sex, Colour &
Sl. Name of the Animal's for Veterinarian
Indigenous/Cross Distinguishing AgeHeight Insured(
No. Owner/Borrower/Loanee Number(Ear which Name
breed/Exotic Marks )
Tag/Marks) Used
Female ,
1 SAROJA KANNAN 430078774286 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BROWNISH
SATHISHKUMAR
2 170252431442 Bovine/JX/Crossbreed BLACK , 3 MILCH DR.V.SESHAGIRI 30000
LATCHUMANAN
BROWNISH
BLACK
Female ,
BROWNISH
SATHISHKUMAR
3 170252431431 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
LATCHUMANAN
BROWNISH
WHITE
Female ,
SATHISHKUMAR
4 170252852382 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
LATCHUMANAN
BROWN
Female ,
BROWNISH
SUBRAMANIYAN
5 170252431327 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
VENKATACHALAM
BROWNISH
WHITE
Female ,
BROWNISH
SUBRAMANIYAN
6 170252470036 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
VENKATACHALAM
BROWNISH
WHITE
Female ,
BLACKISH
MAGESHWARI
7 170251795065 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
SAATHAIYAN
BLACKISH
WHITE
Female ,

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 Female ,
8 VIJAYA SUBBAIYAN 170252431098 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
9 VIJAYA SUBBAIYAN 170252431087 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
10 VIJAYA SUBBAIYAN 170252431178 Bovine/JX/Crossbreed BROWN , 2 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
SELVAGANAPATHY
11 170252431167 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
NAAGAPPAN
BROWN
Female ,
12 VIJAYA RAJAGOPAL 170252431247 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BLACKISH
RAVICHANDRAN
13 170252430938 Bovine/HF/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
PAKKIRISAMY
BLACKISH
WHITE
Female ,
RAVICHANDRAN
14 170252431156 Bovine/JX/Crossbreed BROWN , 6 MILCH DR.V.SESHAGIRI 30000
PAKKIRISAMY
BROWN
Female ,
RAVICHANDRAN
15 170252431225 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
PAKKIRISAMY
BROWN
Female ,
16 MEAGALA RAJENDRAN 170252431236 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
17 MEAGALA RAJENDRAN 170252431180 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BROWNISH
18 SELVAKUMAR MARIMUTHU 170252431258 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
19 SELVAKUMAR MARIMUTHU 170252536402 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
20 SELVAKUMAR MARIMUTHU 170252431021 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
21 GANAPATHI MARIYAPPAN 430078767098 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
22 GANAPATHI MARIYAPPAN 430078767464 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
23 GANAPATHI MARIYAPPAN 430079193662 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BLACKISH
24 MURUGESAN RAMASAMY 430079192783 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
TAMIZHMARAN
25 430079192874 Bovine/JX/Crossbreed BROWN , 6 MILCH DR.V.SESHAGIRI 30000
THIRUGNANASAMBANTHAM
BROWN
Female ,
BLACKISH
TAMIZHMARAN
26 430079192453 Bovine/HF/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
THIRUGNANASAMBANTHAM
BLACKISH
WHITE
Female ,
BLACKISH
27 SATHYA MAHENDRAN 430079183122 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
BLACKISH
28 SATHYA MAHENDRAN 100041276445 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
BROWNISH
29 SATHYA MAHENDRAN 100041276695 Bovine/JX/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
DHANDAPANI
30 100041276720 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
ARUMAIKANNU
BROWN
Female ,
BLACKISH
31 REVATHI KANNUSAMY 100041276616 Bovine/HF/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
BLACKISH

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 WHITE
Female ,
BROWNISH
32 REVATHI MURUGAIYAN 100041276456 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BROWNISHN
33 PAKKIRISAMY RAMASAMY 100041276503 Bovine/JX/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
BROWNISHN
WHITE
Female ,
34 MALARVANNAN ARUMUGAM 170252454064 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
35 MALARVANNAN ARUMUGAM 170252536045 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
36 RAVICHANDRAN SELVARAJ 100041276514 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BLACKISH
37 RAVICHANDRAN SELVARAJ 100041276684 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BLACKISH
BROWN
Female ,
SANTHOSHMERY
38 100041276558 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BALASUBRAMANIYAN
BROWN
Female ,
BROWNISH
SANTHOSHMERY
39 100041276480 Bovine/JX/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
BALASUBRAMANIYAN
BROWNISH
WHITE
Female ,
KALAISELVAN
40 100041276718 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
ULAGANATHAN
BROWN
Female ,
BLACKISH
VIJAYALAKSHMI
41 100041276638 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
ARUNAGIRI
BLACKISH
BROWN
Female ,
BROWNISH
VIJAYALAKSHMI
42 100041276662 Bovine/JX/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
ARUNAGIRI
BROWNISH
WHITE
Female ,
BROWNISH
RAJESHKANNAN
43 100041276707 Bovine/JX/Crossbreed BLACK , 4 MILCH DR.V.SESHAGIRI 30000
SUBRAMANIYAN
BROWNISH
BLACK
Female ,
BLACKISH
BASKARAN
44 170252469761 Bovine/HF/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
GOUTHAMAKUMARAN
BLACKISH
WHITE
Female ,
BROWNISH
SINGARAVEL
45 170252276321 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
RAJAMANIKAM
BROWNISH
WHITE
Female ,
BROWNISH
46 MUNIYAPPAN GOVINDHAN 170252431032 Bovine/JX/Crossbreed WHITE , 3 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BLACKISH
47 MUNIYAPPAN GOVINDHAN 170252431112 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
BLACKISH
48 SARAVANAN MUNIYAPPAN 170252431076 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
BROWN WITH
49 SARAVANAN MUNIYAPPAN 170252431497 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BROWN WITH
WHITE
Female ,
BROWNISH
50 SARAVANAN MUNIYAPPAN 170252431101 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BLROWNISH

4/8
51 SARAVANAN MUNIYAPPAN 170252431065 Bovine/JX/Crossbreed BLACK , 3 MILCH DR.V.SESHAGIRI 30000
BLROWNISH
BLACK
Female ,
52 THANGAVEL VADIVEL 170252431486 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BROWNISH
53 JANAKI SOUNTHARRAJAN 170252431384 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BROWNISH
54 KESAVARAJ NAGOORAN 170252431338 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
55 RAJESHWARI SHANMUGAM 170252431395 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BLACKISH
56 RAJESHWARI SHANMUGAM 170252431145 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
57 LATHAA RAJENDRAN 170252431577 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
58 DEVAGI VAIRAMOORTHI 170252431522 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
AMUTHA
59 170252431566 Bovine/JX/Crossbreed BROWN , 3 MILCH DR.V.SESHAGIRI 30000
CHANDRASEKARAN
BROWN
Female ,
VELLAIYAMMAL
60 170252431500 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
AANANDHAN
BROWN
Female ,
BLACKISH
61 RAMALINGAM 170252431260 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
BROWNISH
62 GOPAL ARUNACHALAM 430078783700 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BROWNISH
MAGESHWARAN
63 170252431191 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
DHARMALINGAM
BROWNISH
WHITE
Female ,
64 AJMAITHIN SAITH HUSAIN 170252469043 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
65 MAHESHWARI ELANKOVAN 170252469395 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
BLACKISH
ABDHUL KHADAR
66 170252469134 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
MOHAMMED SHERIF
BLACKISH
WHITE
Female ,
BROWNISH
67 MALATHI KARUNANITHI 170252431590 Bovine/JX/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BROWNISH
68 MALATHI KARUNANITHI 170252431670 Bovine/JX/Crossbreed WHITE , 6 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BROWNISH
69 MALATHI KARUNANITHI 170252431692 Bovine/JX/Crossbreed WHITE , 6 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
BROWNISH
70 MALATHI KARUNANITHI 170252431453 Bovine/JX/Crossbreed BLACK , 5 MILCH DR.V.SESHAGIRI 30000
BROWNISH
BLACK
PREMAVATHI Female ,
71 170252431624 Bovine/JX/Crossbreed 4 MILCH DR.V.SESHAGIRI 30000
PAKKIRISAMY FAWN , FAWN
Female ,
BROWNISH

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 BLACK
ROBERTNAROSERANI
72 170252470071 Bovine/JX/Crossbreed &WHITE , 6 MILCH DR.V.SESHAGIRI 30000
ADAIKALAKUMAR
BROWNISH
BLACK
&WHITE
Female ,
BROWNISH
73 CHINNAIYAN DEVU 170252463794 Bovine/JX/Crossbreed WHITE , 6 MILCH DR.V.SESHAGIRI 30000
BROWNISH
WHITE
Female ,
GREYISH
DHANALAKSHMI
74 170252431282 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
SAMIYAPPAN
GREYISH
WHITE
Female ,
BLACKISH
75 SUTHA MARIYAPPAN 170252431214 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
76 LALITHA TAMIZHARASAN 170252431407 Bovine/JX/Crossbreed BROWN , 6 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
FAWN WITH
77 DEVI MARIYAPPAN 170252431340 Bovine/JX/Crossbreed 5 MILCH DR.V.SESHAGIRI 30000
BLACK , FAWN
WITH BLACK
Female ,
GREYISH
RAJESHWARI
78 170252431293 Bovine/JX/Crossbreed BLACK , 5 MILCH DR.V.SESHAGIRI 30000
MURUGAIYAN
GREYISH
BLACK
Female ,
BROWNISH
79 THULASI SUBRAMANIYAN 170252431511 Bovine/JX/Crossbreed BLACK , 5 MILCH DR.V.SESHAGIRI 30000
BROWNISH
BLACK
Female ,
GREYISH
VELLAIYAMMAL
80 170252431134 Bovine/JX/Crossbreed BLACK , 5 MILCH DR.V.SESHAGIRI 30000
DURAISAMY
GREYISH
BLACK
Female ,
BLACKISH
81 VASANTHA THAMBUSAMY 170252431271 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
BROWNISH
THANGAMANI
82 170252431602 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
VISWANATHAN
BROWNISH
WHITE
Female ,
GREYISH
DHANALAKSHMI
83 170252430860 Bovine/JX/Crossbreed BLACK , 6 MILCH DR.V.SESHAGIRI 30000
SENTHILKUMARAN
GREYISH
BLACK
Female ,
WHITISH
84 AANDAL PARAMASIVAM 170252430973 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
WHITISH
BROWN
Female ,
85 TAMIZHSELVI PRAKASH 170252431362 Bovine/JX/Crossbreed BROWN , 6 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
SHIYAMALADEVI
86 170252431420 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
JOTHIBASU
BROWN
Female ,
BLACKISH
87 KASTHURI SURESH 170252431351 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
88 GAYATHRI BAKKIYARAJ 170252431418 Bovine/JX/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
WHITE
Female ,
BLACKISH
89 MALATHI KANNAN 170252431010 Bovine/HF/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
BLACKISH
WHITE
Female ,
90 SAROJA GANESAN 170252431373 Bovine/JX/Crossbreed BROWN , 4 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
91 MURUGAIYAN NADESAN 170252431555 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,

6/8
 BLACKISH
TAMIZHARASI
92 170252431657 Bovine/HF/Crossbreed WHITE , 4 MILCH DR.V.SESHAGIRI 30000
SINGARAVELU
BLACKISH
WHITE
Female ,
BLACKISH
TAMIZHARASI
93 170252431635 Bovine/HF/Crossbreed WHITE , 5 MILCH DR.V.SESHAGIRI 30000
SINGARAVELU
BLACKISH
WHITE
Female ,
94 GANESAN RAJADURAI 170252431464 Bovine/JX/Crossbreed BROWN , 5 MILCH DR.V.SESHAGIRI 30000
BROWN
Female ,
95 GANESAN RAJADURAI 170252431475 Bovine/JX/Crossbreed WHITE , 6 MILCH DR.V.SESHAGIRI 30000
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: 2850000 Net Premium : 48,450.00
CGST(0%) : 0.00
SGST(0%) : 0.00
UTGST(0%) : 0.00
IGST(0%) : 0.00
Stamp Duty : 1.00
Total : 48,450.00
Receipt No. : 10109110121106781297
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: 4721I106333801 & 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: 22/09/2021

IN WITNESS WHEREOF,the undersigned being duly authorised has hereunto set his/her hand at BO NAGAPATTINAM 091101 on this 28th
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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