UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE

TWO WHEELER-1 YEAR OWN DAMAGE COVER BUNDLED WITH 5 YEARS LIABILITY COVER UIN: IRDAN545RP0011V01201819

(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)

Policy No. 0103813122P108296513

Customer Id 231********

Name of the Insured MR DHILIPAN D

Address of the Insured

NO 84/44, THIYAGARAYAPURAM 10TH STREET,THIRUVOTTIYUR 600019

TIRUVALLUR

TAMIL NADU

Business/Occupation Others Mobile No.- 638*******

Certificate Number 0103813122P108296513

Issuing Office Address Code 010381

NO. 63, MADHAVARAM HIGH ROAD, FIRST FLOOR,

PERAMBUR Near Canara Bank/Shopping Singapore

600011

CHENNAI

TAMIL NADU

Telephone (044-********

Insured's Declared Value 108400

Period of Insurance

Own Damage From 19:04 Hrs of 19/11/2022 To Midnight of 18/11/2023 Liability From 19:04 Hrs of 19/11/2022 To Midnight of 18/11/2027 CPA Cover From 19:04 Hrs of 19/11/2022 To Midnight of 18/11/2023 Particulars of Vehicle Insured

Registration No.

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

Capacity/KW

Seating including

Vehicle driver

Trailer

(if any)

NEW No

DHXCNA22479

MD2A11CX1NCA63997

Bajaj Auto Ltd / PULSAR 150 SD

BS6

Solo with Pillion

2022 150.00 2

Registration Authority Geographical Area Financier TN03 CHENNAI NORTH EAST INDIA HANSRAJ SETHIA & SONS (HUF)(SOWCARPET,CHENNAI,TAMIL NADU-600079) Amount in words: Five thousand ten 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

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

Premium: 4,246.00

CGST(9%): 382.00

SGST(9%): 382.00

Stamp Duty: 1.00

Total(Rounded Off): 5,010.00

Receipt Number : 10101038122109591726

Receipt Date: 19/11/2022

DebitNote Number:

Document Date:

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: 6000 /-

Agency/Broker Code:

GOMATHI S, Mobile: 994*******

Dealer Name/Code:

Direct Business:

Development Officer Code:

AGN1014059

Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 7,20,22 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: 19/11/2022

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.

For and On behalf of

United India Insurance Co. Ltd.

Duly Constituted Attorney

1 / 3

MOTOR INSURANCE - TWO WHEELER-1 YEAR OWN DAMAGE COVER BUNDLED WITH 5 YEARS LIABILITY COVER(UIN: IRDAN545RP0011V01201819) POLICY SCHEDULE

Policy Number :0103813122P108296513 Previous Policy No : Geographical Area :India(A) Period of Insurance(Own Damage)

:From 19:04 Hrs of 19/11/2022 To Midnight of

18/11/2023

Insured Name/ID : MR DHILIPAN D/231********

Period of Insurance(Liability)

Period of Insurance(CPA)

:From 19:04 Hrs of 19/11/2022 To Midnight of

18/11/2027

:From 19:04 Hrs of 19/11/2022 To Midnight of

18/11/2023

Insured address : Policy Issuing Office Address :

NO 84/44, THIYAGARAYAPURAM 10TH STREET,THIRUVOTTIYUR City: TIRUVALLUR District: TIRUVALLUR

State: TAMIL NADU Pincode: 600019

Telephone: Mobile: 638*******

NO. 63, MADHAVARAM HIGH ROAD, FIRST FLOOR, PERAMBUR Near Canara Bank/Shopping Singapore

,GST No.:- 33AAACU5552C1ZQ

City: CHENNAI District: CHENNAI

State: TAMIL NADU Pincode: 600011

Telephone:(044-********

Business Channel Code: AGN1014059 Business Channel Sub Code: Dealer Name: Agent Name:GOMATHI S

Dealer Code: Land Line No:,Mobile:994*******

VEHICLE DETAILS

Registration Number NEW

Obsolete Vehicle & Engine

Number

No & DHXCNA22479

Year Of

Manufacture

2022

RTA Name TN03 CHENNAI NORTH EAST Chassis Number MD2A11CX1NCA63997 Cubic Capacity/KW 150.00 Registration Date 19/11/2022 Vehicle Make & Model

Bajaj Auto Ltd & PULSAR

150 SD BS6

Type Of Body Solo with Pillion

AA Membership Number

Seating Capacity(Including

SideCar)

2

Geographical

Extension

INSURED DECLARED VALUE Vehicle Trailer/Sidecar Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Co-

Insurance

Details

108400 0 0 0 0 0 108400 100%

OTHER DETAILS

Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services Unique

Reference Code

HANSRAJ SETHIA & SONS (HUF)(SOWCARPET,CHENNAI,TAMIL NADU- 600079)

7,20,22

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

(Under Section IV)

1500000 Compulsory 100 Imposed 0 Voluntary 0

SCHEDULE OF PREMIUM A-OWN DAMAGE PREMIUM

(From 19/11/2022 To 18/11/2023)

B-LIABILITY PREMIUM

(From 19/11/2022 To 18/11/2027)

TOTAL PREMIUM

Basic premium on Vehicle and Accessories

A. Basic OD 370.29

Total 370.29

Gross OD(A) 370.00

B. Basic TP 3,851.00

Restricted TPPD Cover - 250.00

Total 3,601.00

Add :

Compulsory PA for Owner Driver

(From 19/11/2022 To 18/11/2023)

275.00

Sub Total (Additions) 275.00

Gross TP(B) 3,876.00

Gross OD & TP:

(A) + (B)

4,246.00

Premium(A+B) 4,246.00

CGST(9%) 382.00

SGST(9%) 382.00

TOTAL PAYABLE PREMIUM 5,010.00

Stamp Duty 1.00

SAC Code 997134

Invoice No & Date

3122I108296513 &

19/11/2022

Receipt Number 10101038122109591726

Receipt Date 19/11/2022

Receipt Amount 5,010.00

Payment Mode

Paying Party MR DHILIPAN D

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 : 19/11/2022

In Witness Whereof this policy has been signed at MO PERAMBUR 010381 on this 19th day of November,2022 Affix Policy Stamp

For United India Insurance Company Limited

Duly Constituted Attorneys

IP Address: 10.95.40.80

Issuing Agent: GOMATHI S Printed By : CUSTOMER @ 19/11/2022 7:07:30 PM Agent User Name: GOMSSS83 Agent Location: 010381 Underwritten By - GOMSSS83 ( DIRECT AGENT ) 2 / 3

This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid. 3 / 3

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