United India Insurance Company Limited

IRDAI Regn. No. 545. CIN - U93090TN1938GO1000108

CERTIFICATE CUM POLICY SCHEDULE

ORIGINAL FOR RECIPIENT / DUPLICATE FOR SUPPLIER
TAX INVOICE/CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLES RULES, 1989)

Package Policy (Commercial Vehicle - Passenger Carrying) & Proposal No & Date N0007488330 / 09-Jul-2025 20:11
Policy Type & UIN
IRDAN545P0222V01200708 Period of Insurance 09-JUL-2025 20:12 to 08-JUL-2026 23:59
Policy No 04280031250160096054 Vehicle Identification No. MA3ZFDFSKSG227557
Policy Issued On 09-Jul-2025 20:12 Geographical Area India
Insured Name Mr. SUNIL DANGI GST No & State NA | Madhya Pradesh
Invoice No 25MI60096054
23 BHAIRWAKHEDI , TEH KHICHIPUR KULI KHEDA RAJGARH, Accounting Code of Service 997134
Insured Address
KHILCHIPUR , MADHYA PRADESH-465679
Insured State & Code Madhya Pradesh - 23 Place of Supply Madhya Pradesh GSTIN of Customer GSTUNREGISTERED
MOTOR VEHICLE DETAILS
Make Maruti Suzuki Seating Capacity 5
Model - Variant MARUTI TOUR S CNG 1.2L 5MT Type of Body | Color Sedan | PEARL ARCTIC WHITE
Registration No NEW Fuel Type CNG/Petrol
Year of Manufacture 2025 RTO Location INDORE | MP-09
Engine - Chassis No Z12ENF127082 - MA3ZFDFSKSG227557 Zone B
Cubic Capacity 1197 FASTag ID
Insured Declared Value(₹)
Vehicle ₹ 738150 Non Electrical Accessories ₹ 0 Electrical Accessories ₹ 0 CNG/LPG Kit ₹ 0 Total IDV ₹ 738150
Schedule of Premium(Amount in ₹)
OWN DAMAGE SECTION (A) LIABILITY SECTION (B)
Vehicle ₹ 6184 Basic Third Party Liability ₹ 11852
Extra premium towards inbuilt CNG/LPG ₹ 309 Third Party Liability for Bi-fuel Kit ₹ 60
Basic Premium ₹ 6493 Compulsory PA Cover Premium [1 Year ],(Sum Insured 15 lakhs) ₹ 275
Deductibles Legal Liability (WC) to Driver (IMT-28) ₹ 50
Anti-Theft Device (IMT-10) ₹ 155 Legal Liability to Non Fare Paying Passenger(IMT-37) ₹ 125
Sub-Total Deductibles ₹ 155 PA Cover For Paid Driver (IMT-17) of Rs.100000 ₹ 60
NIL Depreciation Add on cover (IRDAN545P0222V01200708) ₹ 3174 Net Liability Premium (B) ₹ 12422
Net own Damage Premium (A) ₹ 9512 Total Premium (A+B) ₹ 21934
IGST @18% ₹ 3948.12
Gross Premium Paid ₹ 25882
Point of Sale - RUKMANI MOTORS PVT LTD
Notes:-
1. Policy Issuance is subject to realisation of premium.
2. Consolidate stamp duty paid to State Exchequer.
3. Policy is subject to a compulsory Deductible of Rs. 500 (IMT-21)
4. Voluntary excess Rs. 0
5. Subject to Endorsements IMT 10,28,17,37
Nominee Details
Nominee Name: MR BHAGWAN SINGH Age: 29 Relation: Brother
Financier Details
Financier Type: Financed Financier Name: AU SMALL FINANCE BANK LTD Financier Branch: JIRAPUR
Payment Details
Payment Mode: Credit Card Cheque No/Transaction No: 113844425652 Bank Name: HDFC BANK LIMITED. Amount: 25882
Limitations as to use:- The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-section 3 of Section 66 of the Motor Vehicle's Act 1988.The
Policy does not cover use for: (1) Organised racing, (2) Pace Making (3) Reliability Trials, (4) Speed Testing (5) Use whilst drawing a trailer except the towing (other than for reward) of any one disabled mechanically
propelled vehicle.
Persons or Classes of Persons entitled to drive:- Any person including insured: Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or
obtaining such a license. Provided also that the person holding an effective learner's license may also drive the vehicle when not used for the transport of passengers at the time of the accident and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limits of Liability:- Under Section II -1(i) of the Policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988. Under Section II -1(ii) of the Policy - Damage
to Third Party Property - Rs. 750000 (as per IMT 20)in respect of any one claim or series of claims arising out of one event. Personal Accident cover for Owner - Driver under section IV: Capital Sum Insured (CSI) - Rs.
1500000 Deductible under Section-I: 500 (Compulsory Deductible Rs. 500 and Imposed Deductible Rs. 0 )
No Claim Bonus:- The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if no claim is made or pending during the preceding year (s), as per the: The preceding year/20%,
Preceding Two consecutive years/25%, Preceding Three consecutive years/35%, Preceding Four consecutive years/45%, Preceding Five consecutive years/50% of NCB on OD Premium. No Claim Bonus will only be
allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
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.
For information on ombudsman you may visit website : https://www.cioins.co.in/Ombudsman:- I / We hereby certify that the Policy to which the certificate relates as well as this certificate of insurance are issued
in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.

For UNITED INDIA INSURANCE COMPANY LIMITED

Authorised Signatory

Policy Issuing Office :B- 39, Inner circle, Conaught Place, New Delhi -110001
GSTIN: 07AAACU5552C1ZL, CIN No: . State Name: Delhi
This Policy is sourced and serviced by Maruti Suzuki Insurance Broking Private Limited
Direct Broker (General) IRDAI License No. 428, valid till 01 February 2027, Mail ID: support@msibpl.co.in, Contact: 33774477 (Prefix 011/022/033/044)
For Policy Terms and Conditions Log on to : www.marutisuzukiinsurance.com, www.uiic.co.in
 Original Certificate of Insurance must be carried in your Car
Carry the Original certificate of insurance with the vehicle at all times - this is mandatory and is an evidence of compliance with Motor Vehicle
Act 1988.

Want to change anything in your policy?

Visit your nearest Dealership or get in touch with Maruti Suzuki Insurance Broking at their dedicated customer support - DIAL 3377 4477 (pre-
fix 011 / 022 / 033 / 044) to update your contact details, address, any change in the vehicle ownership, CNG / LPG fitment status, accesso-
ries addition/deletion etc.

Is your policy falling due for Renewal?

To renew your policy you may: 1) Visit www.marutisuzukiinsurance.com 2) Visit Nearest Dealership 3) Call us at 011 3377 4477 4) SMS
RENEW to 9215292152.

What to do if your four wheeler meets with an accident?

Simply inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011 /022 / 033 / 044) or Visit www.marutisuzukiinsurance.com to locate
nearest Dealership. They will assist you with your claim intimation to us and will also help you with other formalities. In case you intend to
make a claim on your policy, please ensure that the claim is intimated to Maruti Suzuki Insurance Broking within 24 hours of accident or on
the next working day.

What should you do if there is a third party injury/death and/ or third party property damage?
Lodge an FIR with the nearest Police station and obtain a copy. Provide a photocopy of your insurance policy to the affected third party. It is not
necessary to compensate the affected third party on the spot. Inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011 /022 / 033 /
044) for further assistance.

Is your Vehicle Stolen?

Lodge an FIR at the nearest Police Station and obtain a copy of the FIR. Inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011/022 /
033 / 044). Maruti Suzuki Insurance Broking will guide you for proper filing of your claim towards a quick settlement.

Total Loss Claim?

As a convention, it is called a total loss when the damages are so severe that claim assessment (Survey) indicates that the vehicle is beyond
repairs OR it shows that the Insurance Co.’s liability is more than 75% of two wheeler’s insured declared value. Visit your nearest Dealership or
just inform Maruti Suzuki Insurance Broking at 3377 4477 (prefix 011/022/033/044) and you will be guided for a quick claim settlement.

Avoid driving through water log areas!

It can cause damage to your vehicle both internally and externally. Please do not try to start your car in case your vehicle stops by getting
submerged in flood or while crossing a water logged area. This can cause severe damage to the engine which is called Consequential Loss and
is not covered in your policy.

Must to Know
This Policy does not cover damage due to consequential loss, Wear & Tear, Mechanical/Electrical Breakdown, Driving under the influence of liquor or drugs,
Contractual Liability, Driving without valid driving license, Usage outside specified geographical area, Nuclear or War perils. It does not cover Damage to
tyres (unless vehicle is also damaged).

A Compulsory deductible based on Vehicle CC as per India Motor Tariff will apply at the time of every claim.

Depreciation on parts as per India Motor tariff will apply at the time of every claim unless opted for zero depreciation cover.

In case of Zero Depreciation Policy, the benefit of Zero Depreciation would be applicable for specific number of claims as per the Insurance Company's
Terms & Conditions.

AC Gas is fully payable. All Oils/Brake Lining/Glass Sealants/Oil Air Filters are paid @ 50%. Coolant/Fastener are not payable.
Visit Maruti
Visit Maruti SuzukiSuzuki Insurance
Insurance Broking
Broking at www.MarutiInsurance.com
at www.marutisuzukiinsurance.com

Be Safe : Your Safety is Our Concern

Don’t Mix Drinking and Driving Always Keep Your Vehicle In Good Follow Traffic Rule
Condition

Pedestrians Have First Priority on Roads Please Use Child Seats When Children Always Wear Your Seat Belts
are Seated in Front of Airbags