UNITED INDIA INSURANCE COMPANY LIMITED

BRANCH OFFICE - 150804, DR.VULLAKI STREET, SALIPET, TENALI.

GUNTUR - 522201 ANDHRA PRADESH
PH:  (8644) 228083   FAX:     EMAIL:  

MOTORCYCLE / SCOOTER
PACKAGE POLICY
POLICY NO.:1508043119P109191204
VEHICLE NO.:AP - 07 - CB - 6568
 

PERIOD OF INSURANCE
From 12:49 Hrs of 11/10/2019
To Midnight of 10/10/2020

 
Insured
 MR CHOWDARY CHAKRAVARTHY MALLOLU 
S/O SAMUEL JOHN, D NO 1-68, BALIJEPALLI, VEMURU PO
522261
GUNTUR
ANDHRA PRADESH
CONTACT NUMBER: 9550102181 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

 
 
 
  Agent Name : TARAKUMAR M
  Agent Code : AGN1014193
  Mobile/Landline Number/Email : 9908271061
 
 
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 150804@uiic.co.in
 
Regd Office: 24 Whites Road, Chennai-600014,Head Office: No.19,Lane IV,Nungambakkam High Road, Chennai-600034.
Website: http://www.uiic.co.in
Printed By : CUSTOMER @ 11/10/2019 2:21:02 PM
  

UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER PACKAGE POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1508043119P109191204    Certificate Number 1508043119P109191204  
Customer Id 23025817282    Issuing Office Address Code 150804   
Name of the BRANCH OFFICE - 150804, DR.VULLAKI STREET, SALIPET, TENALI.
 MR CHOWDARY CHAKRAVARTHY MALLOLU
Insured
S/O SAMUEL JOHN, D NO 1-68, BALIJEPALLI, 522201
VEMURU P O GUNTUR
Address of the ANDHRA PRADESH
Insured 522261 Telephone (8644) 228083   
GUNTUR
ANDHRA PRADESH
Business/Occupation Service    Telephone :  
Insured's Declared Value    32143   
Period of Insurance From 12:49 Hrs of 11/10/2019 To Midnight of 10/10/2020
Particulars of Vehicle Insured
Seating
Obsolete Year of Type of Cubic
Registration No. Engine No. Chassis No. M a k e / Model including
Vehicle Mfg Body Capacity/KW
driver
Honda Motorcycle and SOLO
AP - 07 - CB - JC36E76023164 ME4JC36NBF7297562 Scooter India, Private WITH
No    2015    125    2   
6568          Limited (HMSI) / CB Shine PILLION
  Self-Drum-Alloy   
Registration Authority Geographical Area   
AP07 GUNTUR    INDIA            
Amount in words: One thousand four hundred eighteen 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: 1,202.00
CGST(9%):   108.00 
The policy covers use of the vehicle for any purpose other than SGST(9%):   108.00 
a) Hire or Reward Stamp Duty: 1.00
b) Carriage Goods (other than samples or personal luggage)
Total(Rounded off): 1,418.00
c) Organized Racing
d) Pace Making Receipt Number :  10115080419109743315
e) Speed Testing and Reliability Trials Receipt Date:   11/10/2019
f) Use in connection with Motor Trade DebitNote Number:  
Document Date:  
Limits of Liability Agency/Broker Code: AGN1014193
Under Section II-I (i) Death or bodily injury in respect of any one TARAKUMAR M  
accident; As per Motor Vehicles Act 1988 Direct Business:
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: Dev Officer :  
100000 /-
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 For and On behalf of
the certificate of insurance are issued in accordance with provisions of United India Insurance Co. Ltd.
Chapter X & XI of M.V Act, 1988.
Date of Issue: 11/10/2019

Duly Constituted Attorney

 PolicyNo.: 1508043119P109191204

MOTORCYCLE / SCOOTER PACKAGE POLICY

SCHEDULE
Policy No. 1508043119P109191204    Previous Policy No. 1508043118P108856537   
Customer Id 23025817282   
Name  MR CHOWDARY CHAKRAVARTHY MALLOLU   
Insured Details Tel (O):    Tel (R)   Fax:   
Email: vagolusyam@gmail.com  Mobile: 9550102181   
Business / Occupation Service   
Period of Insurance From 12:49 Hrs of 11/10/2019 To Midnight of 10/10/2020
C o-Insurance Type

Particulars of Vehicle Insured

Seating
Obsolete Year of Type of Cubic
Registration No. Engine No. Chassis No. M a k e / Model including
Vehicle Mfg Body Capacity/KW
Side Car
Honda Motorcycle and SOLO
AP - 07 - CB - JC36E76023164 ME4JC36NBF7297562 Scooter India, Private WITH
No    2015    125    2   
6568          Limited (HMSI) / CB Shine PILLION
  Self-Drum-Alloy   
Insured's Declared Value
Electrical/Electronic CNG Unit LPG Unit Total
For Vehicle For Side Car Non Electrical Accessories
Accessories Value

32143
32143    0    0    0    0    0   
  
Registration Authority Auto Association Membership No. Geographical Area Extension
AP07 GUNTUR     INDIA              
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
The policy covers use of the Vehicle for any purpose other than:
a) Hire or Reward
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing
d) Pace Making
e) Speed Testing and Reliability Trials
f) Use in connection with Motor Trade
Limits of Liability As narrated in the Certificate of Insurance attached herewith.
EXCLUSIONS :
1) Any accidental loss or damage or Liability / caused or sustained or incurrred 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 any expense whatsoever resulting or arising there from or
any consequential loss.
4) Any liability of whatsoever nature directly or indirectly caused by or constituted to or by or 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 or liability directly or indirectly or proximatley or remotely occasioned by contributed to, by or traceable to
or arising out of or in connection with war, invasion, 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 consequence of any of the said
occurrences or may consequence thereof and in default of such proof, the Company shall not be liable to make any payment in respect
of such a claim.
Personal Accident covers for Owner-Driver CSI:  1500000
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein / attached hereto 22
Imposed Excess   0   
Voluntary Excess   0
Compulsory Excess   100
 PolicyNo.: 1508043119P109191204
SCHEDULE OF PREMIUM (IN )
OWN DAMAGE LIABILITY

Basic premium on Vehicle and Accessories B. Basic TP 752.00

A. Basic OD 269.36 Total 752.00
Total 269.36
Add :
Compulsory PA for Owner Driver 275.00
Less :
No Claim Bonus 35% 94.28 Sub Total (Additions) 275.00
Sub Total (Deductions) 94.28
Gross TP(B) 1,027.00
Gross OD(A) 175.00 Gross OD & TP:
1,202.00
(A) + (B) 

AMOUNT IN WORDS: One thousand four hundred eighteen rupees only

TERMS AND 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 UIIC WEBSITE :
www.uiic.co.in
DISCLAIMER : THE POLICY STANDS CANCELLED OR VOID IN THE EVENT OF CHEQUE DISHONOR. THE COMPANY MAY CANCEL THE POLICY
BY SENDING 7 DAYS NOTICE IN CASE OF ANY FRAUD OR MISREPRESENTATION, NON-DISCLOSURE OF MATERIAL FACT OR NON-C O-
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
VEHICLES ACT, 1988 IS RECOVERABLE FROM THE INSURED. SEE THE CLAUSE HEADED "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF
RECOVERY". FOR LEGAL INTERPRETATION, ENGLISH VERSION WILL HOLD GOOD.
 
Agency/Broker Code:   AGN1014193
Premium:   1,202.00 Receipt Number :   10115080419109743315
TARAKUMAR M
CGST(9%): 108.00 Receipt Date :   11/10/2019Direct Business:  
SGST(9%): 108.00
Development Officer   
Stamp Duty:   1.00 DebitNote Number :   
Code:
Total (Rounded Off):   1,418.00 Document Date :   
       

Customer GST/UIN No.:   Office GST No.: 37AAACU5552C1ZI 

SAC Code: 9971  Invoice No. & Date: 3119I109191204 & 11/10/2019 
Amount Subject to Reverse Charges-NIL

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: 11/10/2019

IN WITNESS WHEREOF, this policy has been signed at BO TENALI 150804 on this 11th day of October 2019.
 
For and On behalf of
United India Insurance Co. Ltd.

Affix Policy
Stamp here.

Duly Constituted Attorney:

Underwritten By - TARMMM80 ( DIRECT AGENT )

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