UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
MOTORCYCLE / SCOOTER - LIABILITY ONLY POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 0125003124P112122333 Certificate Number 0125003124P112122333
Customer Id Issuing Office Address Code 012500
23359406535
DIVISIONAL OFFICE 25,A.R. COMPLEX,III FLOOR, 1090, POONAMALLEE HIGH ROAD,
Name of the Insured MR KARTHI GANESAN P
EMAIL: [email protected]
NO 9/5 KANTHAPPA GRAMINI STREET PURASAWALKAM VEPERY
600084
CHENNAI
CHENNAI
Address of the Insured TAMIL NADU
600007
Telephone (44) 26401432
CHENNAI
TAMIL NADU
Business/Occupation Others Mobile No.- 9600500717
Insured's Declared Value 0

Period of Insurance From 00:00 Hrs of 07/11/2024 To Midnight of 06/11/2025

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)
HONDA MOTORCYCLE & SCOOTER
TN - 01 - BE - JC65ET1234517 ME4JC658AJT037106 INDIA PVT LTD / CB SHINE - Solo with Pillion
No 2018 125 2
0220 SP125(CBF125ML) 3ID/SP125
DISC CBS-BSVI null
Registration Authority Geographical Area Financier
TN01 CHENNAI CENTRAL INDIA
Amount in words: Seven hundred eighty-four 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: 664.00
The policy covers use of the vehicle for any purpose other than CGST(9%): 60.00
a) Hire or Reward
SGST(9%): 60.00
b) Carriage Goods (other than samples or personal luggage)
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total(Rounded Off): 784.00
e) Speed Testing and Reliability Trials Receipt Number : 10101250024114323797
f) Use in connection with Motor Trade Receipt Date: 06/11/2024
DebitNote Number:
Document Date:
Limits of Liability Agency/Broker Code: AGD0040319
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor AMIT S. JAIN , Mobile: 9840286262
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
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: 06/11/2024
Note:-With reference to IRDAI circular no IRDAI/NL/CIR/MOTP/170/10/2018 dated 09/10/2018 and as
per the declaration given in the proposal form by owner driver Compulsory Personal Accident (CPA) cover is
removed, since he/she is not holding a valid driving license. For and On behalf of
United India Insurance Co. Ltd.

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.

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 - LIABILITY ONLY POLICY SCHEDULE
Policy Number :0125003124P112122333 Previous Policy No :
Geographical Area :India(A) Insurance Start Date & Time :07/11/2024 00:00 (hours)
Insured Name/ID : MR KARTHI GANESAN P/23359406535 Insurance expiry Date & Time :06/11/2025 midnight
Insured address : Policy Issuing Office Address :
NO 9/5 KANTHAPPA GRAMINI STREET PURASAWALKAM VEPERY CHENNAI DIVISIONAL OFFICE 25,A.R. COMPLEX,III FLOOR, 1090, POONAMALLEE HIGH ROAD, EMAIL:
City: CHENNAI District: CHENNAI [email protected] ,GST No.:- 33AAACU5552C1ZQ
State: TAMIL NADU Pincode: 600007 City: CHENNAI District: CHENNAI
Telephone: Mobile: 9600500717 State: TAMIL NADU Pincode: 600084
Telephone:(44) 26401432
Business Channel Code: AGD0040319 Business Channel Sub Code:
Dealer Name: Agent Name:AMIT S. JAIN
Dealer Code: Land Line No: ,Mobile:9840286262
VEHICLE DETAILS
Obsolete Vehicle & Engine Year Of
Registration Number TN - 01 - BE - 0220 No & JC65ET1234517 2018
Number Manufacture
RTA Name TN01 CHENNAI CENTRAL Chassis Number ME4JC658AJT037106 Cubic Capacity/KW 125
HONDA MOTORCYCLE &
SCOOTER INDIA PVT LTD
& CB SHINE -
Registration Date 23/02/2018 Vehicle Make & Model Type Of Body Solo with Pillion
SP125(CBF125ML)
3ID/SP125 DISC CBS-BSVI
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
0 0 0 0 0 0 0 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
20
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
0 Compulsory 100 Imposed 0 Voluntary 0
(Under Section III)
SCHEDULE OF PREMIUM ( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 664.00
B. Basic TP 714.00
CGST(9%) 60.00
Restricted TPPD Cover - 50.00 SGST(9%) 60.00
Gross OD(A) 0.00 Total 664.00 TOTAL PAYABLE PREMIUM 784.00
Stamp Duty 1.00
SAC Code 997134
3124I112122333 &
Invoice No & Date
06/11/2024
Gross TP(B) 664.00
Receipt Number 10101250024114323797
Total Liability Premium 664.00 Receipt Date 06/11/2024
Receipt Amount 784.00
Payment Mode
Paying Party MR KARTHI GANESAN P
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 : 06/11/2024

In Witness Whereof this policy has been signed at DO PERIAMET 012500 on this 06th day of November ,2024

CONSOLIDATED POLICY STAMP For United India Insurance Company Limited

DUTY PAID AS PER TAMIL NADU
GOVERNMENT G.O.(RT.) No.
278 dated 02.05.2024 FOR
THE PERIOD FROM 01.04.2024
TO 31.03.2025
Duly Constituted Attorneys
IP Address: 10.95.40.80
Issuing Agent: AMIT S. JAIN Printed By : CUSTOMER @ 06/11/2024 11:02:56 AM Agent User Name: AMIJAI001
Agent Location: 012500 Underwritten By - AMIJAI001 ( 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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