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PRIVATE CAR PACKAGE POLICY

INTERMEDIARY NAME
HUDSON INSURANCE BROKERS PRIVATE LIMITED
INTERMEDIARY CODE
201110285037 PHONE
NO.
7527024510 E-MAIL NA SUB CODE 160
POLICY/INVOICE ISSUED DATE 21/02/2019
INSURED NAME KULBIR SINGH MANUAL COVERNOTE NUMBER USGIA/2019019598
PROPOSER ADDRESS/PLACE S/O PRITAM SINGH REGISTRATION DATE 03/02/2017
OF SUPPLY VPO GATTI PEER UID NO 869153732006
JALANDHAR RTO ZONE B
JALANDHAR - PUNJAB (3)
PIN - 144702 CUSTOMER ID 101676327783
CONTACT NO - 9876209673 NOMINEE NAME NA
GST NUMBER - NA
PERIOD OF INSURANCE FROM 00:01 OF 16/02/2019 RELATIONSHIP WITH PROPOSER NA
TO MIDNIGHT OF 15/02/2020
FINANCIAL INTEREST CAPITAL SMALL FINANCE BANK LTD : JALANDHAR EIA ACCOUNT NO. NA
POLICY ISSUANCE OFFICE JALANDHAR BRANCH OFFICE, SCO 4, 2ND FLOOR, PUDA COMPLEX, LADOWALI ROAD, JALANDHAR, PUNJAB,
STATE CODE - 3, PIN -144001, GSTIN - 03AAACU8917F1ZG
PARTICULARS OF VEHICLE INSURED
REGISTRATION CHASSIS NUMBER ENGINE MAKE MODEL BODY CUBIC MFG CARRYING
NUMBER NUMBER TYPE CAPACITY YEAR CAPACITY
PB-08-DP-1956 MA3FHEB1S00C10707 D13A2974590 MARUTI SWIFT SALOON 1248 2016 5
VDI
PUC Number PUC Center
NA NA
INSURED'S DECLARED VALUE (Rs.)
FOR THE FOR NON-ELEC ELECTRICAL/ELECTRONIC CNG LPG TOTAL
VEHICLE TRAILER ACCESSORIES ACCESSORIES KIT KIT VALUE
479001.00 0.00 0.00 0.00 0.00 0.00 479001.00
SCHEDULE OF PREMIUM (AMOUNT IN Rs.)
OWN DAMAGE (A) LIABILITY (B)
Basic Premium On Vehicle 15285.00 Basic Third Party Liability 2863.00
Total Basic Own Damage 15285.00 Total 2863.00
Detariff Discount Amount 7644.00 Add:
Total OD after Discount/Loading 7641.00 Paid Driver 50.00
Add: PA to Owner-Driver 225.00
Depreciation Waiver Plan A 4072.00 Sub Total (Additions) : 275.00
Total Liability Premium 3138.00
Sub Total(Additions) 4072.00
Total Own Damage Premium 11713.00
TOTAL PACKAGE PREMIUM (A+B) 14851.00
NET PREMIUM 14851.00
CGST (9%) 1336.50
SGST (9%) 1336.50
TOTAL PREMIUM 17524.00
COMPULSORY DEDUCTIBLE 1000.00 VOLUNTARY DEDUCTIBLES 0.00
Policy subject to the following Special Condition(s) :
ROADSIDE ASSISTANCE INCLUDED IN THIS POLICY Toll Free Nos-1800 209 6678/+91 22 40901520
For No Claim Bonus (NCB): a) No Claim Bonus will only be allowed if the policy is renewed within 90 days of the expiry date of the previous year. b) The insured is entitled for a No Claim Bonus on the
Own Damage Section of the policy, if no claim is made or pending during the preceding year(s) as per policy conditions.
DRIVER (Persons or classes of persons entitled to drive): Any person including the 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.
LIMITATIONS AS TO USE: The Policy covers use of the vehicle for any purpose other than: a) Hire or Reward b) Carriage of goods (other than samples or personal luggage) c) Organised racing d) Pace
making e) Speed testing f) Reliability Trials g) Any purpose in connection with Motor Trade.
LIMITS OF LIABILITY: a) Under Section II- 1(i) of the Policy- Death or bodily injury-such amount as is necessary to meet the requirements of the Motor Vehicle Act 1988 b) Under Section II- 1(ii) of the
Policy-Damage to Third Party Property-in respect of any one claim or series of claims arising out of one event (Rs. 6000/- OR Rs 7.5 Lakhs as may be applicable). P.A. Cover under Section III for Owner -
Driver (CSI). Deductible under section 1: Refer Compulsory Deductible.
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"
SUBJECT TO IMT ENDORSEMENT NOS. AND MEMORANDUM PRINTED HEREIN / ATTACHED HERETO : 22,27,7
PREMIUM COLLECTION DETAILS : [Collection No / Amount / ReceiptDate] 1019754312 / 17524 / 15/02/2019
DISCLAIMER: For USGIC renewal policies, the policy wordings including terms and conditions were sent with the first year policy. The same policy wordings stands correct with no changes. You can also
refer the wordings at our website www.universalsompo.com. Policy is valid subject to Realization of Cheque. We accept premium only via legally recognized modes except for cash. If our representatives
request you to pay in cash, kindly report it to us.
CLAIMS DISCLAIMER: In the unfortunate event of any loss or damage to the insured property resulting into a claim on this policy, please intimate the mishap IMMEDIATELY to our Call Centre at Toll Free
Numbers on 1-800-22-4030 (for MTNL/BSNL users) or 1-800-200-4030 (other users) or on chargeable numbers at +91-22-27639800 / +91-22-39133700. Email at [email protected].
Please note that no delay should be allowed to occur in notifying a claim on the policy as the same may prejudice liability.

I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X, XI of M. V. Act 1988.
FOR UNIVERSAL SOMPO GENERAL INSURANCE CO. LTD.
IRDAI UIN NO: IRDAN134P0004V01200708, IRDA/NL/F AND U/USGI/Motor/ Add - On/1

SAC CODE : 997134 DULY CONSTITUTED ATTORNEY(S)

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In Witness whereof this Policy has been signed at Mumbai in lieu of covernote No. USGIA/2019019598
Consolidated stamp duty Rs 0.50 paid towards Insurance policy stamp vide receipt no. CSD/246/2018/5183 dated 28/06/2018 of General Stamp Office Mumbai.
In case of any discrepancy, complaint or grievance, please feel free to contact us within 15 days of receipt of the Policy. Universal Sompo General Insurance Co. Ltd. Express IT Park, Plot
No. EL - 94, T.T.C. Industrial Area, M.I.D.C., Mahape, Navi Mumbai- 400710 Toll Free Numbers: 1-800-22-4030 (for MTNL/BSNL users) or 1-800-200-4030 (other users) Landline
Numbers:+91-22-27639800 / +91-22-39133700 (Local Charges Apply). E-mail Address: [email protected]. Fax Number: 022-39171419 Note: Please include your policy
number for any communication with us.

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