Policy Bazaar Services: 1800 258 5970
Tollfree numbers Claims : 1800 258 5881
MOTOR INSURANCE ‐ PRIVATE CAR PACKAGE POLICY SCHEDULE
Policy Number :22300031240160095080 Previous Policy Number :BCCA00775590800/00
Geographical Area :India Insurance Start Date & Time :30‐01‐2024 00:00﴾hours﴿
Insured Name :Mr SAYEED AHMED K S Insurance Expiry Date & Time :29‐01‐2025 Midnight
Insured Address : Policy Issuing Office Address :
Scala Developers, F no 302, 7th Cross, 2nd main , gospel street, Divisional Office‐30 ﴾Gurugram﴿ Unit no: 34,35,6A,6B,Ground Floor,
Richard's town Vipul Trade Centre, Sector‐48, Sohna Road,
City :BANGALORE RURAL City :Gurugram District :Gurugram
State :KARNATAKA Pincode :560084 State :Haryana Pincode :122001
Mobile No :9738613376 GSTIN : Office Contact Details :0124‐2213170 Email ID :pb.support@uiic.co.in
Email :itssayeed.ks@gmail.com Fax : GSTIN :06AAACU5552C1ZN
Business Channel Code: NA Business Channel Sub Code: BRC0001039
M/S POLICYBAZAAR INSURANCE BROKERS PRIVATE
Mobile No.: 18002585970 ﴾Service﴿ , 18002585881 ﴾Claims﴿ Broker Name :
LIMITED
IRDA License Number: IRDA/ DB 797/ 19
VEHICLE DETAILS
Year of Manufacture Vehicle
Registration Number KA‐03‐MT‐5800 Engine Number D4FBDU346224 2014
Weight﴾kg.﴿
KA03 KA03 BANGALORE EAST:
RTA Name Chassis Number MALCU41ULEM160649 Cubic Capacity / GVW / KWH 1582
INDIRANAGAR ‐ 560038
Registration Date 06/03/2014 Vehicle Make & Model HYUNDAI ‐ VERNA ‐ CRDI SX Type of Body ‐
AA Membership Name Seating Capacity 5 Geographical Extension
INSURED DECLARED VALUE ﴾IN RUPEES﴿
Electrical /Electronic Non‐Electrical Co‐Insurance
Vehicle Trailer FiberGlass CNG Kit LPG Kit TOTAL
Accessories Accessories Details
350,000.00 0 0 0 0 0.00 0.00 350,000.00 0.00
OTHER DETAILS
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers
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.
OTHER DETAILS
EXCLUSIONS: ﴾1﴿ Any accidental loss or damage and/or liability 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 or liability directly or indirectly or proximately or remotely occasioned
by 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 consequence 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 ﴾In Rupees﴿ DEDUCTIBLES ﴾Under Section I﴿ ﴾In Rupees﴿
Owner‐ Driver ﴾Under section IV﴿ 0 Compulsory 2,000.00 Imposed 0 Voluntary 0.00
SCHEDULE OF PREMIUM ﴾IN RUPEES﴿
A‐OWN DAMAGE PREMIUM B‐LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
Basic Own Damage 12,642.00 Basic TP Liability 7,897.00 Package Premium 9,414.04
NCB Discount@20% 379.26 PA Owner Driver 0.00 GST @18.00% 1,695.00
Sub Total﴾Additions﴿ 0.00 Sub Total ﴾Additions﴿ 0.00 TOTAL PAYABLE PREMIUM 11,109.00
Sub Total ﴾Deductions﴿ 11,124.96 Sub Total ﴾Deductions﴿ 0 Stamp Duty Rs. 1
Total 1,517.04 Total 7,897.00 Receipt Date 28/01/2024
Receipt Amount 11,109.00
Payment Mode Online
Paying Party Sayeed Ahmed
CHEQUE DETAIL
Cheque Number Cheque Date Bank Name Branch Name Branch Code Cheque Signatory MICR No
PB86334090 28/01/2024 402869039410 Sayeed Ahmed
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 http://uiic.co.in/sites/default/files/uploads/downloadcenter/IndianMotorTariff.pdf.
For terms and conditions for add on covers go to : http://uiic.co.in/sites/default/files/uploads/downloadcenter/motor_additional_covers.pdf
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 from 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: 28/01/2024 00:00:00.0
In Witness whereof this Policy has been signed at GURGAON this day of , Date
For United India Insurance Company Limited
CONSOLIDATED STAMP DUTY PAID VIDE
GRN NO. 75907349 DTD 31/03/2021
ISSUED BY TREASURY OFFICER, GURGAON
Duly Constituted Attorneys
IP Address: 116.75.82.119, 184.84.232.54, 23.212.50.103
Print Date: 28/01/2024 04:15:49hours
United India Insurance Company Ltd : IRDA Reg: No : 545
Policy Schedule generated by Policy Bazaar on 28‐01‐2024 04:15:49hours
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
"IN CASE OF CLAIM KINDLY CONTACT OUR NEAREST LOCAL OFFICE".
