Office Copy

UNITED INDIA INSURANCE COMPANY LIMITED

D.NO: 29/213-D,OPP: APSPDCL OFFICE, UPSTAIRS OF SOWJANYA MOTORS, MAIN ROAD,
TEKKE, NANDYAL
KURNOOL - 518502 ANDHRA PRADESH
PHONE: (8514) 242040 FAX: EMAIL:

CARRIER' S LEGAL LIABILITY POLICY

POLICY NO.:0511022722P110761929

PERIOD OF INSURANCE
From 00:00 hrs of 21/01/2023
To Midnight of 20/01/2024

Insured
MS SAHASAREDDY FILLING STATION,
PROP: INJETI VENKATA SUBBA REDDY, D.NO: 17/144/K4/A, ATMAKUR BUSTAND, NEAR NTR
FUNCTION HALL, NANDYAL.
KURNOOL
518501
ANDHRA PRADESH
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name : BHASKAR REDDY

Agent Code : AGD0047270
9440882586
Mobile/Landline Number/Email :
bhaskarreddy_b@yahoo.com

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 051102@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 : CUSTOMER @ 20/01/2023 6:39:18 PM

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CARRIER'S LEGAL LIABILITY POLICY

SCHEDULE
Policy No. 0511022722P110761929 Prev. Pol. No.
Name Of Insured/ID MS SAHASAREDDY FILLING STATION,/23043993339
Tel.(O) Fax Tel.(R) Mobile 9441052836
Business/Occupation None Email
Period of Insurance From 21/01/202300:00 Hours To Midnight of 20/01/2024

CO-INSURANCE DETAILS: UIIC 051102 : 100%

PREMIUM: 30,991.00

Territory(Geographical Limits):- Jurisdiction:-

Subsidiaries:-

Vehicle Registration Carrying Capacity in Details of issuing office of

Vehicle Registration Date Motor Package Policy no
Number Tones Package policy
AP16TH1954 19/03/2016 25 0511023122P110697314 UIIC

LIMIT OF LIABILITY PER EVENT 1,500,000.00

LIMIT OF LIABILITY PER POLICY PERIOD 4,500,000.00
EXCESS(MINIMUM DEDUCTIBLE PER ACCIDENT) 2,000.00

Net Premium : 30,991.00

CGST(9%) : 2,789.00
SGST(9%) : 2,789.00
Stamp Duty : 1.00
Total : 36,569.00
Receipt No. : 10105110222112438440
Receipt Date : 20/01/2023

Agency/Broker Code : AGD0047270

BDIS Code : BD23267

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Coverage Details:-
Cover Name SI( ) Premium( )
Wider Cover 4,500,000.00 37,807.78

Customer GST/UIN No.: Office GST No.: 37AAACU5552C1ZI

SAC Code: 997139 Invoice No. & Date: 2722I110761929 & 20/01/2023
Amount Subject to Reverse Charges-NIL

We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said
sub-rule.
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: 21/01/2023

IN WITNESS WHEREOF,the undersigned being duly authorised has hereunto set his/her hand at BO NANDYAL 051102 on this
20th day of January 2023

For United India Insurance Co. Ltd.

Affix Policy
Stamp here.

Authorised Signatory.
Underwritten By - SUD48327 ( BO UW CUM CASHIER )

'Policy form - Claims made with right to defend.'

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

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