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

:23025783441
:RAKESH SAHA S/O SH: R N SAHA
:Others
:9464216816/ 9464216816
:hiteshvermaa11@yahoo.co.in
:

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Policy Number

Policy Start Date & Time :05/07/2016 12:15 (hours)

Policy Expiry Date
:04/07/2017 midnight
Geographical Area
: INDIA
Policy Issuing Office
:
Address
BO SUNAM CITY ROAD,NRG COMPLEX,1ST FLOOR ,SUNAM
City
: SANGRUR
District : SANGRUR
State : PUNJAB
Pincode : 148028
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JOYTI STRUCTURES LTD. RAJ VILLA 183 JAI NAGAR

City
: PALI
District : PALI
State : RAJASTHAN
Pincode : 306401
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Business Channel Code:
Mobile No:
IRDA License Number :
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VEHICLE DETAILS
Registration No:

.
.
.

NA
8054442447
.
6048225
.

RJ-22-SF/9552
.

Engine Number

9082471
.

2009
.

Registering Authority & Place

RJ22 PALI

125/0

.
.

Chassis Number

Cubic Capacity / GVW

AGD0054370
HITESH VERMA

Registration Date

Vehicle Make & Model

Honda Motorcycle and Scooter India, Private Limited (HMSI) - Stunner - Kick
Drum Alloy
.

Type of Body

.
.

Seating Capacity (Including Sidecar)

22/08/2009

Solo with Pillion

Business Channel Sub Code:

Agent Name :

8050431

Year of Manufacture

:1117023116P104441989

Vehicle Color

BLACK

Geographical Extension

2 (Persons)

NoExtn

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INSURED DECLARED VALUE (In Rupees)
.
.
.
.
.
Vehicle
Side Car
Fiber
Electrical /Electronic Non-Electrical
.
.
.
.
.
Accessories
Glass
Accessories
.
.
.
.
.
30000.00

0.00

0.00

0.00

CNG Kit
.

0.00

LPG Kit
.

TOTAL

Co-Insurance
Details
.

0.00

30000.00

100.00

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PREMIUM
Premium -Rs.880

Service Tax (Including Swachh Bharat Cess of 0.5% & Krishi

Kalyan Cess of 0.5%) @ 15.00% - Rs. 131.00
Total Payable - Rs. 1011.00
Stamp Duty - Rs. 1
Service Tax Registration Number:AAACU5552CST001
Receipt Number:10211170216102759027
Receipt Date: 05/07/2016
Receipt Amount:- Rs.1011.00
Payment Mode: CD
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.100000
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.

Financier

Branch Name & Address

Policy Subject to IMT Endorsements

Applicable Add-on covers / Services

.

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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: 08/07/2016 09:44:07 hours
Client IP Address: 150.129.196.31
DULY CONSTITUTED ATTORNEY(S):
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.