UNITED INDIA INSURANCE COMPANY LIMITED

CERTIFICATE OF INSURANCE
PRIVATE CAR -LIABILITY ONLY POLICY
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 1908003121P113823885 Certificate Number 1908003121P113823885
Customer Id 23141808633 Issuing Office Address Code 190800
Name of the Insured MS SOMYA MOTORS PVT LTD CENTRE POINT COMPLEX
NEAR JHANSI ROAD THANA BELOW REGIONAL OFFICE OF MLB ROAD, PHOOLBAGH GWALIOR, GWALIOR, MADHYAPRADESH
CENTRAL BANK OF INDIA 474002
GWALIOR
Address of the Insured MADHYA PRADESH
GWALIOR
474001
MADHYA PRADESH Telephone (0751) 5086899
Business/Occupation Others Telephone: 07512430251
Insured's Declared Value 0

Period of Insurance From 20:39 Hrs of 31/03/2022 To Midnight of 30/03/2023

Particulars of Vehicle Insured
Registration No.
Cubic Seating including
Trailer Obsolete Vehicle Engine No. Chassis No. Make/Model Type of Body Year of Mfg
Vehicle Capacity/KW driver
(if any)
RENAULT /
DUSTER(2012 -
MP - 07 - CE - 2015) 85 PS
No E003955 MEEHSRAW5F1080109 Saloon 2015 1461 5
9448
RXL DIESEL PLUS

Registration Authority Geographical Area Financier

MP07 GWALIOR INDIA
Amount in words: Four thousand four hundred eighty rupees only
Persons or classes of persons entitled to drive
Any person including Insured provided that a person hold an effective driving licence at the time of accident and is not disqualified from holding or obtaining such a licence. Provided also that
the person holding an effective Learner's Licence may also drive the vehicle and such a person satisfies the requirements of Rule 3 of Central Motor Vehicle Rule, 1989.

Limitations as to use Premium: 3,796.00

The policy covers use of the vehicle for any purpose other than
CGST(9%): 342.00
a) Hire or Reward
b) Carriage of Goods (other than samples or personal luggage) SGST(9%): 342.00
c) Organized Racing Stamp Duty: 1.00
d) Pace Making Total (Rounded Off) : 4,480.00
e) Speed Testing and Reliability Trails
f) Use in connection with Motor Trade Receipt Number : 10119080021115666518
Receipt Date: 31/03/2022
DebitNote Number:
Document Date:
Limits of Liability MISP Name: MS SOMYA MOTORS
Under Section II-I (i) Death or bodily injury in respect of any one accident; As per Motor MISP Code: PVT LTD
Vehicles Act 1988 , Mobile: 8966905722 MISP000961
Under Section II-I (ii) Damage to third party property in respect of any one claim or series of Designated Person Name :
claims arising out of one event 750000 KAMESH KUMAR
Direct Business: AGRAWAL
Development Officer Code:

Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 16,17
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance For and On behalf of
are issued in accordance with provisions of Chapter X & XI of M.V Act, 1988. United India Insurance Co. Ltd.

Duly Constituted Attorney:

Date of Issue: 31/03/2022

Amount Subject to Reverse Charges-NIL
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

The genuineness of the policy can be verified

through "Verify Your Policy" link at
www.uiic.co.in.

This document is digitally signed

Signer: N MOHAN SANKAR

Date: Thu, Mar 31, 2022 20:39:42 IST
Location: United India Insurance Company Ltd
1/3 Reason: Signing Policy for UIIC
 MOTOR INSURANCE - PRIVATE CAR LIABILITY ONLY POLICY SCHEDULE
Policy Number :1908003121P113823885 Previous Policy No :12345678
Geographical Area :India(A) Insurance Start Date & Time :31/03/2022 20:39 (hours)
Insured Name/ID : MS SOMYA MOTORS PVT LTD/23141808633 Insurance expiry Date & Time :30/03/2023 midnight
Insured address : Policy Issuing Office Address :
NEAR JHANSI ROAD THANA BELOW REGIONAL OFFICE OF CENTRAL BANK OF CENTRE POINT COMPLEX MLB ROAD, PHOOLBAGH GWALIOR, GWALIOR, MADHYAPRADESH ,GST No.:-
INDIA 23AAACU5552C1ZR
City: GWALIOR District: GWALIOR City: GWALIOR District: GWALIOR
State: MADHYA PRADESH Pincode: 474001 State: MADHYA PRADESH Pincode: 474002
Telephone:07512430251 Mobile: 7985080085 Telephone:(0751) 5086899
MSIP Name/Code:MS SOMYA MOTORS PVT LTD / MISP000961 Business Channel Sub Code:

Designated Person Name :KAMESH KUMAR AGRAWAL Land Line No.: ,Mobile:8966905722
VEHICLE DETAILS
Registration Number MP - 07 - CE - 9448 Obsolete Vehicle & Engine No & E003955 Year Of Manufacture 2015
Number Vehicle Weight(Kg.)
RTA Name MP07 GWALIOR Chassis Number MEEHSRAW5F1080109 Cubic Capacity/KW 1461
RENAULT & DUSTER(2012 - 2015)
Registration Date 06/07/2017 Vehicle Make & Model Type Of Body Saloon
85 PS RXL DIESEL PLUS
AA Membership Number Geographical Extension Seating Capacity(Including 5
Driver)
INSURED DECLARED VALUE ( )
Co-
Vehicle Trailer Electrical/Electronic Accessories Non Electrical Accessories CNG Kit LPG Kit Total Insurance
Details
0 0 0 0 0 0 0 100%
OTHER DETAILS
Unique
Financier Policy Subject to IMT Endorsements Applicable Addon-covers/Services
Reference Code
16,17
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.
EXCLUSIONS:(1)Any accidental Loss Or Damage and/or liabilty 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 and/or liability directly or indirectly or proximately or remotely occasioned by or 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 consequences 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( ) DEDUCTIBLES (Under Section I)( )

Owner Driver CSI
1500000 Compulsory 1000 Imposed 0 Voluntary 0
(Under Section IV)
SCHEDULE OF PREMIUM( )
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PREMIUM
Premium(A+B) 3,796.00
B. Basic - TP 3,221.00
CGST(9%) 342.00
Total 3,221.00
SGST(9%) 342.00
Gross OD(A) 0.00 TOTAL PAYABLE PREMIUM
Add : 4,480.00
Stamp Duty 1.00
Compulsory PA for Owner Driver 275.00
SAC Code 997134
PA to Paid driver 50.00 3121I113823885 &
Invoice No & Date
31/03/2022
PA for Unnamed persons Receipt Number 10119080021115666518
(No of persons: 5, SI per occupant: 250.00
Receipt Date 31/03/2022
100000/-)
Receipt Amount 4,480.00
Payment Mode
Sub Total (Additions) 575.00 Paying Party MS SOMYA MOTORS PVT
LTD

Gross TP(B) 3,796.00

Total Liability Premium 3,796.00

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,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 fom 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.
Anti Money Laundering Clause:-In the event of a claim under the policy exceeding 1 lakh or a claim for refund of premium exceeding 1 lakh, the insured will comply with the provisions of AML policy of the company. The
AML policy is available in all our operating offices as well as Company's web site.

LET US JOIN THE FIGHT AGAINST CORRUPTION. PLEASE TAKE THE PLEDGE AT https://pledge.cvc.nic.in.

Date & Signature of Proposal:31/03/2022

In Witness Whereof this policy has been signed at DO GWALIOR 190800 on this 31st day of March ,2022

For United India Insurance Company Limited

Affix Policy Stamp

Duly Constituted Attorneys

IP Address: 10.95.40.80
MS SOMYA MOTORS PVT
Issuing MISP: Printed By : CUSTOMER @ 31/03/2022 8:39:54 PM MISP User Name: MSMLTD0013
LTD
MISP Location: 190800 Underwritten By - MSMLTD0013 ( MISP )

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This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

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