UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE PRIVATE CAR - LIABILITY ONLY POLICY

(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989) Policy No. 1705013115P108473631 Customer Id 23018793155  Name of the Insured Mr. MR.R VETRIVEDIVELAN  

Address of the Insured

S/O RAMAN 106/1 MULLIMALAI    NILGIRIS 643219 TAMIL NADU

Business/Occupation Others  Telephone:  4232509364

Certificate Number 1705013115P108473631  Issuing Office Address Code 170501 SREEJI CHAMBERS    MOUNT ROAD,, BEDFORD CIRCLE   643101 NILGIRIS TAMIL NADU

 Telephone 0423 2231432 

Effective date of commencement of Insurance for the purpose of Act from   11:53   Hrs   on  23/10/2015 Date of Expiry of the Insurance Midnight on  22/10/2016

Insured's Declared Value    0

 Particulars of Vehicle Insured

Registration No.

Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of MfgCubic

CapacitySeating including

driverVehicleTrailer

(if any)

TN 38 6855    No   DT-02937  MM540DP4CH02 Mahindra &

Mahindra / JEEP   null  

AUTO  1995  2200  5 

 Registration Authority Geographical Area Financier

TN38 COIMBATORE NORTH  INDIA                Amount in words:   Five thousand seven hundred thirty-five rupees only

Persons or classes of persons entitled to drive Any person including Insured provided that a person hold 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 of Goods (other than samples or personal luggage) c) Organized Racing d) Pace Making e) Speed Testing and Reliability Trails f) Use in connection with Motor Trade

Premium:  5031

Service Tax:  704

Stamp Duty:   1Total (Rounded Off) :  5735

Receipt Number :  10217050115105302158

Receipt Date:  23/10/2015

DebitNote Number:  Document Date:  STax Regn No.: AAACU5552CST001

Limits of Liability Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor Vehicles Act 1988 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 750000

Agency/Broker Code: NANDAKUMAR T Dealer Name/Code: Direct Business: Developement Officer Code:

AGD0051643 

 

  Cover Note No.:     Cover Note Date:  Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 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.

For and On behalf ofUnited India Insurance Co. Ltd.

Duly Constituted Attorney:Date of Issue: 23/10/2015

Underwritten by-NANDAKUMAR T ( DIRECT AGENT )

MOTOR INSURANCE - PRIVATE CAR LIABILITY ONLY POLICY SCHEDULEPolicy Number :1705013115P108473631 Previous Policy No :  Geographical Area :India(A) Insurance Start Date & Time :23/10/2015 11:53 (hours)Insured Name :Mr. MR.R VETRIVEDIVELAN Insurance expiry Date & Time :22/10/2016 midnight

Insured address :  Policy Issuing Office Address : S/O RAMAN 106/1 MULLIMALAI  City: NILGIRIS  District: NILGIRIS State: TAMIL NADU  Pincode: 643219 Telephone:4232509364  Mobile: 9442961329 

SREEJI CHAMBERS MOUNT ROAD,, BEDFORD CIRCLE City: NILGIRIS  District: NILGIRIS State: TAMIL NADU  Pincode: 643101 Telephone:0423 2231432 

Business Channel Code:AGD0051643 Business Channel Sub Code:Dealer Name: Agent Name:NANDAKUMAR TDealer Code: Land Line No.: ,Mobile:9443603364VEHICLE DETAILS

Registration Number TN 38 6855  Obsolete Vehicle & Engine Number

No & DT-02937  Year Of Manufacture Vehicle Weight(Kg.)

1995  

RTA Name TN38 COIMBATORE NORTH  Chassis Number MM540DP4CH02  Cubic Capacity 2200 Registration Date 30/03/1995  Vehicle Make & Model Mahindra & Mahindra & JEEP   null Type Of Body AUTO AA Membership Number   Geographical Extension               Seating Capacity(Including

Driver)5 

INSURED DECLARED VALUE ( )

Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit TotalCo-

Insurance Details

0  0   0   0   0   0   0   100% OTHER DETAILS

Financier Policy Subject to IMT Endorsements 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 war like 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 (Under Section IV)

200000  Compulsory 2000  Imposed 0  Voluntary 0 

SCHEDULE OF PREMIUM( )

A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM

Gross OD(A) 0.00

B. Basic - TP 4,931.00

Total 4,931.00

Add :

Compulsory PA for Owner Driver 100.00

Sub Total (Additions) 100.00

Gross TP(B) 5,031.00

Total Liability Premium 5,031.00

Premium(A+B) 5031

Service Tax @14% incl.Edu Cess & Higher Edu Cess

704

TOTAL PAYABLE PREMIUM 5735

Stamp Duty 1

Service Tax Regn. No. AAACU5552CST001

Receipt Number 10217050115105302158 Receipt Date 23/10/2015 

Receipt Amount 5735 Payment Mode CASH Paying Party MR.R VETRIVEDIVELAN

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.inDISCLAIMER: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.Date & Signature of Proposal:23/10/2015 In Witness Whereof this policy has been signed at BO COONOOR 170501 on this 23rd day of October ,2015 in lieu of Cover Note No Date

Affix Policy Stamp

For United India Insurance Company Limited

Duly Constituted AttorneysIP Address: 10.95.3.65Issuing Agent: NANDAKUMAR T  Print Date: 23/10/2015 12:16:44 PM hours Agent User Name: NANT001 Agent Location: 170501 

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