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. 1120003122P101807118 Certificate Number 1120003122P101807118
Customer Id 23146738598 Issuing Office Address Code 112000
Name of the Insured MR MURSHID S O SH. SAHADIN LIC BUILDING
VILL-RANA MAJRA,93,,PANIPAT,HARYANA, RAJGURU MARKET, NEAR BUS STAND PANIPAT, PANIPAT, HARYANA
132103
Address of the Insured 132101 PANIPAT
PANIPAT HARYANA
HARYANA Telephone (180) 2639863
Business/Occupation None Mobile No.- 9671920777
Effective date of commencement of Insurance for the purpose of Act from 00:00 Hrs Insured's Declared Value 4393204
on 29/05/2022
Date of Expiry of the Insurance Midnight on 28/05/2023
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 /
MAT808017M3C05986 SIGNA 4825 TK 47500
HR - 67 - C - 3747 No B6.7B6A250D02112C64145874 TIPPER 2021 6702
BS VI
10X4HD29BX
Registration Authority Geographical Area Financier Public / Private
HR67 PANIPAT INDIA TATA MOTORS FINANCE LTD(MUMBAI,MUMBAI,MAHARASHTRA-400071) Public
Amount in words: Eighty-four thousand five hundred ninety-four 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.
Note:- The policy does not cover liability for death, bodily injury or damage as excluded insection 150 (2) (ii) and (iii); (b) and (c) of the Motor Vehicles Act, 1988.
Limitations as to use Premium: 73,802.00
The policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or CGST-Others(9%): 2,902.00
such a carriage falling under Subsection 3 of Section 66 of the Motor Vehicles Act, 1988.
SGST-Others(9%): 2,902.00
The policy does not cover use for:
a) Organized Racing CGST-Basic TP(6%): 2,494.00
b) Pace Making SGST-Basic TP(6%): 2,494.00
c) Reliability Trials Stamp Duty: 1.00
d) Speed Testing Total(Rounded Off): 84,594.00
Receipt Number: 10111200022101967132
Receipt Date: 28/05/2022
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0009240
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor AMIT KAPOOR , Mobile: 9050007575
Vehicles Act 1988 Dealer Name/Code:
Under Section II-I (ii) Damage to third party property in respect of any one claim or series of
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 7,21,23,28
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: 28/05/2022
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: Mon, May 30, 2022 12:22:01 IST
Location: United India Insurance Company Ltd
1/2 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - GCV PUBLIC CARRIER OTHER THAN 3 WHEELER PACKAGE(UIN. IRDAN545RP0048V01199900) POLICY SCHEDULE
Policy Number :1120003122P101807118 Previous Policy Number :
Geographical Area : India(A) Insurance Start Date & Time :29/05/2022 00:00 (hours)
Insured Name/ID : MR MURSHID S O SH. SAHADIN/23146738598 Insurance expiry Date & Time :28/05/2023 midnight
Insured address : Policy Issuing Office Address :
VILL-RANA MAJRA,93,,PANIPAT,HARYANA, LIC BUILDING RAJGURU MARKET, NEAR BUS STAND PANIPAT, PANIPAT, HARYANA ,GST No.:-
City: PANIPAT District: PANIPAT 06AAACU5552C1ZN
State: HARYANA Pincode: 132101 City: PANIPAT District: PANIPAT
Telephone: Mobile: 9671920777 State: HARYANA Pincode: 132103
Telephone:(180) 2639863
Business Channel Code:AGD0009240 Business Channel Sub Code:
Dealer Name: Agent Name: AMIT KAPOOR
Dealer Code: Land Line No.: ,Mobile:9050007575
VEHICLE DETAILS
Registration Number HR - 67 - C - 3747 Obsolete Vehicle & No & MAT808017M3C05986 Gross vehicle 47500
Chassis Number Weight
Tata Motors / SIGNA 4825 TK
RTA Name HR67 PANIPAT Vehicle Make & Model Type Of Body TIPPER
BS VI 10X4HD29BX
AA Membership
Registration Date 16/04/2021 Cubic Capacity 6702
Name
Engine Number B6.7B6A250D02112C64145874 Year Of Manufacture 2021 Geographical
Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
4393204 0 0 0 0 0 4393204 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
TATA MOTORS FINANCE LTD(MUMBAI,MUMBAI,MAHARASHTRA-400071) 7,21,23,28 Nil Depreciation Without Excess
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
1500000 Compulsory 1500 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 73,802.00
Basic premium on Vehicle and Accessories B. Basic - TP 41,561.00
CGST-Others(9%) 2,902.00
A. Basic - OD 12,811.75 Total 41,561.00
SGST-Others(9%) 2,902.00
Total 12,811.75
CGST-Basic TP(6%) 2,494.00
Add :
SGST-Basic TP(6%) 2,494.00
Compulsory PA for Owner Driver 275.00
Add : TOTAL PAYABLE PREMIUM 84,594.00
Cover for lamps, tyres, tubes etc 1,921.76 LL to Paid Driver IMT 28 150.00
Stamp Duty 1.00
SAC Code 997134
Nil Depreciation Without Excess 17,082.34
Sub Total (Additions) 425.00 3122I101807118 &
Invoice No & Date
30/05/2022
Sub Total (Additions) 19,004.10 Receipt Number 10111200022101967132
Gross TP(B) 41,986.00 Receipt Date 28/05/2022
Receipt Amount 84,594.00
Gross OD & TP:
Gross OD(A) 31,816.00 73,802.00 Payment Mode
(A) + (B)
MR MURSHID S O SH.
Paying Party
SAHADIN
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 : 29/05/2022

In Witness Whereof this policy has been signed at DO PANIPAT 112000 on this 28th day of May ,2022

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 106.204.45.22
Issuing Agent: AMIT KAPOOR Printed By : AMIKAP00 @ 30/05/2022 12:21:53 PM Agent User Name: AMIKAP00
Underwritten By - AMIKAP00 ( DIRECT AGENT ) , Approved
Agent Location: 112000
By - PAR19607(RO UNDERWRITER)

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