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United India Insurance Company Limited

1) This document is a standalone compulsory personal accident insurance policy for Mr. Balaji R. providing coverage of Rs. 1,500,000 from August 26, 2023 to August 25, 2024. 2) The policy details include the nominee (Mr. Ramesh, father), driving license information, and linked motor vehicle insurance policy. 3) The total premium due is Rs. 325 including taxes.

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42 views3 pages

United India Insurance Company Limited

1) This document is a standalone compulsory personal accident insurance policy for Mr. Balaji R. providing coverage of Rs. 1,500,000 from August 26, 2023 to August 25, 2024. 2) The policy details include the nominee (Mr. Ramesh, father), driving license information, and linked motor vehicle insurance policy. 3) The total premium due is Rs. 325 including taxes.

Uploaded by

balajimr758
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

UNITED INDIA INSURANCE COMPANY LIMITED

NO-39, GANDHIJI ROAD,LIC DIVISIONAL OFFICE BUILDING "JEEVAN PRAKASH BUILDING"- GROUND FLOOR, THANJAVUR
- 613001
PH: (4362) 230236 FAX: (4362) 230270 EMAIL:

STANDALONE COMPULSORY PERSONAL ACCIDENT (OWNER -DRIVER) POLICY


POLICY NO.:0911003123P105901529
UIN NO. IRDAN545RP0013V01201819

PERIOD OF INSURANCE
From 00:00 Hrs of 26/08/2023
To Midnight of 25/08/2024

Insured
MR BALAJI R
NO 301 MIDDLE STREET MELAULUR ULUR WEST ORATHANADU TK THANJAVAUR
614904
THANJAVUR
CONTACT NUMBER: 8610439475 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name : RAMESH K


Agent Code : AGD0018716
9566816100
Mobile/Landline Number/Email :
rameshkvlm@gmail.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 091100@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 @ 24/08/2023 2:46:12 PM

This document is digitally signed

Signer: KALAIVENI SUBBIAH


Date: Thu, Aug 24, 2023 14:46:53 IST
Location: United India Insurance Company Ltd
1/3 Reason: Signing Policy for UIIC
STANDALONE COMPULSORY PERSONAL ACCIDENT (OWNER -DRIVER) POLICY
UIN NO. IRDAN545RP0013V01201819
SCHEDULE
Policy No: 0911003123P105901529 Previous Policy Number
Customer name/ID
MR BALAJI R/23239413958
:
Tel.(O) Fax Tel.(R) Mobile 8610439475
Bussiness/Occupation Others E-Mail dum@gmail.com
Period of Insurance From 00:00 Hrs of 26/08/2023 To Midnight of 25/08/2024

Coinsurance Details: UIIC 091100 : 100%

Coverage Details :-
Cover Sum Insured( ) Premium( )
PA Owner Driver 1,500,000.00 275.00

Nominee Details :-
Nominee Name Relationship
MR RAMESH Father

Driving license details :-


License Number License Expiry Date Vehicle Type
TN4920230002865 27/01/2044 Light Motor Vehicle,Motorcycle

Motor Policy Details :-


Policy Number Period of Insurance Name of the Insurer
0911003123P105900285 26/08/2023-25/08/2024 UNITED INDIA INSURANCE CO.LTD.

Premium: 275.00
CGST(9%): 25.00
SGST(9%): 25.00
Stamp Duty: 1.00
Total(Rounded Off): 325.00
Receipt Number : 10109110023106749173
Receipt Date: 24/08/2023

Agency/Broker Code : AGD0018716


RAMESH K
Dev. Officer Code :
Direct Business :

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POLICY NO.: 0911003123P105901529
UIN NO. IRDAN545RP0013V01201819

Customer GST/UIN No.: Office GST No.: 33AAACU5552C1ZQ


SAC Code: 997134 Invoice No. & Date: 3123I105901529 & 24/08/2023
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: 24/08/2023


IN WITNESS WHEREOF, this policy has been signed at DO THANJAVUR 091100 on this 24th day of August 2023

For and On behalf of CONSOLIDATED


United India Insurance Co. Ltd. STAMPS DUTY PAID
AS PER TAMILNADU
GOVERNMENT G.O.
(RT.)NO.146 DATED
28-03-2023 FOR THE
PERIOD FROM 01-
Duly Constituted Attorney(s) 04-2023 TO 31-03-
2024.
Underwritten By - RAMKKK001 ( 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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