UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTOR INSURANCE - {lblDealProductName} PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 262104/31/2022/723 Certificate Number 2018033121P109409279
Customer Id 23026166060 Issuing Office Address Code 201803
Name of the Insured RASHIM GANDOTRA IST FLOOR , BHAMBRI APPARTMENT
WARD NO 14 RAM DALHOUSIE ROAD, PATHANKOT
NAGAR KATHUA 145001
JAMMU GURDASPUR
Address of the Insured PUNJAB
ANDKASHMIR
184101 Telephone (186) 2224981,(186) 5080482

Business/Occupation None Tel:

EffectivedateofcommencementofInsuranceforthepurposeofActfrom00:00HrsInsured'sDeclaredValue 650000
on 23/12/2021
Date of Expiry of the Insurance Midnight on 22/12/2022
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
(ifany)
ASHOK LEYLAND
MB1PBEHD4KAAK817 BUS(HPV) 16200
JK - 08 - J - 4899 No KBPZ130550 / 2019 5760
7
VK1611.0D4R
Registration Authority Geographical Area Financier Public / Private
JK08 KATHUA INDIA Public
Amount in words: Fifty-two thousand four hundred seventy rupees only
Persons or classes of persons entitled to drive
AnypersonincludingInsuredprovidedthatapersonholdsaneffectivedrivinglicenceatthetimeofaccidentandisnotdisqualifiedfromholdingorobtainingsuchalicence.Providedalsothat
thepersonholdinganeffectiveLearner'sLicencemayalsodrivethevehicleandsuchapersonsatisfiestherequirementsofRule3ofCentralMotorVehicleRule,1989.
Limitations as to use Premium: 46,654.00
The policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or CGST-Others(9%): 326.00
such a carriage falling under Subsection 3 of Section 66 of the Motor Vehicles Act, 1988. SGST-Others(9%): 326.00
The policy does not cover use for:
CGST-Basic TP(6%): 2,582.00
a) OrganizedRacing
b) PaceMaking SGST-Basic TP(6%): 2,582.00
c) ReliabilityTrials Stamp Duty: 1.00
d) SpeedTesting Total(Rounded Off): 52,470.00
Receipt Number: 10120180321110564812
Receipt Date: 23/12/2021
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGI0068542
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor ATUL BHATIA , Mobile: 9814114688
Vehicles Act 1988 Dealer Name/Code:
UnderSectionII-I(ii)Damagetothirdpartypropertyinrespectofanyoneclaimorseriesof claims
arising out of one event: 750000/- Direct Business:
BusinessAssociateCode: BAS22516
BACHAN DASS
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 For and On behalf of
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988. United India Insurance Co.Ltd.
Date of Issue: 23/12/2022
Amount Subject to Reverse Charges-NIL
The genuineness of the policy can be verified
through "Verify Your Policy" link at
www.uiic.co.in. Duly ConstitutedAttorney

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Tue, Dec 21, 2021 15:30:03 IST
Location: United India Insurance Company Ltd
1/3 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - {lblDealProductName} PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY SCHEDULE
PolicyNumber :2018033121P109409279 PreviousPolicyNumber :2018033120P110474293
GeographicalArea :India(A) Insurance Start Date&Time :16/12/2021 00:00 (hours)
InsuredName/ID :M/sAMRITSARIAMALSTONE Insurance expiry Date&Time :15/12/2022midnight
CRUSHER/23026166060
Insuredaddress : Policy IssuingOfficeAddress :
VILL.JASWAN,NAROTJAIMALSINGH,TEH.PATHANKOT.(GSTNUMBER
03AAQFA8753N1ZV ) ,GST/UIN No.:-03AAQFA8753N1ZV IST FLOOR , BHAMBRI APPARTMENT DALHOUSIE ROAD, PATHANKOT
City: GURDASPUR District:GURDASPUR ,GST No.:- 03AAACU5552C1ZT
State: PUNJAB Pincode:145024 City: GURDASPUR District: GURDASPUR
Telephone: Mobile: 9417231646 State: PUNJAB Pincode: 145001
BusinessChannelCode:AGI0068542 Business Channel SubCode:
DealerName: Agent Name: ATULBHATIA
DealerCode: Land Line No.:,Mobile:9814114688
VEHICLE DETAILS
Registration Number PB - 06 - K - 2369 Obsolete Vehicle & No & MAT42602390P22077 Gross vehicle 25000
Chassis Number Weight
Tata Motors / LPT2515TC
RTA Name PB06 GURDASPUR Vehicle Make & Model Type Of Body TRUCK(PLATFORM)
TRUCK
AA Membership
Registration Date 04/01/2010 Cubic Capacity 5883
Name
Engine Number 90M62819712 Year Of Manufacture 2009 Geographical
Extension
INSUREDDECLAREDVALUE( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
650000 0 0 0 0 0 650000 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
propertywhatsoeveroranylossorexpensewhatsoeverresultingorarisingtherefromoranyconsequentialloss.(4)Anyliabilityofwhatsoevernaturedirectlyorindirectlycausedbyorcontributedtoorbyarisingoutofionizing
radiationsorcontaminationbyradioactivityfromanynuclearfuel.Forthepurposeofthisexception,combustionshallincludeanyselfsustainingprocessofnuclearfission.(5)Anyaccidentallossordamageorliabilitydirectlyor
indirectlycausedbyorcontributedtobyorarisingfromnuclearweaponsmaterial.(6)Anyaccidentallossdamageand/orliabilitydirectlyorindirectlyorproximatelyorremotelyoccasionedbyorcontributedtobyortraceable 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
directorindirectconsequencesofanyofthesaidoccurrencesoranyconsequencesthereofandindefaultofsuchproof,theCompanyshallnotbeliabletomakeanypaymentinrespectofsuchaclaim.
PA Cover CSI ( ) DEDUCTIBLES (Under Section I) ( )
Owner Driver
0 Compulsory 1500 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULEOFPREMIUM( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 46,654.00
Basic premium on Vehicle and Accessories B. Basic - TP 43,037.00
CGST-Others(9%) 326.00
A. Basic-OD 3,822.76 Total 43,037.00 SGST-Others(9%) 326.00
Total 3,822.76 CGST-Basic TP(6%) 2,582.00
Add :
SGST-Basic TP(6%) 2,582.00
LL to Paid Driver IMT 28 100.00
Add : TOTAL PAYABLE PREMIUM 52,470.00
Cover for lamps, tyres, tubes etc 573.41 Stamp Duty 1.00
Sub Total (Additions) 100.00 SAC Code 997134

Sub Total (Additions) 573.41 3121I109409279&

Invoice No & Date
16/12/2021
Gross TP(B) 43,137.00 Receipt Number 10120180321110564812
Less : Receipt Date 16/12/2021
Gross OD & TP:
879.23 (A) + (B) Receipt Amount 52,470.00
No ClaimBonus20% 46,654.00
Payment Mode
SubTotal(Deductions) 879.23
M/s AMRITSARIA MAL
Paying Party STONE CRUSHER

GrossOD(A) 3,517.00

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.
IMPORTANTNOTICE:TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisschedule.AnypaymentmadebytheCompanybyreasonofwidertermsappearingintheCertificatein
ordertocomplywiththeMotorVehicleAct,1988isrecoverablefomtheInsured.Seetheclauseheaded"AVOIDANCEOFCERTAINTERMSANDRIGHTOFRECOVERY".ForLegalinterpretation,EnglishVersionwillholdgood.In
caseofaccidenttheinsuredmustinformUnitedIndiaInsuranceCo.Immediatelytoarrangespotsurvey.
AntiMoneyLaunderingClause:-Intheeventofaclaimunderthepolicyexceeding 1lakhoraclaimforrefundofpremiumexceeding 1lakh,theinsuredwillcomplywiththeprovisionsofAMLpolicyofthecompany.The
AMLpolicyisavailableinallouroperatingofficesaswellasCompany's website.

LET US JOIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT https://pledge.cvc.nic.in.

Date & Signature of Proposal : 16/12/2021

InWitnessWhereofthispolicyhasbeensignedatBOPATHANKOT201803onthis16thdayofDecember,2021

ForUnitedIndiaInsuranceCompanyLimited

Affix Policy Stamp

IPAddress: 10.95.40.80 DulyConstitutedAttorneys

IssuingAgent: ATULBHATIA Printed By : CUSTOMER @ 21/12/2021 3:30:00PM AgentUserName: NEE49336
AgentLocation: 201803 Underwritten By - NEE49336 ( BO UW CUM CASHIER)

2
This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.