UNITED INDIA INSURANCE COMPANY LIMITED

DIVISIONAL OFFICE - 1, LUDHIANA, PHASE II, FOCAL POINT, LUDHIANA, PUNJAB - 141010
LUDHIANA - 141010 PUNJAB
PH: (0161) 5092618,(0161) 5020726 FAX: EMAIL:

GCV PUBLIC CARRIER OTHER THAN 3 WHEELER

PACKAGE POLICY
UIN. IRDAN545RP0048V01199900
POLICY NO.:2007003125P108310588
VEHICLE NO.:UK - 07 - CA - 9651

PERIOD OF INSURANCE
From 00:00 Hrs of 23/08/2025
To Midnight of 22/08/2026

Insured
MR JAHID ALI
S/O ISHAK, KARAUNDI BHAGWANPUR, HANIDWAR , BHAGWANPUR
247661
HARIDWAR
UTTARAKHAND
CONTACT NUMBER: ******9164 (M)
IMPORTANT NOTICE: KINDLY UPDATE YOUR AADHAAR NO. AND PAN/FORM 60. PLEASE IGNORE IF ALREADY UPDATED.

Agent Name : GIRNAR INSURANCE BROKERS PVT LTD

Agent Code : BRC0000905
7551196989
Mobile/Landline Number/Email :
support@[Link]

The genuineness of the policy can be verified through "Verify Your Policy" link at [Link].

For any Information, Service Requests, Claim intimation and Grievances please write to 200700@[Link]

Download Customer App([Link]). REGD. & HEAD OFFICE, 24, WHITES ROAD, CHENNAI - 600014.
Website: [Link]
Printed By : CUSTOMER @ 22/08/2025 [Link] PM

This document is digitally signed

Signer: DS UNITED INDIA INSURANCE CO LTD 1

Date: Fri, Aug 22, 2025 [Link] IST
Location: United India Insurance Company Ltd
1/7 Reason: Signing Policy for UIIC by Harmeet Singh Chahal
 UNITED INDIA INSURANCE COMPANY LIMITED
CERTIFICATE OF INSURANCE
GCV PUBLIC CARRIER OTHER THAN 3 WHEELER-PACKAGE POLICY
UIN. IRDAN545RP0048V01199900
(FORM 51 OF CENTRAL MOTOR VEHICLE RULES 1989)
Policy No. 2007003125P108310588 Certificate Number 2007003125P108310588
Customer Id 23485083703 Issuing Office Address Code 200700
Name of the Insured MR JAHID ALI DIVISIONAL OFFICE - 1, LUDHIANA,
S/O ISHAK, KARAUNDI BHAGWANPUR, PHASE II, FOCAL POINT, LUDHIANA, PUNJAB - 141010
HANIDWAR , BHAGWANPUR 141010
LUDHIANA
Address of the Insured
247661 PUNJAB
HARIDWAR Telephone (0161) 5092618,(0161) 5020726
UTTARAKHAND
Business/Occupation None Mobile No.- ******9164
Effective date of commencement of Insurance for the purpose of Insured's Declared Value 251000
Act from 00:00 Hrs on 23/08/2025
Date of Expiry of the Insurance Midnight on 22/08/2026
Particulars of Vehicle Insured
Registration No.
Obsolete Type of Year of HP/Cubic
Trailer Engine No. Chassis No. Make/Model GVW
Vehicle Vehicle Body Mfg Capacity
(if any)
Mahindra &
Mahindra /
BOLERO
GHF1E35870 MA1ZF2GHKF1E50721 CAMPER
UK - 07 - CA - 9651 No Closed 2015 2523 2960
BOLERO
CAMPER SC
XL FB CBC
2WD
Registration Public / Private
Geographical Area Seating Capacity
Authority
UK07 DEHRA DUN INDIA 2 Public
Amount in words: Seventeen thousand one hundred eleven rupees only
Persons or classes of persons entitled to drive:-
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.
Note:- The policy does not cover liability for death, bodily injury or damage as excluded insection 150 (2) (ii) and (iii); (b) and (c) of the
Motor Vehicles Act, 1988.
Limitations as to use Premium: 17,111.00
The policy covers use only under a permit within the meaning of IGST-Others(18%): 191.00
Motor Vehicles Act,1988 or such a carriage falling under Subsection IGST-Basic TP(12%): 1,926.00
3 of Section 66 of the Motor Vehicles Act, 1988. Stamp Duty: 1.00
The policy does not cover use for: Total(Rounded Off): 19,228.00
a) Organized Racing
Receipt Number : 10120070025110586606
b) Pace Making
Receipt Date: 22/08/2025
c) Reliability Trials
DebitNote Number:
d) Speed Testing
Document Date:
Limits of Liability Agency/Broker Code: BRC0000905
Under Section II-I (i) Death or bodily injury in respect of any one GIRNAR INSURANCE BROKERS
accident; As per Motor Vehicles Act 1988 PVT LTD
Under Section II-I (ii) Damage to third party property in respect of Direct Business:
any one claim or series of claims arising out of one event: Development Officer Code:
750000 /-
Subject to IMT Endorsement No.s, terms and conditions printed herein / attached hereto 21,23,28
I/We hereby certify that the policy to which the certificate relates as well as For and On behalf of
the certificate of insurance are issued in accordance with provisions of United India Insurance Co. Ltd.
Chapter X & XI of M.V Act, 1988.
Date of Issue: 22/08/2025

Duly Constituted Attorney

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 PolicyNo.: 2007003125P108310588

GCV PUBLIC CARRIER OTHER THAN 3 WHEELER-PACKAGE POLICY

UIN. IRDAN545RP0048V01199900
SCHEDULE
Policy No. 2007003125P108310588 Previous Policy No. 108028/31/25/015297
Customer Id 23485083703
Name MR JAHID ALI
Insured Details Tel (O): ******9164 Tel (R) Fax:
Email: ******@[Link] Mobile: ******9164
Business / Occupation None
Period of Insurance From 00:00 Hrs of 23/08/2025 To Midnight of 22/08/2026
Co-Insurance Type

Particulars of Vehicle Insured

Registration No.
Obsolete
Trailer Engine No. Chassis No. Make/Model Year of Mfg
Vehicle Vehicle
(if any)
Mahindra &
Mahindra /
MA1ZF2GHKF1E50721 BOLERO CAMPER
UK - 07 - CA - 9651 No GHF1E35870 2015
BOLERO CAMPER
SC XL FB CBC
2WD
HP/Cubic
Type of Body GVW Seating Capacity Public/Private
Capacity
Closed 2523 2960 2 Public
Insured's Declared Value
Electrical/Electronic Total
For Vehicle For Trailer Non Electrical Accessories CNG Unit LPG Unit
Accessories Value

251000 0 0 0 0 0 251000
Registration Authority Auto Association Membership No. Geographical Area Extension
UK07 DEHRA DUN INDIA
Amount in words: Nineteen thousand two hundred twenty-eight rupees only
Persons or classes of persons entitled to drive:-
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.

Limitations as to use
The policy covers use only under a permit within the meaning of Motor Vehicles Act,1988 or such a carriage falling under Subsection 3 of
Section 66 of the Motor Vehicles Act, 1988.
The policy does not cover use for:
a) Organized Racing
b) Pace Making
c) Reliability Trials
d) Speed Testing

Limits of Liability As narrated in the Certificate of Insurance attached herewith.

EXCLUSIONS :
1) Any accidental loss or damage or Liability / caused or sustained or incurrred 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 any expense whatsoever resulting or arising there from or any
consequential loss.
4) Any liability of whatsoever nature directly or indirectly caused by or constituted to or by or 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 proximatley or remotely occasioned by contributed to, by or traceable to
or arising out of or in connection with war, invasion, act of foreign enemies, hostilities or warlike 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 consequence thereof and in default of such proof, the Company shall not be liable to make any payment in respect of
such a claim.
Personal Accident covers for Owner-Driver CSI: 1500000
This policy is subject to terms and conditions and IMT Endorsement Nos. printed herein / attached hereto 21,23,28

Imposed Excess 0
Voluntary Excess 0
Compulsory Excess 500

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 PolicyNo.: 2007003125P108310588

SCHEDULE OF PREMIUM (IN )

OWN DAMAGE LIABILITY

Basic premium on Vehicle and Accessories B. Basic - TP 16,049.00

A. Basic - OD 918.66 Total 16,049.00
Total 918.66
Add :
Compulsory PA for Owner Driver 275.00
Add :
LL to Paid Driver IMT 28 100.00
Cover for lamps, tyres, tubes etc 137.80

Sub Total (Additions) 137.80 Sub Total (Additions) 375.00

Less :
Gross TP(B) 16,424.00
No Claim Bonus 35% 369.76
Gross OD & TP:
17,111.00
Sub Total (Deductions) 369.76 (A) + (B)

Gross OD(A) 687.00

TERMS AND 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 UIIC website : [Link]
DISCLAIMER : The Policy stands cancelled or void in the event of Cheque Dishonor. The Company may cancel the policy by sending 7 days
notice in case of any fraud or 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 Vehicles 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 the event of accident, the Insured should inform United India Insurance Co. immediately to arrange spot survey.

Agency/Broker BRC0000905
Code:
Receipt
Premium: 17,111.00 10120070025110586606 GIRNAR
Number :
INSURANCE
BROKERS PVT LTD
IGST-Others(18%): 191.00 Receipt Date : 22/08/2025Direct Business:
IGST-Basic TP(12%): 1,926.00
DebitNote Development
Stamp Duty: 1.00
Number : Officer Code:
Document
Total (Rounded Off): 19,228.00
Date :

Customer GST/UIN No.: Office GST No.: 03AAACU5552C1ZT

SAC Code: 997134 Invoice No. & Date: 3125I108310588 & 22/08/2025
Amount Subject to Reverse Charges-NIL

We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said
sub-rule.
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 [Link]

Date of Proposal and Declaration:22/08/2025

IN WITNESS WHEREOF, this policy has been signed at DO 1 LUDHIANA 200700 on this 22nd day of August 2025
For and On behalf of
United India Insurance Co. Ltd.

Affix Policy
Stamp here.

Duly Constituted Attorney:

Underwritten By - PRA60684 ( DO UNDERWRITER )
Warranty:Warranted that at no time the Gross Laden Weight of the Vehicle exceeds the Gross Vehicle Weight mentioned in the schedule
of the policy.

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 CUSTOMER INFORMATION SHEET
This document provides only key information about your policy. Please refer to Policy document for detailed terms and conditions
Sl No Title Description Policy Clause
1 Product Name Goods Carrying Vehicle Package policy Policy Schedule
Unique Identification
2. Number (UIN) allotted by UIN: IRDAN545RP0048V01199900 Policy Schedule
IRDAI
Section I : Own Damage - Indemnity based
Section II : Liability to Third Parties
Structure Basis of Sum
3. Section III : Towing Disabled Vehicles - Indemnity based Policy Schedule
Insured (IDV)
Section IV : Section IV : Personal Accident Cover for Owner cum
driver - Benefit based
Section I : Motor Own Damage - Covers damages to vehicle due to
perils listed in the policy
Section II : Motor Third Party Liability - Covers Liability towards Third
Party Death/Injury and Third Party Property Damage
4. Interests Insured Policy Schedule
Section III : Towing Disabled Vehicles
Section IV : Personal Accident cover for Owner cum Driver -
Covers Death and Permanent Total Disablement of the Owner cum
driver of the Insured vehicle.
5. Sum Insured / Motor Section I - Loss of Or Damage To The Vehicle Insured: Section I - Loss of or
Insured Declared Value Damage To the Vehicle
Scope The IDV of the vehicle (and any fitted accessories) is based on the Insured
manufacturer's listed selling price of the brand and model at the
start of insurance or renewal, adjusted for depreciation. For vehicles
over 5 years old and obsolete models, the IDV is determined by
agreement between the insurer and insured.
The insured vehicle shall be treated as a CTL if the aggregate cost
of retrieval and / or repair of the vehicle, subject to terms and
conditions of the policy, exceeds 75% of the IDV of the vehicle.

IDV depreciation schedule is as follows:

% of Depreciation
Age of Vehicle
for Fixing IDV
Not Exceeding 6 months 5%
Exceeding 6 months but not
15%
exceeding 1 year
Exceeding 1 year but not
20%
exceeding 2 years
Exceeding 2 years but not
30%
exceeding 3 years
Exceeding 3 years but not
40%
exceeding 4 years
Exceeding 4 years but not
50%
exceeding 5 years
IDV of vehicles beyond 5 years of age and of obsolete models of
the vehicles (i.e. models which the manufacturers have discontinued
to manufacture) is to be determined on the basis of an
understanding between the insurer and the insured.
Section II - Liability to
Section II - Liability to Third Party Third Party
For Third Party Death / bodily injury/Third Party Property Damage
Section III - Towing
Section III - Towing Disabled Vehicles:
Disabled Vehicles:
Whilst the Insured vehicle is being used for the purpose of towing
Section IV - Personal
any one disabled mechanically propelled vehicle
Accident Cover for Owner
cum Driver (Death and
Section IV- Personal Accident Cover For Owner cum Driver: Benefit
Permanent Total
payment up to 15 Lakhs.
Disablement)
6 Policy Coverage Section I Loss of or damage to the vehicle insured Section I - Loss of or
Damage To the Vehicle
List of perils covered are as per Policy schedule Insured
Section II Legal Liability to Third parties (TP) for personal injury, Section II - Liability to
Death and property damage resulting from accident Third Party

Section III - Towing Disabled Vehicles Section III -Towing

disabled vehicles
Policy will be operative, whilst the Insured vehicle is being used for
the purpose of towing any one disabled mechanically propelled
vehicle
Section IV - Personal
Accident Cover for Owner-
Section IV Compulsory Personal Accident (CPA) Cover for Owner-
Driver (Death and
Driver resulting from accident
Permanent Total
Disablement)
7 Add-on covers available • Nil Depreciation without excess Addons Section
• Return to Invoice
• Consumables
• RSA
• EMI protect
• EV Protect
*Addons which are Opted by the Insured and which are mentioned in
the policy are only applicable
8 Loss Participation Deductible applicable: Compulsory excess/Voluntary Policy Schedule

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 excess/Imposed excess
The Company shall not be liable for each and every claim under
Section - I (loss of or damage to the vehicle insured) of this Policy in
respect of the deductible stated in the schedule.

Compulsory Excess: As mentioned in the Policy Schedule.

9 Major Exclusions Major Exclusions are as shown below: General Exclusions
• any accidental loss damage and/or liability caused sustained or
incurred outside the Geographical Area.
• any accidental loss damage and/or liability caused sustained or
incurred whilst the vehicle insured herein is
• being used otherwise than in accordance with the 'Limitations as
to Use'
or
• being driven by or is for the purpose of being driven by him/her
in the charge of any person other than a Driver as stated in the
Driver's clause.
Detailed list of exclusions are as per policy schedule
10 Special Conditions and Conditions and warranties are as stated in policy Conditions
Warranties In case of Theft of vehicle, immediate notice should be given to
insurance company along-with FIR.
Notice should be given to RTO about the theft of vehicle and be
guided by claims dealing office to follow theft guidelines.
In case of Death of Registered Owner of vehicle, the policy will not
lapse immediately but will remain valid for 3 months from the date
of death of Registered Owner or expiry of the policy whichever is
earlier.
In addition to above, detailed Conditions and Warranties are as
mentioned in the Policy
11 Admissibility of Claim Claim should be notified immediately on the date of accident
through online intimation, email to the address mentioned in policy
or through any other means.
Due diligence should be taken by Insured upon occurrence of loss as
mentioned in conditions of the policy.
Claim will be indemnified in any one of the methods;
[Link] basis - Indemnity with deduction for depreciation /excess
applicable-cashless or reimbursement to Insured
[Link] Loss/CTL basis- Based on the Net of Salvage loss/ Total loss
basis after deduction of Wreck value and Excess.
[Link] Claims Calculation:
A Gross Assessed Liability Rs.10,000/-
Less: Depreciation (if
B (Rs.3,000/-)
applicable)
C Net Assessed Liability (A-B) Rs.7,000/-
(Rs.1,500/-) Based
on the compulsory
D Less: Compulsory deductible deductible as
mentioned in the
Policy Schedule)
E Net Payable Amount(C-D) Rs.5,500/-
12 Policy service/ Claim • Please contact your Policy issuing office, details of which are
service mentioned in your Policy Schedule for any assistance in policy
• In case of accident, Online intimation of the claim can be given
through phone, online through mail to Agent or policy issuing office
or through portal. Details of the contact number and mail id are
mentioned in the policy.
• Surveyor appointment will be done within 24hrs of receiving
intimation
The following are the Basic Claim documents to be submitted by the
insured:
Insured has to submit all the relevant documents at the time of
taking insurance. List of documents mentioned in the proposal form
should be submitted along-with the proposal.
Basic Documents to be submitted during proposal acceptance;
• Proposal form duly signed by Insured
• Vehicle Documents of the Insured vehicle/Invoice copy in case of
new vehicle
• Pollution certificate
• KYC document of the Insured
• Bank details of the Insured
Basic Documents at the time of claim:
• Motor Claim Form - claim form may be downloaded from [Link]
website
• KYC documents if there is any change in ownership
• Copy of RC and Vehicle documents of the Insured vehicle if there
is change in ownership
• Copy of Driving License of person driving at the time of accident
• FIR in case of TP Injury/Death Case/Theft claim
• NOC in case of theft claim
Any other specific documents related to the claim
13 Cancellation a) The policyholder can cancel the policy at any time during the Conditions
term, by informing the insurer. In case the policyholder cancels the
policy, he/she is not required to give reasons for cancellation.
The insurer can cancel the policy only on grounds of established
fraud, by giving minimum notice of 7 days to the policy holder.
b) Under no circumstances can the insurer cancel the statutory Motor
Third Party Liability Insurance or any other compulsory insurance
mandated by law except in case of double insurance or total loss

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 c) The insurer shall -
i. Refund proportion of premium for unexpired policy period, If the
term of the policy is upto one year and there is no claim(s) made
during the policy period.
ii. Refund premium for the unexpired policy period, in respect of the
policy with the term more than one year and the risk coverage for
such policy years has not commenced.
d) In all cases minimum premium of Rs.100/- will be retained by the
insurer
14 Policy Servicing / • Details of company officials: Please contact your Policy issuing
Grievances Complaints office, details of which are mentioned in your Policy Schedule
• In case of any grievance, you may contact UIIC through:
• [Link]: [Link]
• [Link] Free Number: 1800 425 333 33
• c.E-Mail: customercare@[Link]
• [Link] may also approach the grievance cell at any of our branches
with details of the grievance
• [Link] may lodge a complaint in our Inhouse Grievance portal -
UGMS Portal
• Alternatively, you may lodge a complaint at the IRDAI Integrated
Grievance Management System ([Link]
.
15 Obligations of the • Insured is at obligation to disclose all material information in the
Policyholder Proposal form.
• In the event of misrepresentation, mis-description or non-
disclosure of any material fact by the Insured, the Policy shall be
void
• Insured can contact our policy issuing office, details of which are
mentioned in the policy schedule.
(i)To intimate any change to the material information affecting the
policy.
(ii)Any change in the ownership of the vehicle, any kind of
modification in the vehicle/RC which might enhance the risk is
considered as material information and should be informed to
insurance company for necessary endorsement on policy.

Legal Disclaimer Note: The information must be read in conjunction with the policy document. In case of any conflict between the CIS and
the policy document, the terms and conditions mentioned in the policy shall prevail.

Declaration by the Policy Holder:

I have read the above and confirm having noted details

Place:
Date:
Signature of Policy Holder
*Duplicate copy has to be signed and submitted to the company.

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

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