MOTOR INSURANCE - Two Wheeler Liability Only SCHEDULE

Policy Number :22300031250160466447 Previous Policy Number :

Geographical Area :India Insurance Start Date & Time :07/05/2025 0:00 (hours)
Insured Name :JUBIN DEKA Insurance Expiry Date & Time :06/05/2026 midnight
Insured Address : Policy Issuing Office Address :

Divisional Office-30 (Gurugram) Unit no: 34,35,6A,6B,Ground Floor,Vipul Trade Centre, Sector-48,
VILL- TETELIA,PS- DHOPGURI,KAMRUP,
Sohna Road
City :GUWAHATI
City :GURUGRAM District :Gurugram
State :ASSAM Pincode :781123
State :HARYANA Pincode :122001
Mobile No :9957303972
Office Contact Details :0124-2213171 Email Id :pb.support@uiic.co.in
Email :mrofficial80555@gmail.com
GSTIN :06AAACU5552C1ZN

Business Channel Code: NA Business Channel Sub Code: BRC0001039

M/S POLICYBAZAAR INSURANCE BROKERS
Helpline No: 18002585970 Broker Name :
PRIVATE LIMITED
IRDA License Code - Number: IRDA/DB797/19 - 742
VEHICLE DETAILS
Year of Manufacture Vehicle
Registration Number AS01DM3241 Engine Number JF39EU2184784 2017
Weight(kg.)
RTA Name AS01 Guwahati Chassis Number ME4JF39DKHU111991 Cubic Capacity / GVW 102

Registration Date 26/10/2017 Vehicle Make & Model HONDA - Dio - STD (102 cc) Type of Body Two Wheeler
AA Membership Name Seating Capacity 2 Geographical Extension NoExtn

INSURED DECLARED VALUE (IN RUPEES)

Electrical /Electronic Non-Electrical Co-Insurance
Vehicle Trailer FiberGlass CNG Kit LPG Kit TOTAL
Accessories Accessories Details
0 0 0 0.00 0.00 0.00 0.00 0 0.00

OTHER DETAILS
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers

LIMITS OF LIABILITY : PERSONS OR CLASS OF PERSONS ENTITLED TO DRIVE: As narrated in the certificate of insurance
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor Vehicles Act attached herewith.
1988. LIMITATIONS AS TO USE : As narrated in the certificate of insurance attached herewith.
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: 100000/-
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) N/A Compulsory 0.00 Imposed 0.00 Voluntary 0.00

SCHEDULE OF PREMIUM (IN RUPEES)

A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
Basic Own Damage 0 Basic TP Liability 714 Package Premium 714
Anti Theft Device Discount PA Owner Driver 0 GST @18.00% 129
Nil depreciation withoutExcess 0 PA for Unnamed Passenger 0
Roadside Assistance Cover
0
Premium
Engine Protection Cover
0
Premium
RTI Cover Premium 0
NCB Discount @ 0 % 0 Sub Total (Deductions) 0
Total 0 Total 714

TOTAL PAYABLE PREMIUM 843

Receipt Date 06/05/2025
Receipt Amount 843
Payment Mode Online
Paying Party JUBIN DEKA

CHEQUE DETAIL
Cheque Number Cheque Date Bank Name Branch Name Branch Code Cheque Signatory MICR No
PB125415656 06/05/2025 bank name JUBIN DEKA

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 allUnited 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 ofwider 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 ANDRIGHT 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: 06/05/2025 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 In case of any claim, you can contact nearest local office of United India
GRN NO. 75907349 DTD 31/03/2021 AND
CIN. NO. 122748020 DTD 06/04/2021 ISSUED BY Insurance Company ltd. or contact on 0124-2213171 or
TREASURY OFFICER, GURGAON pbservicehubgurugram@uiic.co.in
Duly Constituted Attorneys
IP Address:
2401:4900:752c:8e92:bb72:89e6:4c47:ef1b, 23.215.60.68, Print Date: 6/5/2025 16:09:34
104.124.54.61, 10.40.1.220