MOTOR INSURANCE - MOTORCYCLE / SCOOTER STANDALONE OWN DAMAGE(UIN: IRDAN545RP0001V02201920 ) POLICY SCHEDULE

Policy Number :1704003123P112813203 Previous Policy No :1704003122P110092544

Geographical Area :India(A) Insurance Start Date & Time :05/01/2024 00:00 (hours)
Insured Name/ID : MR DHANUS KARAN J/23130688051 Insurance expiry Date & Time :04/01/2025 midnight
Insured address : Policy Issuing Office Address :
81, KARUNANIDHI NAGAR, RAMANATHAPURAM NEW NO. 768, OLD NO.1028, UNITED INDIA BUILDINGS AVANASHI ROAD, NEAR DINATHANTHI OFFICE
City: COIMBATORE District: COIMBATORE COIMBATORE, COIMBATORE, TAMIL NADU ,GST No.:- 33AAACU5552C1ZQ
State: TAMIL NADU Pincode: 641045 City: COIMBATORE District: COIMBATORE
Telephone: Mobile: 8220745702 State: TAMIL NADU Pincode: 641018
Telephone:(0422) 2211257,(0422) 2211513
Business Channel Code: AGN1006678 Business Channel Sub Code:
Dealer Name: Agent Name:GAYATHRI S
Dealer Code: Land Line No: ,Mobile:9965308999
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number TN - 66 - AJ - 2849 No & M-936*62855* 2021
Number Manufacture
RTA Name TN66 COIMBATORE Chassis Number MD2JYCXH4MC004433 Cubic Capacity/KW 200
KTM & RC 200 ABS BS6
Registration Date 05/01/2022 Vehicle Make & Model Type Of Body SOLO WITH PILLION
null
Seating Capacity(Including Geographical
AA Membership Number 2
SideCar) Extension
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer/Sidecar Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
175000 0 0 0 0 0 175000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
22 Consumables Cover,Nil Depreciation Without
Excess
Persons or classes of persons entitled to drive
Any person including Insured provided that a person hold 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.
Limitations as to use
The policy covers use of the vehicle for any purpose other than
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage)
c) Organized Racing
d) Pace Making
e) Speed Testing and Reliability Trails
f) Use in connection with Motor Trade
EXCLUSIONS:(1)Any liability for death or injury to any passenger or third party or damage to property within or outside the vehicle caused by or arising out of use of the vehicle. (2)Any accidental Loss Or Damage and/or
liabilty caused sustained or incurred outside the geographical area.(3)Any claim arising out of any contractual liability.(4)Any accidental loss or damage to any property whatsoever or any loss or expense whatsoever resulting
or arising there from or any consequential loss.(5)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.(6)Any accidental loss or damage or liability directly or indirectly caused by or contributed to by or arising from
nuclear weapons material.(7)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 CSI
0 Compulsory 100 Imposed 0 Voluntary 0
(Under Section III)

This document is digitally signed

Signer: KALAIVENI SUBBIAH

Date: Thu, Jan 4, 2024 20:42:07 IST
Location: United India Insurance Company Ltd
1/2 Reason: Signing Policy for UIIC
SCHEDULE OF PREMIUM ( )
OWN DAMAGE PREMIUM TOTAL PREMIUM
Premium 1,950.00
Basic premium on Vehicle and Accessories
CGST(9%) 176.00
Basic OD 1,232.00
SGST(9%) 176.00
Total 1,232.00 TOTAL PAYABLE PREMIUM 2,302.00
Stamp Duty 1.00
SAC Code 997134
Add :
3123I112813203 &
Invoice No & Date
Nil Depreciation Without Excess 877.80 04/01/2024
Receipt Number 10117040023114419914
Consumables Cover 262.50 Receipt Date 04/01/2024
Receipt Amount 2,302.00
Sub Total (Additions) 1,140.30 Payment Mode
Paying Party MR DHANUS KARAN J
Less :

No Claim Bonus 20% 421.96

Sub Total (Deductions) 421.96

Gross OD 1,950.00

Existing TP Policy Details :

Policy No Insurer Name Insurer Address Policy Start Date Policy End date
1716013121P110179000 UIIC COIMBATORE 05/01/2022 04/01/2027
WARRANTED THAT IN CASE OF CANCELLATION OF EXISTING TP POLICY UNDER ANY CIRCUMSTANCES, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED.
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.

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.

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.

Date & Signature of Proposal : 04/01/2024

In Witness Whereof this policy has been signed at DO 4 COIMBATORE 170400 on this 04th day of January ,2024

CONSOLIDATED POLICY STAMP For United India Insurance Company Limited

DUTY PAID AS PER TAMILNADU
GOVT GO RT NO. 81
DT.22/2/2023 FOR THE
PERIOD 01/04/2023 TO
31/03/2024.
Duly Constituted Attorneys
IP Address: 10.95.40.80
Issuing Agent: GAYATHRI S Printed By : CUSTOMER @ 04/01/2024 8:43:33 PM Agent User Name: GAYSSS87
Agent Location: 170400 Underwritten By - GAYSSS87 ( DIRECT AGENT )

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

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