UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - PACKAGE
UIN: IRDAN545RP0222V01200708
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 0131003120P111202981 Certificate Number 0131003291386
Customer Id Issuing Office Address Code 013100
23009754526
Name of the Insured MR SYED SAMSUDEEN SB
FAGUN CHAMBERS, NO. 1 & 2, II FLOOR, 26A, ETHIRAJ SALAI, EGMORE, CHENNAI 600008
NO 12/12 MAIN STREET
600008
CHENNAI
Address of the Insured 600080
TAMIL NADU
CHENNAI
Telephone (044) 28261473,(044) 28252935
TAMIL NADU
Business/Occupation None Mobile No.- 9361405438
Insured's Declared Value 70000

Period of Insurance From 00:00 Hrs of 30/12/2021 To Midnight of 31/12/2025

Particulars of Vehicle Insured
Registration No.
Trailer Cubic Seating including
Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle (if Capacity/KW driver
any)
TN - 05 -CD G3N3E0106620ME1RG6672M0006124 YAMAHA MOTOR INDIA PVT LTD / Solo with Pillion
No 2021 149 2
2736 R15 MOTOR CYCLE null
Registration Authority Geographical Area Financier
TN04 CHENNAI INDIA
Amount in words: One thousand seven hundred one 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: 1,441.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 130.00
a) Hire or Reward
SGST(9%): 130.00
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 1,701.00
e) Speed Testing and Reliability Trials Receipt Number : 10101310023102414231
f) Use in connection with Motor Trade Receipt Date: 29/12/2021
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0043293
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor PRABHAKAR K , Mobile: 9840365044
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: 6000 /- Direct Business:
Development Officer Code:
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 20,22
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988.
Date of Issue: 29/05/2023
For and On behalf of
Amount Subject to Reverse Charges-NIL
United India Insurance Co. Ltd.
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.
Duly Constituted Attorney

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 MOTOR INSURANCE - MOTORCYCLE / SCOOTER - PACKAGE(UIN: IRDAN545RP0222V01200708) POLICY SCHEDULE
Policy Number :0131003123P102081319 Previous Policy No :P00
Geographical Area :India(A) Insurance Start Date & Time :30/05/2023 00:00 (hours)
Insured Name/ID : MR PRAVEEN KUMAR V/23009754526 Insurance expiry Date & Time :29/05/2024 midnight
Insured address : Policy Issuing Office Address :
NO 12/12 ARUMUGAM STREET MYLAPORE FAGUN CHAMBERS, NO. 1 & 2, II FLOOR, 26A, ETHIRAJ SALAI, EGMORE, CHENNAI 600008 ,GST No.:-
City: CHENNAI District: CHENNAI 33AAACU5552C1ZQ
State: TAMIL NADU Pincode: 600004 City: CHENNAI District: CHENNAI
Telephone: Mobile: 9361403318 State: TAMIL NADU Pincode: 600008
Telephone:(044) 28261473,(044) 28252935
Business Channel Code: AGD0043293 Business Channel Sub Code:
Dealer Name: Agent Name:PRABHAKAR K
Dealer Code: Land Line No: ,Mobile:9840365044
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number TN - 06 - R - 1038 No & G3C7E0062775 2016
Number Manufacture
RTA Name TN06 CHENNAI SOUTH EAST Chassis Number ME1RG0622G0011751 Cubic Capacity/KW 149
YAMAHA MOTOR INDIA
Registration Date 30/03/2016 Vehicle Make & Model PVT LTD & R15 MOTOR Type Of Body Solo with Pillion
CYCLE 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
70000 0 0 0 0 0 70000 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
20,22
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 warlike 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
1500000 Compulsory 100 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 1,441.00
Basic premium on Vehicle and Accessories B. Basic TP 714.00
CGST(9%) 130.00
A. Basic OD 502.04 Restricted TPPD Cover - 50.00 SGST(9%) 130.00
Total 502.04 Total 664.00 TOTAL PAYABLE PREMIUM 1,701.00
Stamp Duty 1.00
Add : SAC Code 997134
3123I102081319 &
Compulsory PA for Owner Driver 275.00 Invoice No & Date
29/05/2023
Gross OD(A) 502.00 Receipt Number 10101310023102414231
Receipt Date 29/05/2023
Sub Total (Additions) 275.00
Receipt Amount 1,701.00
Payment Mode
Gross TP(B) 939.00 Paying Party MR PRAVEEN KUMAR V

Gross OD & TP:

1,441.00
(A) + (B)

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 : 29/05/2023

In Witness Whereof this policy has been signed at DO 31 013100 on this 29th day of May ,2023

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.40.80
Issuing Agent: PRABHAKAR K Printed By : CUSTOMER @ 29/05/2023 3:55:44 PM Agent User Name: PRAK004
Agent Location: 013100 Underwritten By - PRAK004 ( 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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