UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - PACKAGE POLICY

(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)

Policy No.

2215003116P107446985

Customer Id

23017371227
MrMR.SUSHILKUMARSHARMA
31 A/2, PREM NAGAR, NATHUPURA, BURARI

Name of the Insured

Address of the Insured

110084
NORTH DELHI
DELHI

Business/Occupation

Others

Certificate Number
Issuing Office Address
D 8, C.S.A. MARG
VIKAS MARG, LAXMI NAGAR
110092
EAST DELHI
DELHI
Telephone

2215003116P107446985
Code
221500

(011)22529875

Telephone:

Effective date of commencement of Insurance for the purpose of Act from 11:00 Hrs
on 06/09/2016

Insured's Declared Value

10667

Date of Expiry of the Insurance Midnight on05/09/2017

Particulars of Vehicle Insured
Registration No.
Vehicle

Trailer
(if any)

Obsolete Vehicle

Engine No.

Chassis No.

Make/Model

Type of Body

Year of Mfg

Cubic Capacity

Seating including
driver

DL - 13 - SF - 1562

No

GH09469

GH09645

Hero Honda /
HeroHonda
Passion PRO

Solo with Pillion

2009

100

Registration Authority
Geographical Area
Financier
DL13 EAST DELHI II: SURAJMAL VIHAR /

INDIA
SHAHDARA
Amount in words:
Eight hundred fifty-eight 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.
Limitations as to use
Premium:
746.00
Service Tax:
104.00
The policy covers use of the vehicle for any purpose other than
Swachh Bharat Cess:
4.00
a) Hire or Reward
b) Carriage Goods (other than samples or personal luggage)
Krishi Kalyan Cess:
4.00
c) Organized Racing
Stamp Duty:
1.00
d) Pace Making
Total(Rounded Off):
858.00
e) Speed Testing and Reliability Trials
Receipt Number :
10222150016104714700
f) Use in connection with Motor Trade
Receipt Date:
06/09/2016
DebitNote Number:

Document Date:

STax Regn No.:

AAACU5552CST001
Limits of Liability
Agency/Broker Code:
AGD0104692
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor
ABHAY SHARMA

Vehicles Act 1988

Dealer Name/Code:
Under Section II-I (ii) Damage to third party property in respect of any one claim or series

Direct Business:
of claims arising out of one event: 100000 /Developement Officer Code:
Cover Note No. :

Cover Note Date :

Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 22
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance
For and On behalf of
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988.
United India Insurance Co. Ltd.
Date of Issue: 06/09/2016

Duly Constituted Attorney

Underwritten by:ATUL KUMAR ( DO UNDERWRITER )

MOTOR INSURANCE - MOTORCYCLE / SCOOTER PACKAGE POLICY SCHEDULE

Policy Number
:2215003116P107446985
Geographical Area
:India(A)
Insured Name
:MrMR.SUSHILKUMARSHARMA
Insured address
:
31 A/2, PREM NAGAR, NATHUPURA, BURARI
City:
NORTHDELHI
District: NORTHDELHI
State:
DELHI
Pincode: 110084
Telephone:
Mobile:
7838262693
Business Channel Code: AGD0104692
Dealer Name:
Dealer Code:
VEHICLE DETAILS

Previous Policy No
:2215003115P105920638
Insurance Start Date & Time
:06/09/2016 11:00 (hours)
Insurance expiry Date & Time
:05/09/2017 midnight
Policy Issuing Office Address
:
D8,C.S.A.MARGVIKASMARG,LAXMINAGAR
City:
EASTDELHI
District:
EASTDELHI
State:
DELHI
Pincode:
110092
Telephone:(011)22529875
Business Channel Sub Code:
Agent Name:ABHAY SHARMA
Land Line No: ,Mobile:7838262693

Registration Number

DL - 13 - SF -1562

Obsolete Vehicle & Engine

Number

No&GH09469

Year Of
Manufacture

2009

RTA Name

DL13 EAST DELHI II: SURAJMAL VIHAR /

SHAHDARA

Chassis Number

GH09645

Cubic Capacity

100

Vehicle Make & Model

Hero Honda & Hero

HondaPassionPRO

Type Of Body

SolowithPillion

Seating Capacity(Including
SideCar)

Geographical
Extension

Registration Date

18/08/2009

AA Membership Number
INSURED DECLARED VALUE ( )
Vehicle

Trailer/Sidecar

Electrical/Electronic Accessories

Non Electrical Accessories

CNG Kit

LPG Kit

Total

10667

10667
OTHER DETAILS

Financier

Policy Subject to IMT Endorsements

22

CoInsurance
Details
100%

Applicable Addon-covers/Services

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 ( )
Owner Driver CSI
(Under Section IV)

DEDUCTIBLES (Under Section I) ( )

100000

Compulsory

Imposed

100

SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM

B-LIABILITY PREMIUM

Basic premium on Vehicle and Accessories

A. Basic OD

95.63

Total

95.63

B. Basic TP

619.00

Total

619.00

19.13
19.13

77.00

746.00

Service Tax

104.00

Swachh Bharat Cess:

4.00
4.00

TOTAL PAYABLE PREMIUM

Compulsory PA for Owner Driver

Sub Total (Deductions)

Premium(A+B)

Krishi Kalyan Cess:

50.00

Stamp Duty

50.00

Service Tax Regn. No.

Receipt Number
Receipt Date

Less :
No Claim Bonus 20%

TOTAL PREMIUM

Add :

Gross OD(A)

Voluntary

Sub Total (Additions)

Gross TP(B)

669.00

Gross OD & TP:

(A)+(B)

746.00

Receipt Amount
Payment Mode

858.00
1.00
AAACU5552CST001
10222150016104714700
06/09/2016
858.00
CASH
Mr MR.SUSHIL KUMAR
SHARMA

Paying Party

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 cooperation 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 Rs. 1 lakh or a claim for refund of premium exceeding Rs. 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.
Date&SignatureofProposal:06/09/2016
In Witness Whereof this policy has been signed at DO 15 NEW DELHI 221500 on this 06th day of September,2016 in lieu of Cover Note No Date .

For United India Insurance Company Limited

Affix Policy
Stamp

Duly Constituted Attorneys

IP Address:
Issuing Agent:
Agent Location:

10.95.3.65
ABHAYSHARMA
221500

Print Date:

07/09/2016 8:34:31 AM hours

Agent User Name:

ATU46606

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