2025040334062

Policy No. AVO/2318/11846742 Date 03-04-2025

GOPAL SUMAN
S/O KAMAR LAL SUMAN VILL
KHEJRA MAHAVEER PURA GUNA .
3001 473001
99******88
mpi***bra***gma***com

Dear GOPAL SUMAN

Welcome to Universal Sompo General Insurance family and we thank you for choosing us as your Insurance Partner for Standalone Motor Third Party
Insurance – Miscellaneous Vehicles policy.

We are committed to providing you with reliable motor insurance coverage. Ensuring your safety on the road is our top priority, and our policies are
crafted to provide you reliable protection and peace of mind.

We are pleased to share a list of those garages in your city which have been trusted and rated highly by our customers basis their experience. You
may like to consider their services in the unfortunate event of an accident or damage to your vehicle. Please visit below link to check the garage list or
scan the QR code.

To make your insurance experience seamless, we have introduced below tech-based solutions.

USGI PULZ App - One stop solution for all your insurance needs. Now enjoy below complimentary value-added benefits with our app.
· Insurance Wallet - Manage insurance policies on the go with buy and renew Option
· Claim Management - Intimate claim online and track claim status
· 24X7 Roadside Assistance*- In case you are in distress due to flat tyre, drained battery, minor repairing or towing of vehicle in case of break
down or accident of your vehicle, Key locked in car or lost, fuel run dry or arrangement of taxi/ ambulance.
· Location based Service - Find nearest authorised garages, nearest network hospital, nearest pharmacy, blood bank, wellness centre, lab test
centre, petrol pump, parking pollution centre. Also, you can track your daily activity, set reminders, and maintain your health profile and much
more
· Additional Services - Check pollution certificate, check vehicle challans, check fuel prices.
* Subject to Terms and conditions of Universal Sompo Policy covering the vehicle with RSA cover

AI-Powered Virtual Agent- Helps you intimate claim with ease.

You may reach us at our toll-free number 1-800- 200-4030 (Other Users), 1-800-22-4030 (MTNL/BSNL Users), or email us at
contactus@universalsompo.com Please visit www.universalsompo.com for detailed information on policy coverage, benefits, and exclusions.

Kindly go through the enclosed information in the attached policy copy. In case of any error, discrepancy, or clarification that you may need, please
let us know within 15 days of policy received, otherwise all particulars will be deemed to be correct. Please mention your policy number for any
communication with us.

Once again, we are delighted to have you with us.

Happy driving!
Digitally signed by VARSHA MANISH GUJARATHI
Date: 2025.04.03 16:23:11 IST
Reason:
Location:

scan to check Scan to download

Garage List USGI PULZ App
 UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED
Certificate of Insurance cum Policy Schedule

PRODUCT NAME :Standalone Motor Third Party Insurance – Miscellaneous Vehicles; POLICY NUMBER : AVO/2318/11846742
INSURED DETAILS INTERMEDIARY DETAILS INVOICE NUMBER USGAF231825843724
GOPAL SUMAN NAME HARISH SAHU POLICY / INVOICE ISSUED DATE 03-04-2025
S/O KAMAR LAL SUMAN VILL CODE 200627189960 EIA ACCOUNT NUMBER NA
KHEJRA MAHAVEER PURA GUNA . CONTACT NUMBER 9977449688 CKYC NUMBER AVO/2025040334062918
3001 473001 EMAIL ID mpitambra12@gmail.com GSTIN NUMBER
99******88 RTO LOCATION GUNA HYPOTHECATION / FINANCER NAME SHRIRAM FINANCE LTD
mpi***bra***gma***com
PERIOD OF INSURANCE FROM 00:00:00 OF
04/04/2025 TO MIDNIGHT OF
03/04/2026
POLICY ISSUANCE OFFICE E-5/18, FIRST FLOOR, BITTAN MARKET, ARERA COLONY, BHOPAL, MADHYA PRADESH -46201664,
462016
PAYMENT DETAILS INSTRUMENT/TRANSATCTION NUMBER: "C0304253646212 / 509349056013"; INSTRUMENT DATE:
"03-04-2025"; MODE OF PAYMENT: "OnlinePayment"
VEHICLE DETAILS
LICENSED
TRAILER CUBIC MFG. YEAR / CARRYING
REGISTRATION ENGINE CHASSIS
CHASSIS MAKE/MODEL BODY TYPE FUEL TYPE CAPACITY/KW/ REGISTRATION CAPACITY
NUMBER NUMBER NUMBER
NUMBER GVW DATE (including
driver)
MAHINDRA
2006/16-10-
MP-08-AA-2200 NATR6968 NATR6968 TRACTOR/575 TRACTOR Diesel 2450 / 2450 1
2006
BP
SECTION II - THIRD-PARTY LIABILITY SCHEDULE OF PREMIUM (Amount in Rs.)
Basic TP Premium 7,267
Add: Extension of Geographical area (IMT1) 0
Add: Bi-fuel/CNG/LPG Kit (IMT25) 0
Add: Trailers (IMT 30) 0
Less: Premium for TPPD (IMT20) 0
TOTAL BASIC THIRD-PARTY PREMIUM (A) 7,267
ADD: PA BENEFITS 0
Private Use-TP 0
Compulsory PA Cover for Owner Driver under Section III, SI Rs.15 Lacs 0
PA cover to unnamed passengers (IMT 16) No. of Passengers : "0" CSI per passenger: "0" 0
PA cover to Paid Driver, Cleaners, Conductors (IMT17) 0
Legal Liablity to paid driver (IMT28) 50
Legal Liability to NON-Fare paying passengers (IMT37) 0
TOTAL LIABILITY PREMIUM (B) 50
NET LIABILITY PREMIUM (A+B) 7,317
GST 18% : CGST (9%) "659" ; SGST (9%) "659" ; IGST (18%) "0"
1317

TOTAL POLICY PREMIUM 8,634

GEOGRAPHICAL AREA COMPULSORY DEDUCTIBLE (IMT22) 0 VOLUNTARY DEDUCTIBLE (IMT22A) 0
PREVIOUS POLICY NO. PYP POLICY PERIOD & INSURER NAME EXPIRING NCB
NOMINEE FOR OWNER DRIVER RELATIONSHIP
ENDORSEMENT DETAILS
ENDT. NO ENDORSEMENT DISCRIPTION EFFECTIVE DATE PREMIUM GST (18%) : CSGT (9%); SGST (9%) TOTAL PREMIUM
0 0 0
SPECIAL CONDITIONS
SUBJECT TO IMT ENDORSEMENT NOS. AND MEMORANDUM PRINTED HEREIN / ATTACHED HERETO:
DRIVER (Persons or classes of persons entitled to drive): Any person including the insured, provided that a person driving holds an effective driving license at the time of the
accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an effective Learner's License may also drive the vehicle and
that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 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 f) Reliability Trials g) Any purpose in connection with Motor Trade.
LIMITS OF LIABILITY: A) Under Section II 1 (i) of policy (Death of or bodily injury) Such amount as is necessary to meet the requirements of the Motor Vehicles Act,1988. B)
Under Section II 1 (ii) of policy (Third Party Property Damage) - in respect of any one claim or series of claims arising out of one event (Rs.6000/- or Rs.7,50,000/- as may be
applicable). C) P.A Cover under Section III for owner Driver (CSI) - Rs.15,00,000/-.
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 from the insured. See the clause headed "AVOIDANCE
OF CERTAIN TERMS AND RIGHT OF RECOVERY".
DISCLAIMER: Policy is valid subject to Realization of premium.Please visit our website www.universalsompo.com to know more about the policy coverage, benefits, and
exclusions. Kindly write to us on contactus@universalsompo.com to get the copy of the policy wordings, if required.
CLAIM DISCLAIMER: : In the unfortunate event of any loss or damage to the insured property FOR UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED
resulting into a claim on this policy, please intimate the mishap IMMEDIATELY to our Call
Centre at Toll Free Numbers on 1800-22-4030/1-800-200-4030 or on chargeable numbers at
+91-22-27639800 / +91-22-39133700. Email at contactclaims@universalsompo.com. Please
note that no delay should be allowed to occur in notifying a claim on the policy as the same
may prejudice liability. I/We hereby certify that the policy to which the certificate relates as
well as the certificate of insurance are issued in accordance with the provision of chapter X, XI IRDAI UIN NO:
of M. V. Act 1988. IRDAN134RP0004V01
202122 DULY CONSTITUTED ATTORNEY(S)
SAC CODE: 997134 USGI IRDAI REGISTRATION NO: 134
In Witness whereof this Policy has been signed at Mumbai in lieu of covernote No. Consolidated stamp duty Rs . 1 paid towards Insurance policy stamp vide receipt no.
LOA/ENF-1/CSD/19/2024-25/2348 dated of General Stamp Office Mumbai.
NOTE: 1) Please include your policy number for any communication with us. 2) The policy schedule should be read in conjunction with Policy wording and CIS.
Registered Office Address: 8th Floor and 9th Floor, Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway, Goregaon East, Mumbai -
400062
Contact Address: Universal Sompo General Insurance Co. Ltd. Airoli Office-Unit No.601 & 602, A wing, 6th floor, Reliable Tech Park, Cloud City Campus, Gut no 31, Mouje
Elthan, Thane Belapur Road, Airoli, Navi Mumbai - 400708
1) If You have a query about any matter relating to the Policy, or our decision on any matter, or the claim you may call us on 1-800-224030 or email us at
Contactus@universalsompo.com. In case, You are not satisfied with the decision/resolution or have not received any response within 15 working days, You may write or email
to Grievance Redressal Officer gro@universalsompo.com or visit any of our branches GRO. For updated details of grievance officer (name and number), kindly refer the link
https://www.universalsompo.com/resourse-grievance-redressal and click on Branch wise Grievance Redressal Officer
2) Universal Sompo General Insurance Co. Ltd. shall abide by Insurance Regulatory and Development Authority (Protection of Policyholder’s Interests) Regulations 2024.
Under this regulation and with an objective to provide a forum to Personal Lines policy holders for resolution of claims related complaints, Insurance Ombudsman has been
constituted under the aegis of Governing Body of Insurance Council. For further Information you could refer https://www.cioins.co.in/ombudsman
UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED

PROPOSAL FORM CUM TRANSCRIPTION LETTER FOR Standalone Motor Third Party Insurance – Miscellaneous Vehicles
INSURED DETAILS VEHICLE DETAILS PROPOSAL DETAILS
MAKE MAHINDRA TRACTOR PROPOSAL NUMBER USN2025040334062918
MODEL 575 BP ISSUANCE DATE 03-04-2025
FROM 00:00:00 OF
GOPAL SUMAN RTO MP08 PERIOD OF INSURANCE 04/04/2025 TO MIDNIGHT
S/O KAMAR LAL SUMAN VILL OF 03/04/2026
KHEJRA MAHAVEER PURA REGISTRATION NUMBER MP-08-AA-2200 RTO LOCATION GUNA
GUNA .3001 473001 ENGINE NUMBER NATR6968 HYPOTHECATION/FINANCER NAME SHRIRAM FINANCE LTD
99******88 CHASSIS NUMBER NATR6968 FUEL TYPE Diesel
mpi***bra***gma***com CUBIC CAPACITY/GVW/KW 2450 / 2450 LICENSED CARRYING CAPACITY 1
TRAILER CHASSIS NUMBER PUBLIC CARRIER/PRIVATE CARRIER
MANUFACTURING YEAR /
2006 GSTIN NUMBER
REGISTRATION DATE
SCHEDULE OF PREMIUM (Amount in Rs.)
BASIC THIRD-PARTY PREMIUM 7,267
Compulsory PA Cover for Owner Driver under Section III, SI Rs.15,00,000/- 0
PA Cover to named passengers (IMT15) 0
PA cover to unnamed passengers (IMT 16) No. of Passengers : "0" CSI per passenger: "0" 0
PA cover to Paid Driver, Cleaners, Conductors (IMT17) 0
Legal Liablity to paid driver (IMT28) 50
Negligence Of Hirer Or Hirers Employee 0
Legal Liability to NON-Fare paying passengers (IMT37) 0
TOTAL LIABILITY PREMIUM 7317
GST (18%) : CGST (9%) "659"; SGST (9%) "659"; IGST (18%) "0" 1317
TOTAL PREMIUM 8,634
SPECIAL CONDITION
GEOGRAPHICAL AREA COMPULSORY DEDUCTIBLE (IMT22) 0 VOLUNTARY DEDUCTIBLE (IMT22A) 0
INTERMEDIARY NAME HARISH SAHU INTERMEDIARY CODE 200627189960 INTERMEDIARY CONTACT DETAILS 9977449688
NOMINEE FOR OWNER DRIVER RELATIONSHIP
PREVIOUS POLICY NUMBER PYP INSURER & POLICY PERIOD EXPIRING NCB
ANTI REBATE CLAUSE
Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended):
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or
property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an insurance agent of commission in
connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such
acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees..
TERMS AND CONDITIONS
I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C:
A) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract
between me/us and Universal Sompo General Insurance Company Limited.
B) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately.
C) Any person who, knowingly and with intent to defraud the Insurance Company or other persons, files a proposal for insurance containing any false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a denial of insurance
benefits.
GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details provided
during policy issuance. For any subsequent changes or addition (i.e. if GSTIN not entered at the time of policy issuance) on policy schedule, changes shall be carried out through fresh policy issuance
with prospective effect.
D) Your policy will be cancelled in case vehicle class/category of the vehicle is different than what is mentioned in policy schedule.
E) I understand the Proposal No."DYNAMIC FIELD" is issued to me basis on above information.
F) I understand that my premium is derived on the basis of information filled by me, which includes my previous year policy details and No claim Bonus Discount %, if any.
Universal Sompo General Insurance Company Limited may verify my previous year policy details and may hold claim settlement process till the time confirmation is received from previous insurer. The
Company shall have no liability under this insurance contract if it is found that any of my / our statement on particulars or declaration (other than NCB discount) in this proposal form or other
documents are incorrect and / or untrue / false.
If any discrepancy found in the information provided for arriving at NCB discount %, Company shall communicated to me via e-mail and or letter for payment of the balance premium amount within 20
days from the date of communication. If the balance amount is not paid by me within 20 days from the date of communication, then claim will be paid proportionately.
G) I / we declare and confirm having a valid PUC / Fitness Certificate.
Transcript Declaration : In case disagreement or objection or any other changes with respect to information and contents mentioned herein above, please contact our toll free number and register
your objections / changes / disagreement to the content of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days from date of your
receipt of this transcript along.
AML Declaration:
1.I/We hereby confirm that all premiums have/will be paid from bona fide sources and no premium have/will be paid out of proceeds of crime related to any of the offences as listed under Prevention
of Money Laundering Act, 2002 and its subsequent amendments as applicable
2.I understand that the company has the right to call for documents to establish the sources of funds.
3.The insurance company has the right to cancel the insurance contract in case I am/have been found guilty by any competent court of law under any of the statues, directly or indirectly governing the
prevention of money laundering in India.
Email-Id : contactus@universalsompo.com Toll-Free No : 1800 200 4030 / 1800 22 4030