blank line

RECEIPT
blank line

blank line

PROPOSER ADDRESS

ISSUING OFFICE ADDRESS

Customer ID : 3390691015
Mr. Mr. Mr. BONDILI PRAVEEN
22/31, 2ND FLOOR, VALLAM BANGARU STREET,
PURASAWALKAM
City
: CHENNAI
District : CHENNAI
State : Tamil Nadu
PinCode : 600007

UNITED INDIA INSURANCE Co. Ltd.

DO 11 CHENNAI, OFFICE TYPE:DO,BUILDING
NAME:SUDARSAN BUILDING,DOOR NO:OLD NO.14,NEW
NO.27,FLOOR NO: 2,ROAD NAME:WHITES
ROAD,LOCALITY/AREA:ROYAPETTAH
City
: CHENNAI
District : CHENNAI
State : Tamil Nadu
PinCode : 600014

blank line

BUSINESS CHANNEL DETAILS

.
.

Channel Code
IRDA License Number
Blank

.
.

60/99999
545

.
.

Channel Name
Contact Number

Office direct
support.onlinepolicies@uiic.co.in

Received with thanks from a sum of Rs. 915 (RUPEES NINE HUNDRED FIFTEEN ONLY) by towards policy number
01110131140160003874 as per details given hereunder
blank line
blank line
Blank
.
Receipt Number
.
Receipt Date
.
Receipt Total
.
Payment Mode
Blank

01110182148000020319
02/01/2015
.
915
.
CARD
.

1. Receipt valid subject to realization of CARD

2. Warranted that in case of non- realization of CARD Policy and Receipt stands
cancelled automatically ab initio.
3. Please quote Customer Id, Receipt No. and Receipt Date in all correspondences
blank line
Blank
Policy stamp defaced and retained at office
Blank

For United India Insurance Company Limited

Client IP Address : 117.200.10.174

Print date & time: 02/01/2015 14:32:21 hours

Blank
.

Duly Constituted Attorneys

Blank
United India Insurance Company Ltd : IRDA Reg: No : 545
* This document is digitally signed document and does not require signature
This receipt is computer generated and does not require any seal or signature in original.

-1-

blank line
blank line

MOTOR INSURANCE - MOTORCYCLE/ SCOOTER PACKAGE POLICY SCHEDULE

blank line
Policy Number
:01110131140160003874
Geographical Area : India(A)
Insured Name
:Mr. Mr. Mr. BONDILI PRAVEEN
Insured Address :
22/31, 2ND FLOOR, VALLAM BANGARU STREET,
PURASAWALKAM
City
: CHENNAI
District : CHENNAI
State : Tamil Nadu
Pincode : 600007
Mobile No: 9492100040

.
.
.
.

.
.
.
.
.
.
.

blank line
Business Channel Code:
Mobile No:

.
.
.

60
support.onlinepolicies@uiic.co.in

Previous Policy Number

:31110131130160002583
Insurance Start Date & Time
:07/01/2015 00:00:00 (hours)
Insurance Expiry Date & Time
:06/01/2016 midnight
Policy Issuing Office Address
:
DO 11 CHENNAI, OFFICE TYPE:DO,BUILDING
NAME:SUDARSAN BUILDING,DOOR NO:OLD NO.14,NEW
NO.27,FLOOR NO: 2,ROAD NAME:WHITES
ROAD,LOCALITY/AREA:ROYAPETTAH
City
: CHENNAI
District : CHENNAI
State : Tamil Nadu
Pincode : 600014
Office Contact Details: 044- 28525473, 28520470,
FAX: 04428520972
.
.

Business Channel Sub Code:

Agent Name :

99999
Direct

IRDA License Number:

blank line
VEHICLE DETAILS
.
TN-01-AR-0788
Registration Number
.
Regional Transport Officer,
RTA Name

.
.

Chennai Central (Ayanavaram), .

Tamil Nadu
.
.
07/01/2012

Registration Date

.
.
MBLHA10EWBHL23566
HA10EDBHL24200

Engine Number
Chassis Number

.
.

.
PASSION PRO

Vehicle Make &

Model

.
.

.
.
AA Membership
Seating Capacity
.
Number
(Including Sidecar)
blank line
INSURED DECLARED VALUE (In Rupees)
.
.
.
.
Vehicle
Trailer
Electrical /Electronic Non-Electrical
.
.
.
.
Accessories
Accessories
.
.
.
.
33408.00
0.00
0.00
0.00

blank line
OTHER DETAILS
.
Financier

2 In All

Solo With Pillian

Geographical
Extension

No Extension

LPG Kit

0.00

0.00

Type of Body

CNG Kit

.
.
100

2012

Year of Manufacture
Cubic Capacity

TOTAL
.

33408.00

Co-Insurance
Details
.
100.00

Policy Subject to IMT Endorsements

Applicable Add-on covers / Services

22

blank line
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.

blank line
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)
.
.
.
.
.
.
.
.
1,00,000.00
100.00
0.00
0.00
Owner- Driver
Compulsory
Imposed
Voluntary
(Under section IV)
blank line
SCHEDULE OF PREMIUM (In Rupees)
.
.
.
A-OWN DAMAGE PREMIUM
B-LIABILITY PREMIUM
TOTAL PACKAGE PREMIUM
.
.
.
.
.
.
399.56 Basic TP Liability
464.00 Package Premium
814.00
Basic Own Damage
.
.
.
.
.
.
399.56 Sub Total
50.00 Service Tax@12.36%
101.00
Total
.
.
.(Deductions)
ADD
. Incl.Edu.Cess &
.
..
0.00.
0.00 Employee Insured
Sub
.
. Higher Edu. Cess
.
0.00.
Total(Additional)
Paid drivers,
915.00
TOTAL PAYABLE
.
..
.
cleaners etc.
Less
.
. PREMIUM
..
.
514.00.
-99.89 TOTAL
Bonus (25%)
1.00
Stamp Duty
.
.
.
.
.
.
-99.89 ADD
Sub Total
AAACU5552CST001
.
.. Service Tax Regn.
(Deductions)
0.00
No.
.
. Sub Total
.
300.00(Additions)
.
Total
01110181148000020317
.
... Receipt Number
.
LESS
02/01/2015
.
. Receipt Date
0.00.
.
Sub Total
915.00
Receipt Amount
(Deductions)
.
.
514.00
Total
.
.

.
.
.

Payment Mode
Paying Party

.
.

CARD
Mr. Mr. Mr. BONDILI PRAVEEN

blank line
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, non
disclosure 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: 27/12/2012
In Witness whereof this Policy has been signed at CHENNAI this 07 day of January ,2015 in lieu of cover Note No Date

.
For United India Insurance Company Limited

.
CONSOLIDATED
STAMP DUTY
PAID

Duly Constituted Attorneys

.
.
IP Address:

117.200.10.174
Print Date:

02/01/2015 14:32:21 hours

blank line
blank line

CERTIFICATE OF INSURANCE
(MOTORCYCLE / SCOOTER)
Customer Id
Insured Name
Occupation
Phone/Mobile/Fax
E-mail
Insured Address

blank line
Policy Number
:01110131140160003874
Certificate Number
:
Policy Start Date & Time :07/01/2015 00:00:00 (hours)
Policy Expiry Date
:06/01/2016 midnight
Geographical Area
: INDIA (A)
Policy Issuing Office
:
Address
DO 11 CHENNAI, OFFICE TYPE:DO,BUILDING
NAME:SUDARSAN BUILDING,DOOR NO:OLD NO.14,NEW
NO.27,FLOOR NO: 2,ROAD NAME:WHITES
ROAD,LOCALITY/AREA:ROYAPETTAH
City
: CHENNAI
District : CHENNAI
State : Tamil Nadu
Pincode : 600014
blank line

:3390691015
:Mr. Mr. Mr. BONDILI PRAVEEN
:Sr.Sales Officer
:9999999999 9492100040
:b.praveensingh@gmail.com
:

22/31, 2ND FLOOR, VALLAM BANGARU STREET,

PURASAWALKAM
City
: CHENNAI
District : CHENNAI
State : Tamil Nadu
Pincode : 600007

.
.

blank line
Business Channel Code:
Mobile No:
blank line
VEHICLE DETAILS
Registration No:

.TN-01-AR-0788

.
.

99999
Direct

Registration Date
.07/01/2012

Vehicle Make & Model

.PASSION PRO
.

Type of Body
.Solo With Pillian

..

Seating Capacity (Including Sidecar)

.2 In All (Persons)
.

Business Channel Sub Code:

Agent Name :

Cubic Capacity
.100

Registering Authority & Place

.Chennai Central (Ayanavaram), Tamil Nadu

Chassis Number
.MBLHA10EWBHL23566

Year of Manufacture
.2012

Engine Number
.HA10EDBHL24200

60
support.onlinepolicies@uiic.co.in

Vehicle Color

Geographical Extension
.No Extension

blank line
INSURED DECLARED VALUE (In Rupees)
.
.
Vehicle
Trailer /
Electrical /Electronic
.
.
Sidecar
Accessories
.
.
.
33408.00
0.00
0.00

.
.

Non-Electrical
Accessories
.
0.00

.
.

CNG Kit
.

0.00

.
.

LPG Kit
.

0.00

.
.

TOTAL
.

33408.00

Co-Insurance
Details
.
100.00

blank line
PREMIUM
Premium -Rs.814.00

Service Tax @ 12.36% - Rs. 101.00 Total Payable - Rs. 915.00

Stamp Duty - Rs. 1
Service Tax Registration Number:AAACU5552CST001
Receipt Number:01110181148000020317
Receipt Date: 02/01/2015
Receipt Amount:- Rs.915.00
Payment Mode: CARD
NOTE: Warranted that in case of dishonor of the premium cheque, this document stands cancelled automatically ab-initio.
blank line
LIMITATIONS AS TO USE
The policy covers use of 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.
blank line
DRIVER:
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.
blank line
LIMITS OF LIABILITY:
Under Section II-1(i) of the policy
Death of or bodily injury
Such amount as is necessary to meet the
requirement of the Motor Vehicles Act,1988
Under Section II-1(ii) of the policy
Damage to Third Party Property
Rs.0
blank line
.
.
Policy Subject to IMT Endorsements
Applicable Add-on covers / Services
.
.
22

.
.
.
blank line
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 provisions of Chapter X and Chapter XI of MV Act, 1988.
.
For United India Insurance Company Limited
.

Print Date: 02/01/2015 14:32:21 hours

DULY CONSTITUTED ATTORNEY(S):

United India Insurance Company Ltd : IRDA Reg: No : 545
* This document is digitally signed document and does not require signature

blank line
blank line

DO'S and DONT'S FOR MOTOR INSURANCE CUSTOMERS OF UNITED INDIA

blank line
Thank you for placing your business with United India, the fastest growing general insurer in India. Ours is a Government owned Company at
your service. The Company has very high claim paying capacity as may be seen by our high solvency margin ratio and the highest rating given
by ICRA. Our customer service parameters may be seen at our web site www.uiic.co.in.
blank line

We give below certain important guiding points which will be of use to you to ensure that your policy serves you in the fullest manner:
blank line

Proposal Form:
blank line

This is a very important document in Motor insurance which seeks vital information regarding the vehicle and also yourself. It should be filled in
all respects giving your contact number and E-mail id (if you have) and signed by you only. The items provided in the proposal are simple and
brief. In case, you need any clarification or information, you may seek the assistance of our Office or the Marketing Representatives viz. Agents,
Development Officers and our Intermediaries. A copy of the proposal will be returned to you along with the policy. In case you do not receive it,
please contact the policy issuing office.
blank line

Policy Document:
blank line

Please ensure that the policy document issued to you is duly checked with regard to the following important information.
blank line

a. The vehicle number, Engine and Chassis Number mentioned in the policy are correct.
blank line

b. Name and address given are correct. The name given in the policy should tally with R.C Book.
blank line

c. The period of insurance is in order.

blank line

d. The policy contains the terms of coverage, exclusions and conditions. In case you need any clarification in respect of any condition or
exclusion, you may seek the help of our Office or our Marketing Representatives.
blank line

Important Conditions for Insurance:

blank line

a. You must have insurable interest. In other words, you must be the Registered Owner of the vehicle. In case of transfer of ownership on sale of
your vehicle, the transferee (buyer of the vehicle) shall apply for transfer of the policy within 14 days from the date of transfer of R.C to the
Company so that the necessary change of ownership is recorded in the policy by the Company and issue a fresh Certificate of Insurance. If this
is not done within the stipulated period of 14 days, claims if any will be rejected. This may kindly be noted.
blank line

b. In case your vehicle is fitted with bi-fuel system such as Petrol/ Diesel and CNG/ LPG as permitted by the concerned RTA, the same should
be mentioned in the proposal form itself so that required premium can be charged. Non-disclosure of this can prejudice the claim.
blank line

c. It is always advised to renew your motor policy before the expiry date so that there is continuity. In case there is any break in insurance policy,
the vehicle needs to be physically inspected at your cost and a fresh proposal form will be collected.
blank line

d. The Insured Declared Value (IDV) of the vehicle will be deemed to be Sum Insured for the purpose of insurance. Therefore, when your
vehicle is brand new, it is covered at 95% of Invoice Price for the first policy period. Thereafter depreciation is charged for the vehicle based on
the usage i.e. age of the vehicle as per schedule of depreciation for arriving at IDV. The said schedule of depreciation is very much available
with our Office and the same can be verified by you if you feel it necessary. However, if your vehicle is beyond 5 years of age or an obsolete
model, IDV fixation under the policy is only based on an understanding between you and our Company. Therefore you may exercise proper care
before fixing IDV under the policy.
blank line

e. We advise you to keep safely all previous policy records so that you are helped in case Third party claims are filed after many years.
blank line

Claims:
blank line

In case an unfortunate loss covered in the policy occurs, we request you to take the following steps to get prompt service:
blank line

blank
1. Contact the policy issuing Office of United India immediately or if the accident takes place anywhere other than the City/ Town where
line policy issuing Office is located, contact the nearest Office of United India so that survey is arranged. List of our Offices with addresses
across the country with Phone Numbers are available in our Company's web site for your ready reference. Check our web site
www.uiic.co.in for list of our Offices across the country.
blank
2. In case of major accidents including fire/riot losses, keep the vehicle at the accident spot/ site until the spot surveyor comes to the place of
line accident and inspects the same. However, please note that spot survey is necessary in case of accident to all commercial vehicles. Please
keep the phone No. of the agent/ policy issuing Office for quick response from our side.
blank
3. Simultaneously if there are any third party injuries/ deaths, make sure to inform the nearest Police Station about the accident and also full
line details of injuries/ deaths or damage to any Third Party Property as the case may be. In case you provide treatment to any injured person/s
in any Hospital, the name of the hospital and also Doctor's Name who has given the treatment may be informed to us.
blank
4. After completing the said formalities you may move/ tow the vehicle to any authorized workshop of your choice and obtain estimate from
line them and the same may be submitted to us together with completed claim form (this can be obtained from any of our nearest office) for our
arranging final survey. You may also please submit to the surveyor copy of the complaint lodged with the police station along with original
FIR, if immediately available. However, in case where TP injuries are involved, FIR is compulsory and the same must be submitted to the
office.
blank
5. It should be ensured that under no circumstances repair work is commenced until the final surveyor verifies the damage and gives green
line signal to proceed with the repairs.
blank
6. After the repairs are carried out for partial loss claims, you have to submit the cash bills for spare parts and labour and seek
line reimbursement if the claim is admissible.
blank line

Salvage:
blank line

Utmost care should be taken by you to preserve the salvage (wherever replacements of parts are allowed) in whatever form i.e. parts of the
vehicle/vehicle as a whole till the claim is disposed off either by deducting the value of salvage from the claim amount or collecting the salvage
from you and settling the claim in Toto. This is applicable whatever be the mode settlement i.e. whether on repair loss basis/total loss basis/net
of salvage loss basis, as otherwise the claim settlement will be jeopardized which may be carefully noted. At any stage of the claim if the
company feels the necessity to inspect the salvage, the company may do so. In case the claim settlement is delayed due to unavoidable
reasons, you may take the assistance of the surveyor and our Office in prompt disposal of the salvage.
blank line
blank line

Theft losses:
blank line

Immediate intimation to the police as well as our policy issuing office is compulsory. Please note that the delay in lodging FIR and intimating the
claim to our office may ultimately result into rejection of the claim. Please note that filing of the FIR is not only a policy condition, but also a
requirement under law.
blank line

Finally, you should not engage any unauthorized persons for your insurance purpose, so also at the time of claim. It is always safe for you either
to contact the office or any of our authorized representatives of the company viz. Agents, Development Officers, and our Intermediaries.
blank line

Grievance Redressal:
blank line

In case you have a complaint or grievance regarding the services rendered by us, you may approach or write or e-mail to the policy issuing
office, Regional office/Head office for redressal. If you are not satisfied with the response from the Company you are free to take up the matter
with the Hon'ble Ombudsman, details of which may be obtained from the policy issuing office or log on to uiic.co.in.
blank line

Your support is our strength.