2025080751283
Policy No. AVO/2374/12132130 Date 11-08-2025
SATPAL .
33 FF 1 KAPDA MILL, PANCHWATI
GHAZIABAD-201201
GHAZIABAD UTTAR PRADESH INDIA201201
78******76
LIC***ESH***PTA***AIL***M
Dear SATPAL .
Welcome to Universal Sompo General Insurance family and we thank you for choosing us as your Insurance Partner for Motor Goods Carrying Vehicle
policy.
We are committed to providing you with reliable motor insurance coverage. Ensuring your safety on the road is our top priority, and our policies are
crafted to provide you reliable protection and peace of mind.
We are pleased to share a list of those garages in your city which have been trusted and rated highly by our customers basis their experience. You may
like to consider their services in the unfortunate event of an accident or damage to your vehicle. Please visit below link to check the garage list or scan
the QR code.
To make your insurance experience seamless, we have introduced below tech-based solutions.
USGI PULZ App - One stop solution for all your insurance needs. Now enjoy below complimentary value-added benefits with our app.
· Insurance Wallet - Manage insurance policies on the go with buy and renew Option
· Claim Management - Intimate claim online and track claim status
· 24X7 Roadside Assistance*- In case you are in distress due to flat tyre, drained battery, minor repairing or towing of vehicle in case of break
down or accident of your vehicle, Key locked in car or lost, fuel run dry or arrangement of taxi/ ambulance.
· Location based Service - Find nearest authorised garages, nearest network hospital, nearest pharmacy, blood bank, wellness centre, lab test
centre, petrol pump, parking pollution centre. Also, you can track your daily activity, set reminders, and maintain your health profile and much
more
· Additional Services - Check pollution certificate, check vehicle challans, check fuel prices.
* Subject to Terms and conditions of Universal Sompo Policy covering the vehicle with RSA cover
AI-Powered Virtual Agent- Helps you intimate claim with ease.
You may reach us at our toll-free number 1-800- 200-4030 (Other Users), 1-800-22-4030 (MTNL/BSNL Users), or email us at
contactus@universalsompo.com Please visit www.universalsompo.com for detailed information on policy coverage, benefits, and exclusions.
Kindly go through the enclosed information in the attached policy copy. In case of any error, discrepancy, or clarification that you may need, please
let us know within 15 days of policy received, otherwise all particulars will be deemed to be correct. Please mention your policy number for any
communication with us.
Once again, we are delighted to have you with us.
Happy driving!
Digitally signed by VARSHA MANISH GUJARATHI
Date: 2025.08.11 13:25:47 IST
Reason:
Location:
scan to check Scan to download
Garage List USGI PULZ App
UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED
Certificate of Insurance cum Policy Schedule
PRODUCT NAME : Motor Goods Carrying Vehicle ; POLICY NUMBER: AVO/2374/12132130
INVOICE NUMBER USGAF237425129
INSURED DETAILS INTERMEDIARY DETAILS
085
SATPAL . NAME RUBY PANDEY POLICY / INVOICE ISSUED DATE 11-08-2025
33 FF 1 KAPDA MILL, PANCHWATI CODE 200726288052 EIA ACCOUNT NUMBER NA
GHAZIABAD-201201 CONTACT NUMBER 9810639211 CKYC NUMBER
GHAZIABAD UTTAR PRADESH EMAIL ID deepmalaramesh@gmail.com GSTIN NUMBER
INDIA201201 RTO LOCATION GHAZIABAD HYPOTHECATION / FINANCER NAME NA
78******76 PERIOD OF INSURANCE FROM 13:23:52 OF
LIC***ESH***PTA***AIL***M 11/08/2025 TO MIDNIGHT OF
10/08/2026
POLICY ISSUANCE OFFICE Office No.513, 5th Floor, Laxmideep building,
Dist Centre Laxmi Nagar, New Delhi-110092
DELHI 11009274, 110092
PAYMENT DETAILS INSTRUMENT/TRANSATCTION NUMBER: "C1108254238722 / 24668092738"; INSTRUMENT DATE:
"11-08-2025"; MODE OF PAYMENT: "OnlinePayment"
VEHICLE DETAILS
LICENSED
TRAILER PUBLIC CUBIC MFG. YEAR /
REGISTRATION ENGINE CHASSIS BODY TYPE / CARRYING
CHASSIS CARRIER/PRIVA MAKE/MODEL CAPACITY/KW/ REGISTRATION
NUMBER NUMBER NUMBER FUEL TYPE CAPACITY
NUMBER TE CARRIER GVW DATE
(including driver)
ASHOK
MB1CTCHD9KPX 2019/08-01-
UP-14-JT-3917 KXPZ132059 LEYLAND TRUCKS 6595 / 25000 3
K8688 2020
2518 XL BSIV
INSURED DECLARED VALUE (IDV) (Amount in Rs.)
ELECTRICAL NON-ELECTRICAL Bi-fuel/CNG/LPG
VEHICLE IDV TRAILER IDV BODY IDV CHASSIS IDV Total VALUE
ACCESSORIES ACCESSORIES KIT
2080000 0 0.00 0.00 0 0 0 2080000
SCHEDULE OF PREMIUM (Amount in Rs.)
SECTION I - OWN DAMAGE (A) SECTION II - LIABILITY (B)
Basic Own Damage 10082 Basic TP Premium 43950
Add: Extension of Geographical area (IMT1) 0 Add: Extension of Geographical area (IMT1) 0
Add: % for Vehicles imported without custom duty (IMT19) 0 Add: Bi-fuel/CNG/LPG Kit (IMT25) 0
Add: Cover for lamps, tyres/tubes, mudguards/bonnet/side- 1512 Less: Premium for TPPD (IMT20) 0
part (IMT23)
Add: Electrical / Non-Electrical Accessories (IMT24) 0 TOTAL BASIC THIRD-PARTY PREMIUM (A) 43950
Add: Bi-fuel/CNG/LPG Kit (IMT25) 0 ADD: PA BENEFITS 0
Add: Indemnity to Hirer - Negligence of the Owner or Hirer 0 Compulsory PA Cover for Owner Driver under Section III, SI Rs.15 Lacs 225
(IMT44)
Private Use-OD 0 Private Use-TP 0
TOTAL BASIC OD PREMIUM 11594 PA cover to Paid Driver, Cleaners, Conductors (IMT17) 50
Less: DETARIFF DISCOUNT 90 Legal Liablity to paid driver (IMT28) 50
OWN DAMAGE PREMIUM (A) 11594 Legal Liability to NON-Fare paying passengers (IMT37) 0
Less: No Claim Bonus (%) 0 Legal Liability to Fare paying passengers (IMT38)
Less: Discount on Anti-theft devices (IMT10) 0
Less: Discount on specially designed vehicles for blind, 0
handicapped and mentally retarded persons (IMT12)
Less: Discount on Voluntary deductible (IMT22A) 0 TOTAL LIABILITY PREMIUM (B) 325
OWN DAMAGE PREMIUM (B) 11594 NET LIABILITY PREMIUM (A+B) = II 44275
Add: TOTAL ADD-ON PREMIUM (C) 0 TOTAL PACKAGE PREMIUM (I+II) 55869
NET OWN DAMAGE PREMIUM (B+C) = I 11594 CGST (6%) "0" ; SGST(6%) "0"; IGST (12%) "5274"; UGST "0" 5274
CGST (9%) "0" ; SGST(9%) "0"; IGST (18%) "2145"; UGST 2145 63288
TOTAL POLICY PREMIUM
"0"
GEOGRAPHICAL AREA COMPULSORY DEDUCTIBLE (IMT22) 1500 VOLUNTARY DEDUCTIBLE (IMT22A) 0
PREVIOUS POLICY NO. PYP POLICY PERIOD & INSURER NAME EXPIRING NCB
NOMINEE FOR OWNER DRIVER SHAYADA RELATIONSHIP SPOUSE NCB % 0
ENDORSEMENT DETAILS
ENDT. NO ENDORSEMENT DISCRIPTION EFFECTIVE DATE PREMIUM GST (18%) : CSGT (9%); SGST (9%) TOTAL PREMIUM
0 0 0
SPECIAL CONDITIONS
SUBJECT TO IMT ENDORSEMENT NOS. AND MEMORANDUM PRINTED HEREIN / ATTACHED HERETO:
If declaration found incorrect, benefits under the present policy in respect of own damage section will stand forfeited
PRE-INPSECTION: If any inaccuracies are identified in the details retrieved during the pre-inspection process, benefits under the current policy pertaining to the own damage
section will be forfeited.
DRIVER CLAUSE: Persons or classes of persons entitiled to drive: Stage carriage/Contract carraige/ Private service vehicle, Any person including the 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 and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Goods Carriage: Any person including insured: Provided that a person driving hold 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 goods at the time
of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Non Transport vehicles: 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 and that such a person satisfies the
requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Warranty for Goods Carrying Vehicles: Warranted that at no time the Gross Laden Weight of the vehicle exceeds the Gross Vehicle weight mentioned in the Schedule of the
policy.
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 f) Reliability Trials g) Any purpose in connection with Motor Trade. LIMITS OF LIABILITY: A) Under Section II 1 (i) of policy
(Death of or bodily injury) Such amount as is necessary to meet the requirements of the Motor Vehicles Act,1988. B) Under Section II 1 (ii) of policy (Third Party Property
Damage) - in respect of any one claim or series of claims arising out of one event (Rs.6000/- or Rs.7,50,000/- as may be applicable). C) P.A Cover under Section III for owner
Driver (CSI) - Rs.15,00,000/-.
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".
DISCLAIMER: Policy is valid subject to Realization of premium. Please visit our website www.universalsompo.com to know more about the policy coverage, benefits, and
exclusions. Kindly write to us on contactus@universalsompo.com to get the copy of the policy wordings, if required.
CLAIM DISCLAIMER: : In the unfortunate event of any loss or damage to the insured property FOR UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED
resulting into a claim on this policy, please intimate the mishap IMMEDIATELY to our Call
Centre at Toll Free Numbers on 1800-22-4030/1-800-200-4030 or on chargeable numbers at
+91-22-27639800 / +91-22-39133700. Email at contactclaims@universalsompo.com. Please
note that no delay should be allowed to occur in notifying a claim on the policy as the same
may prejudice liability. I/We hereby certify that the policy to which the certificate relates as
well as the certificate of insurance are issued in accordance with the provision of chapter X, XI IRDAI UIN NO:
of M. V. Act 1988. IRDAN134RP0009V01
200809
DULY CONSTITUTED ATTORNEY(S)
SAC CODE: 997134 USGI IRDAI REGISTRATION NO: 134
In Witness whereof this Policy has been signed at Mumbai in lieu of covernote No. Consolidated stamp duty Rs . 1 paid towards Insurance policy stamp vide receipt no.
LOA/ENF-1/CSD/19/2024-25/2348 dated of General Stamp Office Mumbai.
NOTE: 1) Please include your policy number for any communication with us. 2) The policy schedule should be read in conjunction with Policy wording and CIS.
Registered Office Address: 8th Floor and 9th Floor, Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway, Goregaon East, Mumbai -
400062
Contact Address: Universal Sompo General Insurance Co. Ltd. Airoli Office-Unit No.601 & 602, A wing, 6th floor, Reliable Tech Park, Cloud City Campus, Gut no 31, Mouje
Elthan, Thane Belapur Road, Airoli, Navi Mumbai - 400708
1) If You have a query about any matter relating to the Policy, or our decision on any matter, or the claim you may call us on 1-800-224030 or email us at
Contactus@universalsompo.com. In case, You are not satisfied with the decision/resolution or have not received any response within 15 working days, You may write or email
to Grievance Redressal Officer gro@universalsompo.com or visit any of our branches GRO. For updated details of grievance officer (name and number), kindly refer the link
https://www.universalsompo.com/resourse-grievance-redressal and click on Branch wise Grievance Redressal Officer
2) Universal Sompo General Insurance Co. Ltd. shall abide by Insurance Regulatory and Development Authority (Protection of Policyholder’s Interests) Regulations 2024.
Under this regulation and with an objective to provide a forum to Personal Lines policy holders for resolution of claims related complaints, Insurance Ombudsman has been
constituted under the aegis of Governing Body of Insurance Council. For further Information you could refer https://www.cioins.co.in/ombudsman
UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED
PROPOSAL FORM CUM TRANSCRIPTION LETTER FORMotor Goods Carrying Vehicle
INSURED DETAILS VEHICLE DETAILS PROPOSAL DETAILS
MAKE ASHOK LEYLAND PROPOSAL NUMBER USN2025080751283568
SATPAL . MODEL 2518 XL BSIV ISSUANCE DATE 11-08-2025
33 FF 1 KAPDA MILL, FROM 13:23:52 OF
PANCHWATI RTO UP14 PERIOD OF INSURANCE 11/08/2025 TO MIDNIGHT
GHAZIABAD-201201 OF 10/08/2026
GHAZIABAD UTTAR PRADESH REGISTRATION NUMBER UP-14-JT-3917 RTO LOCATION GHAZIABAD
INDIA201201 ENGINE NUMBER KXPZ132059 HYPOTHECATION/FINANCER NAME NA
78******76 CHASSIS NUMBER MB1CTCHD9KPXK8688 FUEL TYPE Diesel
LIC***ESH***PTA***AIL***M CUBIC CAPACITY/GVW/KW 6595 / 25000 LICENSED CARRYING CAPACITY 3
TRAILER CHASSIS NUMBER PUBLIC CARRIER/PRIVATE CARRIER
MANUFACTURING YEAR / 2019
GSTIN NUMBER
REGISTRATION DATE 08-01-2020
TRAILER REGISTRATION NUMBER
INSURED DECLARED VALUE (IDV)
ELECTRICAL NON-ELECTRICAL Bi-fuel/CNG/LPG
VEHICLE IDV TRAILER IDV BODY IDV CHASSIS IDV Total VALUE
ACCESSORIES ACCESSORIES KIT
2080000 0 0.00 0.00 0 0 0 2080000
PREMIUM DETAILS (Amount in Rs.)
OWN DAMAGE PREMIUM AFTER LOADING/DISCOUNT (INCLUDING ALL ACCESSORIES PREMIUM)
(Extension of Geographical area; Vehicles imported without custom duty: Cover for lamps, tyres/tubes, 11594
mudguards/bonnet/side-part; Electrical / Non-Electrical Accessories; Bi-fuel/CNG/LPG Kit; Indemnity to Hirer - Negligence
of the Owner or Hirer)
TOTAL OWN DAMAGE PREMIUM 11594
BASIC THIRD-PARTY PREMIUM 43950
Compulsory PA Cover for Owner Driver under Section III, SI Rs.15,00,000/- 225
PA Cover to named passengers (IMT17) 50
Legal Liablity to paid driver (IMT28) 50
Legal Liability to NON-Fare paying passengers (IMT37) 0
Legal Liability to Fare paying passengers (IMT38)
TOTAL LIABILITY PREMIUM 44275
NET PREMIUM 55869
TP- CGST (6%) "0" ; SGST(6%) "0"; IGST (12%) "5274" 5274
OD- CGST (6%) "0" ; SGST(6%) "0"; IGST (12%) "2145" 2145
TOTAL PREMIUM 63288
SPECIAL CONDITION
GEOGRAPHICAL AREA COMPULSORY DEDUCTIBLE (IMT22) 1500 VOLUNTARY DEDUCTIBLE (IMT22A) 0
INTERMEDIARY NAME RUBY PANDEY INTERMEDIARY CONTACT DETAILS 7838786676 INTERMEDIARY CODE 200726288052
NOMINEE FOR OWNER DRIVER SHAYADA RELATIONSHIP SPOUSE NCB (IN CURRENT POLICY) 0
PREVIOUS POLICY NUMBER PYP INSURER & POLICY PERIOD EXPIRING NCB
ANTI REBATE CLAUSE
Prohibition of Rebates (Section 41 of Insurance Act, 1938 as amended):
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or
property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer: provided that acceptance by an insurance agent of commission in
connection with a policy of life insurance taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such
acceptance the insurance agent satisfies the prescribed conditions establishing that he is a bona fide insurance agent employed by the insurer.
2. Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees..
TERMS AND CONDITIONS
I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following T&C:
A) I/We hereby declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the basis of the contract
between me/us and Universal Sompo General Insurance Company Limited.
B) I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers immediately.
C) Any person who, knowingly and with intent to defraud the Insurance Company or other persons, files a proposal for insurance containing any false information, or conceals for the purpose of
misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the Company's sole discretion and result in a denial of insurance
benefits.
GSTIN :- Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor, HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details provided
during policy issuance. For any subsequent changes or addition (i.e. if GSTIN not entered at the time of policy issuance) on policy schedule, changes shall be carried out through fresh policy issuance
with prospective effect.
D) Your policy will be cancelled in case vehicle class/category of the vehicle is different than what is mentioned in policy schedule.
E) I understand the Proposal No."DYNAMIC FIELD" is issued to me basis on above information.
F) I understand that my premium is derived on the basis of information filled by me, which includes my previous year policy details and No claim Bonus Discount %, if any.
Universal Sompo General Insurance Company Limited may verify my previous year policy details and may hold claim settlement process till the time confirmation is received from previous insurer. The
Company shall have no liability under this insurance contract if it is found that any of my / our statement on particulars or declaration (other than NCB discount) in this proposal form or other
documents are incorrect and / or untrue / false.
If any discrepancy found in the information provided for arriving at NCB discount %, Company shall communicated to me via e-mail and or letter for payment of the balance premium amount within
20 days from the date of communication. If the balance amount is not paid by me within 20 days from the date of communication, then claim will be paid proportionately.
G) I / we declare and confirm having a valid PUC / Fitness Certificate.
Transcript Declaration : In case disagreement or objection or any other changes with respect to information and contents mentioned herein above, please contact our toll free number and register
your objections / changes / disagreement to the content of this transcript or you may also send us email or written correspondence at the following details within a period of 15 days from date of your
receipt of this transcript along.
AML Declaration:
1.I/We hereby confirm that all premiums have/will be paid from bona fide sources and no premium have/will be paid out of proceeds of crime related to any of the offences as listed under Prevention
of Money Laundering Act, 2002 and its subsequent amendments as applicable
2.I understand that the company has the right to call for documents to establish the sources of funds.
3.The insurance company has the right to cancel the insurance contract in case I am/have been found guilty by any competent court of law under any of the statues, directly or indirectly governing the
prevention of money laundering in India.
Email-Id : contactus@universalsompo.com Toll-Free No : 1800 200 4030 / 1800 22 4030
ADD-ON COVER DETAILS
