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No. 354Universal Sompo General Insurance ‘Suraksha, Hamesha Aapke Saath ‘CERTIICATE CUI POLICY NUMBER:USG/WERAS/0755135/00/000 Intemmeoury woe POLICY BAZAAR INSURANCE WEB AGGREGATOR PVT LTD inrameouny cove 201670875657 pnoneno. NA wa (NA fuscone [NIA POU ROE Gon yan INSURED NAME A.SAIDALISALAMUDOI RAN ana coveworE HHDAS AVENUE CHSFLAT08.MILTARY CAMP fcostanca one anvane RRORDKALNASANTACRUZ EAST MUMBA PROPOSER eee (RTO ZONE a tarsus ‘SUPPLY a ely ena [CUSTOMER 1D NAL HORLENO 9960033977 Lio -ersanicainanggmai'eom (esr nuMaen Na NOMINEE NAME FAROAKHIN, PEROD OF MSURANCE TORMDNNGHT OF 130122029, propose aa FOUCYSSUANCEOFECE CSF RouD NSH EAST MUMEAL OOM: bara Tn OUT ICZT@MACUBETTEIES une cessor mato rosmtsesvawconoenmvieine Tats MEAEP27 oye | arp eats) 7 a ST FORTHE VEAKCLE | FORTRALER | NON-ELECACCESSORES | ELECTRICAL/ELECRONICACCESSORES —|/CNKT |LPGKT | TOTAL VALUE aiss000 | 000 00 I eo 00 | 000 61631000 SCHEDULE OF PRERMUNT (AMOUNT WR) ‘Own DAMAGE A) ‘vn Damage Premio eata10 etalon euaso uaa (8) No CtimBonus (203%) YE82.00 asic Hid Pat Litty 7300.00 Road SiaeAasietenee En coke Add On opted: Depreiton Pian, Toa Prema 7390.00 ‘Adoni Premium 185200 TetatOwn Damage Premiom i620 TOTAL PACKAGE PREMIUM (A) [___testa00 errr [881300 cost om) I 138.7 seston I 1750-7 vost | 00 vost I 00 Tora. PREM [2025.00 ‘ComPULSORY DEDUCTLE 200000 VOUUNTARY DEDUCTILES I 0 For Mo Gaim Bonus (NBN Gm sn oy eons te ay swe ihe Ont ery net Oe sein et) he monn erie re Ne Sima enns Gun Goa Sc oy # nn ta pagan Yn se Pe ane DRIVER Persons or doses of person ete to deve: oy nu neutas he cues Pec ta esin ante matecie Dey newest et se tartan nein sangeet Pentre etnies na ooneney rt ate LMTATIONS AS. TO USE: ne cy core a ee ny poe are rect eu Capa ot ete hansen cr secre [Syuntneg ofa msg spay Ray Sag Ay ogc Women eae alas OF ARTY» ner en ee Fly De oy ain ai any ete enna fe ent) se SR aA SS AOS OA TT RT eT a le |MPORTANT NONE: Te rend st nen te cn td ive stein en cc in di dy pt a ye pny i wre upg Caress haya enc cee bse fr be a NE FATA TE SUBUECT To IMT ENDORSEMENT NOS. AND MEMORANDUM PRINTED HEREIN ATTACHED HERETO: 2 RERUN COLLECTION DETALS: [etn heron Season Por ANSIDON ECE pure nn py uy by gee yey Ma yp Se ielant rovrpesetnes easter meme sy eoor ss ern aithien tne tom ass ors mes wt bcs anes wan nope ones haa Suh ose Ems an se ond oa ragga cacy Paya ec ype aytenet set ate ply an eto ae ee a acetone Leeann De pon spe lee LUN No: NA Ines monet ney hte ayant nem MA a DULY CONSTITUTED ATTORNEYS) cote stp iy 109 nae nance py stp ie ce CSOSHS DSTI eae O22 of Cm tne (eit ont Pi: false fess Pon Coni by Gomme to get, ae Secon hoi ft ee wren aes er NEN ‘Sts reds soe ea rare Naru 0b Sessa ab a neh ica wah an OOS ak peter apeenrUniversal Sompo General Insurance ‘Suraksho, Hamesha Aopke Saath Sa er io frees necro arcpinge tienen mine HEXAXE 4x27 STR Issuance dete faouzoz2 QHEROAALRAGNITHCRIZEAST, OS aamnerfinSDasdelT Pret wank PRON GOnTAVOF TAO TEOOTO MONET OF TORRE ae = ftw ore peotatzare foie eowre nas cioenioammeyc reel ——pesioneent area fo aire ‘Cubic capacity 2179 Hyoothetication BANK OF BARODA TERETE senor? ee LVEHICLEIDV | TRAWLER “ELECTRICAL IDV | _NON-ELECTRICAL IDV ‘eG Kir wot | TOTALIOV 00 [000 000 T "000 00 ‘300 | ‘000 PREMIUM DETAILS « (ores a anaes SATS STAN Foo eae nea! tere oot a eae ae pee OT z Se ‘ eneerenere q aan oee om ae feo Ss fa Seu 7 i pas ape i ate eS oot oe ow sere ‘rohition af Rebotesiecion Aiflnsuance Aa, 293Bneamended) ‘+ srcon shall allow or ofr mallow, ether diecsiyor indirect 35 an inducement any person te out renew or continue an nsurance in respec: of any kinds ‘eles Ives o prope in nd, ny rebate of re hole or part ofthe commission payable or ny rebate ofthe premium snoun on he policy. fr shal any person 3KIre Sutarrenening a continuing e ply accept ary rebel, excep auch febate ar ay bv llowed in aceardane th he pu sed aroxpectaes oleae ner Provide thet eccpterce by en insurance ape of commision in connection with» pec fife insurance taken ot by hmatf on is own fe shall ret be eared to be {ceestnce ofa bai of premium within te meaning this sub secon at tet of such acceptance the nsurance agent satisfies he prescribed canons establishing ‘hotheisa bone figeinsuronce ager employes by the Insurer ay psomneing dete incomplyng wih avis of sacl fli ic a ply ch mye beth rips. ‘ermeand condone "hereby declare tht he Insured Persons) listed inProparel Farm will abide tothe allowing erms and conditions «+ \ywehere by declare tatshe satements made by me/us aretrueto the best of my our knowledge and bli and ve heraby arc that this declaration shall form the basi= hike cant betacen mefusand Univeral Same General Insurance Company Lined = Weal decleethet, fany ition: alterations are carried at eftr the subrasion fthis proposal form then the same icul be conveyed ote insurer immediately \/weaita shall endeavour 1 gracure the eneual notice snd pass onthe same to Universal Sompe Genel Insurance ied asly upon fhe receipt of uch ene roice 1 Anyperson ho, knowiny ara wrtn ntent vo stra he insurance Company or oer persns files 3 proposal for insurance corsinng anaes information or coneea= ‘athe puraze ot mislescing information concerning any tet meter hers, commierrsuculentsetuhchwlnaershepelieyusiele atthe Companys le Gece edi wes ates tec OF bce aepe cheese el Pte poy coset thc nec cle elytra UE a private comoany ec), STIN sprints on the galiey, bass the detaisprviced during policy issuance Foray subsequent charges or sito ef GSTIN not ected atthe “ime of pole suancs] en polly sehceue, change: shall be carried aut rough tesh pli isuance wth aospectve ctfac. + Tine dears and contin ving avid Puc 2 Cpcecleaton ty one of alan de lnirer o be printed athe azemay be 12 Coftcover isnot opted by me a do nothve elective diving cee ot {© CeAcover frat opted by me as | have standalone CPA cover (1% ac. or © Ceacover is notated by me a | have Personal ncisent cove fore) of 45 lesa Migr. + unsestanethe Proporta. QUIDI27S4G60% ir emu to me osizon saave nformst on Tremcript Declaration in case dizgreemert ar abjection anyother charge wih rezect to information ard conteis mentioned hersn above plese contact cu lee ‘umber andregistr your cbjections /chanaes/disagreenant othe catlrt ofthis Wanserpt or you ray aso send us mall or witan cortespondence ate folowing ‘etal wrtnna period of 15 ys om dat of your receipt ofthis tansere long ‘aid: conectan@universalompo com Taree No: 1800724030 / 1800 2004030.