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PREMIUM RECEIPT
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PROPOSER ADDRESS ISSUING OFFICE ADDRESS
Customer Id: 23012605281 DO KATPADI NO.84, 14TH EAST CROSS ROAD, VELLORE-
Customer Name: Mr DEEPAK PRAVEENRAJ A City : VELLORE District :
S/O. APPOSDURAI. #9, 2ND CROSS ST, R.M.S. COLONY, State : Pincode :
KALINJUR, GANDHINAGAR WEST Office Contact Details: - , ,
City : VELLORE District : VELLORE
State : TAMIL NADU Pincode : 632006
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BUSINESS CHANNEL DETAILS
. . . .
Business Channel Code: 60 Business Channel Sub Code: AGD0102156
. . . .
Mobile No: 9999999999 Agent Name : VELU P
. . . .
Agent Email:
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Received with thanks from Mr DEEPAK PRAVEENRAJ A a sum of Rs. 2745.00 (RUPEES TWO THOUSAND SEVEN
HUNDRED FORTY FIVE ONLY) as per details given hereunder
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Collection Number 11328070016121377461
. .
Collection Date 18/02/2017
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Premium Amount 2745.00
. .
Payment Mode CREDIT CARD/NEFT-RTGS
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1. Receipt valid subject to realization of CREDIT CARD/NEFT-RTGS
2. Warranted that in case of non- realization of CREDIT CARD/NEFT-RTGS Policy and Receipt stands
cancelled automatically ab initio.
3. Please quote Customer Id, Receipt No. and Receipt Date in all correspondences
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Policy stamp defaced and retained at office For United India Insurance Company Limited
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Client IP Address : 220.225.126.138

Print date & time: 18/02/2017 08:49:33 hours

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Duly Constituted Attorneys

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This receipt is computer generated and does not require any seal or signature in original.
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.

-1-
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MOTOR INSURANCE - PRIVATE CAR LIABILITY ONLY POLICY SCHEDULE
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Policy Number :2807003116P115698908 Previous Policy Number :2807003115P111449830
Geographical Area : India Insurance Start Date & Time :20/02/2017 00:00 (hours)
Insured Name :Mr DEEPAK PRAVEENRAJ A Insurance Expiry Date & Time :19/02/2018 midnight
Insured Address : Policy Issuing Office Address :
S/O. APPOSDURAI. #9, 2ND CROSS ST, R.M.S. COLONY, KALINJUR, GANDHINAGAR DO KATPADI NO.84, 14TH EAST CROSS ROAD, VELLORE-
WEST City : VELLORE District :
City : VELLORE District : VELLORE State : Pincode :
State : TAMIL NADU Pincode : 632006 Office Contact Details: - , ,
Mobile No : 9842518040 FAX:
Email : DEEP_PRAVEEN84@YAHOO.CO.IN
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. . . .
Business Channel Code: 60 Business Channel Sub Code: AGD0102156
. . . .
Mobile No: 9999999999 Agent Name : VELU P
. .
IRDA License Number : 545
.
E-Insurance Account Detail
. .
E-Insurance Account Number Name of Repository
. .
. .
. .
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VEHICLE DETAILS
. . . . . .
Registration Number TN-20-AT-8449 Engine Number 7E45571 Year of Manufacture 2007
. .
....... Vehicle Weight(kg.)
.

. . . . . .
RTA Name TN20 TIRUVALLUR - Chassis Number MAJBXXMRJB7E45571 Cubic Capacity / GVW 1399/
.
....... 602001 .......
. .

. . . . . .
Registration Date 10/05/2007 Vehicle Make & Model Fusion Type of Body SALOON
. .

. . . . . .
AA Membership Seating Capacity 5 Geographical No Extension
. . .
Name (Including Sidecar) Extension
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INSURED DECLARED VALUE (In Rupees)
. . . . . . .
Vehicle Trailer Electrical /Electronic Non-Electrical CNG Kit / LPG Kit TOTAL Co-Insurance Details
. . . . . .
Accessories Accessories
. . . . . . .
0.00 0.00 0.00 0.00 0.00 0.00 100.00
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OTHER DETAILS
. . .
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers
IMT 28, GR 36A
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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.
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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 2,00,000.00 Compulsory 1000.00 Imposed 0.00 Voluntary 0.00
(Under section IV)
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SCHEDULE OF PREMIUM (In Rupees)
. . .
A-OWN DAMAGE PREMIUM B-LIABILITY PREMIUM TOTAL PACKAGE PREMIUM
. .. .. .
Basic Own Damage 0.00 Basic TP Liability 2237.00 Package Premium 2387
. .. .. .
Sub Total(Additions) 0 PA Owner Driver 100.00 Service Tax@15.00% 358.00
. .. ..
Sub Total (Deductions) 0 LL to Paid Driver IMT 28 50.00 Incl.Edu.Cess &
. .. ..
Total 0.00 Sub Total (Additions) 300 Higher Edu. Cess &
. ..
Sub Total (Deductions) 0 Swachh Bharat Cess of
. ..
Total 2387.00 0.5% &
. .
Krishi Kalyan cess of
. .
0.5%
. .
TOTAL PAYABLE 2745.00
.
PREMIUM
. .
Stamp Duty Rs. 1
. .
Service Tax Regn. AAACU5552CST001
.
No.
. .
Receipt Number 11328070016121377461
. .
Receipt Date 18/02/2017
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Receipt Amount 2745.00
. .
Payment Mode CREDIT CARD/NEFT-RTGS
. .
Paying Party Mr DEEPAK PRAVEENRAJ A
.

.
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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 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, 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: 2015-12-30 00:00:00.0
In Witness whereof this Policy has been signed at VELLORE this day of , Date
.
.
For United India Insurance Company Limited
Affix Duly Constituted Attorneys
. .
policy
.
stamp
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IP Address: 220.225.126.138
Print Date: 18/02/2017 08:49:33 hours
United India Insurance Company Ltd : IRDA Reg: No : 545
Underwritten by CUSTOMER on 18-02-2017 12:00:00
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
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CERTIFICATE OF INSURANCE
(PRIVATE CAR)
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Customer Id :23012605281 Policy Number :2807003116P115698908
Insured Name :Mr DEEPAK PRAVEENRAJ A Certificate Number :
Occupation :Software Professional Policy Start Date & Time :20/02/2017 00:00 (hours)
Phone/Mobile /Fax:2244338 / 9842518040 / 9842518040 Policy Expiry Date :19/02/2018 midnight
E-mail :DEEP_PRAVEEN84@YAHOO.CO.IN Geographical Area : INDIA (No Extension)
Insured Address : Policy Issuing Office :
Address
S/O. APPOSDURAI. #9, 2ND CROSS ST, R.M.S. COLONY, DO KATPADI NO.84, 14TH EAST CROSS ROAD, VELLORE-
KALINJUR, GANDHINAGAR WEST City : VELLORE District :
City : VELLORE District : VELLORE State : Pincode :
State : TAMIL NADU Pincode : 632006 blank line
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. . . .
Business Channel Code: 60 Business Channel Sub Code: AGD0102156
. . . .
Mobile No: 9999999999 Agent Name : VELU P
. .
IRDA License Number : 545
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VEHICLE DETAILS
. . .
Registreation Number: Registering Authority & Place Registration Date
. . .
TN-20-AT-8449 TN20 TIRUVALLUR - 602001 10/05/2007
. . .
Engine Number Chassis Number Vehicle Make & Model
. . .
7E45571 MAJBXXMRJB7E45571 Fusion
. . . .
Year of Manufacture Cubic Capacity / GVW Type of Body Vehicle Color
. . . .
2007 1399/ SALOON M.D.SILVER
. .
Seating Capacity (Including Sidecar) Geographical Extension
. .
5 (Persons) No Extension
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INSURED DECLARED VALUE (In Rupees)
. . . . . . . .
Vehicle Trailer Electrical /Electronic Non-Electrical CNG Kit LPG Kit TOTAL Co-Insurance
. . . . . . .
Accessories Accessories Details
. . . . . . . .
0.00 0 0.00 0.00 0.00 0.00 0.00 100.00
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PREMIUM
Premium -Rs.2387 Service Tax (Including Swachh Bharat Cess of 0.5% &Krishi
Kalyan Cess of 0.5%) @ 15.00% - Rs. 358.00
Total Payable - Rs. 2745.00 Stamp Duty - Rs. 1
Service Tax Registration Number:AAACU5552CST001
Receipt Number:11328070016121377461 Receipt Date: 18/02/2017 Receipt Amount:- Rs.2745.00 Payment Mode: CREDIT
CARD/NEFT-RTGS
NOTE: Warranted that in case of dishonor of the premium cheque, this document stands cancelled automatically ab-initio.
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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.
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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.
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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.750000
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. . .
Financier Branch Name & Address Policy Subject to IMT Endorsements/Applicable covers
. . .
.
IMT 28, GR 36A
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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: 18/02/2017 08:49:33 hours DULY CONSTITUTED ATTORNEY(S):
Client IP Address : 220.225.126.138
United India Insurance Company Ltd : IRDA Reg: No : 545
* This is a system generated document and any manual alteration / correction / overwriting in the document will make it invalid.
Issuing Dealer: Intermediary name:
Intermediary address:
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DO'S and DONT'S FOR MOTOR INSURANCE CUSTOMERS OF UNITED INDIA
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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.
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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:
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Proposal Form:
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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.
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Policy Document:
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Please ensure that the policy document issued to you is duly checked with regard to the following important information.
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a. The vehicle number, Engine and Chassis Number mentioned in the policy are correct.
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b. Name and address given are correct. The name given in the policy should tally with R.C Book.
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c. The period of insurance is in order.
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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.
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Important Conditions for Insurance:
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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.
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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.
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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.
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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.
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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.
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Claims:
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In case an unfortunate loss covered in the policy occurs, we request you to take the following steps to get prompt service:
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blank1. 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.
blank2. 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.
blank3. 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.
blank4. 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.
blank5. 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.
blank6. 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.
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Salvage:
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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.
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Theft losses:
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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.
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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.
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Grievance Redressal:
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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.
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Your support is our strength.