Policy No.

2352/CSC/00129069/00/000
SAGAR GOHAR,
VILL-SIVIL AREA PACHAMARI, TEH-PIPARIYA, , , MADHYA PRADESH, 999999
PACHAMARHI
HOSHANGABAD
MADHYA PRADESH
461881
+91 87xxxx2751
mxxxxxxx@gmail.com
Dear SAGAR GOHAR,
Thank you for choosing us as your insurance partner for TWO WHEELER LIABILITY POLICY CSC - CUM TAX INVOICE Policy. We’re extremely delighted to have you on-
board. And we are going to be with you every step of the way.
We are pleased to share a list of those garages in your city which have been trusted and rated highly by our customers basis their experience. You may like to
consider to utilize their services in the unfortunate event of an accident or damage to your vehicle. Please visit below link to check the garage list or scan the QR
code.
https://www.universalsompo.com/cashless/

To make your insurance experience seamless, we have introduced below tech-based solutions.

USGI PULZ App - One stop solution for all your insurance needs. Now enjoy below complimentary value added benefits with our app.

Insurance Wallet – Manage insurance policies on the go with buy and renew Option
Claim Management – Intimate claim online and track claim status
Complete Auto Care Solutions – Online car service appointment, road side assistance, extended
warranty, buy spare parts and accessories, sell car online, self-drive car discount, tips to maintain your vehicle.
24X7 Road Side Assistance* – In case you are in distress due to flat tyre, drained battery, minor repairing or towing of vehicle in case of break down or
accident of your vehicle, Key locked in car or lost, fuel run dry or arrangement of taxi/ ambulance
Location based Service – Find nearest pharmacy, blood bank, wellness center, lab test center, online medicine stores. Also you can track your daily
activity, set reminders, and maintain your health profile and much more

* Subject to Terms and conditions of Universal Sompo Policy covering the vehicle with RSA cover

AI-Powered Virtual Agent

• Helps you intimate claim with ease

We’re committed to offer you best-in-class services. For any query, call us on our toll-free number 1-800- 200-4030 (Other Users), 1-800-22-4030 (MTNL/BSNL
Users), or mail us at contactus@universalsompo.com. You can also drop by at one of our branches. For more information visit our website
www.universalsompo.com
Please note that your policy is issued as per the information provided by you to us in the proposal form/ e-proposal form as well as the terms and conditions
accepted by you. In case of any disagreement, discrepancy, or clarification that you may need, please let us know within 15 days of policy received.

We thank you again for choosing Universal Sompo as your insurance provider, and look forward to a long and healthy relationship.

Varsha Gujarathi Head

Operations & Customer
Services

Scan to download
Scan to check Garage List
USGI Pulz App
Regd. No. 134
 TWO WHEELER LIABILITY POLICY CSC - CUM TAX INVOICE
CERTIFICATE CUM POLICY NUMBER:2352/CSC/00129069/00/000
INVOICE NUMBER : WEB2320241222409
INTERMEDIARY NAME CSC E GOVERNANCE SERVICES PRIVATE LIMITED
INTERMEDIARY CODE 201851997892 PHONE NO. 8126211011 E-MAIL mjyotishanker@gmail.com SUB CODE NA
POLICY/INVOICE ISSUED DATE 08/05/2024
INSURED NAME SAGAR GOHAR MANUAL COVERNOTE NUMBER CSC0001935841
VILL-SIVIL AREA PACHAMARI, TEH-PIPARIYA, , ,
REGISTRATION DATE 25/06/2018
MADHYA PRADESH, 999999
PACHAMARHI
NA RTO ZONE B
PROPOSER ADDRESS/PLACE OF SUPPLY HOSHANGABAD - MADHYA PRADESH
PIN - 461881 CUSTOMER ID NA
MOBILE NO - 87xxxx2751
EMAIL ID - mxxxxxxx@gmail.com
NOMINEE NAME NA
GST NUMBER - NA
FROM 00:01 AM OF 10/05/2024
PERIOD OF INSURANCE RELATIONSHIP WITH PROPOSER SELECT
TO MIDNIGHT OF 09/05/2025
FINANCIAL INTEREST EIA ACCOUNT NO. NA
UNIVERSAL SOMPO GENERAL INSURANCE CO LTD. OFFICE NO 103, FIRST FLOOR, ACKRUTI STAR,MIDC CENTRAL ROAD,ANDHERI (EAST), MUMBAI-
POLICY ISSUANCE OFFICE
400093,MAHARASHTRA, GSTIN- 27AAACU8917F1Z6
PARTICULARS OF VEHICLE INSURED
REGISTRATION NUMBER CHASSIS NUMBER ENGINE NUMBER MAKE MODEL BODY TYPE CUBIC CAPACITY MFG YEAR SEAT CAP
MP-05-MT-9376 MD2A13EY2HCG79469 DKYCHG68675 BAJAJ PULSAR 220 DTS F TWIN SPORTS 220 2018 1
PUC Number PUC Center
NA NA

SCHEDULE OF PREMIUM (AMOUNT IN Rs.)

LIABILITY
Basic Third Party Liability 1366.00
Total 1366.00
Total Liability Premium 1366.00
TOTAL PREMIUM 0.00
NET PREMIUM 0.00
IGST 0.00
CGST (9%) 123.00
SGST (9%) 123.00
UGST 0.00
TOTAL PREMIUM 1612.00
COMPULSORY DEDUCTIBLE NA VOLUNTARY DEDUCTIBLES 0.00
For Policy Terms and Conditions Log on to : www.universalsompo.com
VLE ID : 653534540017 VLE Name : Vikrant Mehrolia VLE Contact NO. : Null
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)Organized 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) : Rs. 1500000/-. 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 : NA
PREMIUM COLLECTION DETAILS: [Collection No / Amount / ReceiptDate] NA
DISCLAIMER: 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 contactclaims@universalsompo.com. 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: USG-MT-P16-42-V01-15-16

IRDAI REGISTRATION NO: 134
GSTIN : 27AAACU8917F1Z6
SAC CODE : 997134
DULY CONSTITUTED ATTORNEY(S)
In Witness whereof this Policy has been signed at Mumbai in lieu of covernote No. CSC0001935841
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). Local
Branch office : 022 - 61055700 Head Office: 02229211800 Grievance redressal officer: 022-62931375. E-mail Address: contactus@universalsompo.com. Note: Please include your policy number for any communication with
us.
 PROPOSAL FORM CUM TRANSCRIPT LETTER FOR TWO WHEELER LIABILITY POLICY CSC - CUM TAX INVOICE
Make BAJAJ Proposal No. NA
VILL-SIVIL AREA PACHAMARI, TEH-PIPARIYA, Model PULSAR 220 DTS F TWIN Issuance date 08/05/2024
, , MADHYA PRADESH, 999999 FROM 00:01 AM OF 10/05/2024
Registration Number MP-05-MT-9376 Period of Insurance
PACHAMARHI TO MIDNIGHT OF 09/05/2025
SAGAR GOHAR FROM 00:01 AM OF 10/05/2024
RTO B OD Period
HOSHANGABAD TO MIDNIGHT OF 09/05/2025
MADHYA PRADESH FROM 00:01 AM OF 10/05/2024
Chassis No. MD2A13EY2HCG79469 TP Period
PIN - 461881 TO MIDNIGHT OF 09/05/2025
Cubic capacity 220 Hypothetication NA
MOBILE NO - 87xxxx2751 Year of Manufacturing 2018
Engine Number DKYCHG68675

VEHICLE IDV TRAILER ELECTRICAL IDV NON-ELECTRICAL IDV CNG KIT LPG KIT TOTAL IDV
0.00 0.00 0.00 0.00 0.00 0.00 0.00

PREMIUM DETAILS ₹
OWN DAMAGE AFTER LOADING/DISCOUNT (INCLUDING ALL ACCESORIES PREMIUM) 0.00
TOTAL OWN DAMAGE PREMIUM 0.00
BASIC THIRD PARTY 1366.00
COMPULSORY PERSONAL ACCIDENT COVER**: (OWNER-DRIVER) (SUM INSURED-1500000) 0.00
PERSONAL ACCIDENT: UNNAMED PERSONS 0.00
LEGAL LIABILITY: PAID DRIVER 0.00
TOTAL LIABILITY PREMIUM 1366.00
NET PREMIUM 0.00
SGST@9% 123.00
CGST@9% 123.00
IGST@18% 0.00
Total Premium 1612.00

Add-on Covers

Special Condition NA

Geographic Area Compulsory Excess 0.00 Voluntary Excess 0.00

Anti Rebate Clause

Prohibition of Rebates(Section 41of Insurance Act, 1938asamended) :

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of
risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any
person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of
the insurer: provided that acceptance by an insurance agent of commission in connection with a policy of life insurance taken out by himself on his own life shall not be
deemed to be acceptance of a rebate of premium within the meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed
conditions establishing that he is a bona fide insurance agent employed by the insurer.
Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.

Terms and Conditions

I hereby declare that the Insured Person(s) listed in Proposal Form will abide to the following terms and conditions:

I/We here by declare that the statements made by me/us are true to the best of my / our knowledge and belief and I/we hereby agree that this declaration shall form the
basis of the contract between me/us and Universal Sompo General Insurance Company Limited.
I/We also declare that, if any additions or alterations are carried out after the submission of this proposal form, then the same would be conveyed to the insurers
immediately.
I/We also shall endeavour to procure the renewal notice and pass on the same to Universal Sompo General Insurance immediately upon the receipt of such renewal
notice.
Any person who, knowingly and with intent to defraud the Insurance Company or other persons, files a proposal for insurance containing any false information, or
conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act which will render the policy voidable at the
Company's sole discretion and result in a denial of insurance benefits. GSTIN :Motor(Comprehensive and TP):For policy issued in the name of corporate entity (proprietor,
HUF, partnership, private company etc), GSTIN is printed on the policy, basis the details provided during policy issuance. For any subsequent changes or addition (i.e. if
GSTIN not entered at the time of policy issuance) on policy schedule, changes shall be carried out through fresh policy issuance with prospective effect.
I / we declare and confirm having a valid PUC.
CPA declaration: Any one of below disclaimer to be printed as the case may be:
CPA cover is not opted by me as I do not have effective driving license, or
CPA cover is not opted by me as I have standalone CPA cover (SI ₹ 15 lac), or
CPA cover is not opted by me as I have Personal Accident cover for CSI of ₹ 15 lacs or higher.
I understand the Proposal No. NA is issued to me basis on above information.
Transcript Declaration :In case disagreement or objection or any other changes with respect to information and contents mentioned herein above, please contact our toll
free number and register your objections / changes / disagreement to the content of this transcript or you may also send us email or written correspondence at the
following details within a period of 15 days from date of your receipt of this transcript along.

EMail-Id : contactus@universalsompo.com Toll-Free No : 1800 22 4030 / 1800 200 4030.