Motor Commercial Vehicle Package Policy - Miscellaneous and Special Type of Vehicles

(See Rule 51 of Central Motor Vehicles Rules, 1989 of Motor Vehicles Act,1988.)

CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.

ADDRESS: N A G P U R - B R A N C H GST Invoice No.: 3 3 8 0 4 6 9 5 0 6 2 0 9
GROUND FLOOR, PLOT NO. 22, DATE: 2 2 / 0 9 / 2 0 2 3
TILAK NAGAR, NAGPUR - 440010 PAN: A A B C C 6 6 3 3 K
GANDHI NAGAR S.O SAC Code: 9 9 7 1 3 4
CITY: N A G P U R STATE: M A H A R A S H T R A SAC Description: Motor vehicle insurance services
GSTIN: 2 7 A A B C C 6 6 3 3 K 1 Z J
Business Location: NAGPUR - BRANCH Cover Note No: -
Policy Number: 3380/02466881/000/00 Customer Code: 101357574582 Policy Type: Miscellaneous & Special Type Vehicle
Name&Communication Address: Name and Registration Address:
KGN TRADERS
PROP MUSHTAQ MOHAMMAD ALI QURESHI 431, NEAR OLD BUS STAND, WARDHA PROP MUSHTAQ MOHAMMAD ALI QURESHI 431, NEAR OLD BUS STAND, WARDHA
ROAD, BUTIBORI CHOTIBURI DIST NAGPUR, ROAD, BUTIBORI CHOTIBURI DIST NAGPUR,
INDUSTRIAL AREA BUTIBORI S.O,NAGPUR INDUSTRIAL AREA BUTIBORI S.O,NAGPUR
MAHARASHTRA,PIN- 441122 MAHARASHTRA,PIN- 441122 Mobile-8087922168
GST No.: 27AABPQ0290K1ZL Mobile-8087922168
Aadhar No.: - PAN No.:AABPQ0290K
Period of Insurance: from 22/09/2023 11:34 hours to midnight on 21/09/2024 Business or Profession: Corporate Geographical Area: No Extension
Certificate Number: 3380/02466881/000/00 Issue Date: 22/09/2023
PARTICULARS OF THE VEHICLE INSURED
Date of Registration: 22/09/2023 Place of Registration: NAGPUR Registration Mark: NEW
Make: ESCORT Model: HYDRA 14 Variant: 4P WITH AIR BRAKE CRANE Vehicle Colour: - Year of Mfg: 2023
Type of Body: CRANE Fuel Used: DIESEL Engine No: AE4312C3AE3738247 Chassis No: ECE01195PP0901512
Cubic Capacity: 3605 K.Watts : - Gross Vehicle Weight(GVW)/HP: - GVW as per RC: - Public/Private Carrier: PUBLIC Registration Mark(Trailer): - Contract No: -
Licensed Passenger Carrying Capacity: 0 Driver 1 Cleaner: 1 Conductor: 0 Total Seating Capacity Including Driver: Chassis No.(Trailer): -
IDV (Insured Declared Value)
Value of Chassis (Rs): 2200000 Value of Body (Rs): 0 For Vehicle (Rs): 2200000 For Trailer (Rs): 0 Non-Electrical Accessories (Rs): 0
Electrical/Electronic Accessories (Rs): 0 Value of CNG/LPG Kit (Rs): 0 Total Value (Rs): 2200000
A. OWN DAMAGE B. LIABILITY
SI No. of Person I M T Premium (Rs) SI No. of Person I M T Premium (Rs)
Basic OD 2,200,000.00 26,180.00 Basic T P 7,267.00
IMT 2 3 26,180.00 23 3,927.00 Paid Driver 1 40 50.00

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TOTAL 30,107.00 Legal Liability to 40 50.00
Add: Cleaner 1
Over-Turning Loading 11,000.00 Conductor
Sub Total:(additions) 11,000.00 TOTAL 7,367.00
Own Damage Premium 41,107.00 TOTAL PREMIUM(B) 7,367.00

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Experience Based Discount (80%) 32,885.60 C.PERSONAL ACCIDENT COVERS
TOTAL(A) 8,221.00 TOTAL PREMIUM(C) .00
Add-On Covers Discount .00
E.OTHER CHARGES (NON PREMIUM) TOTAL (A+B+C+D+E) 15,588.00
Chola value added services 0.00 TOTAL CONSIDERATION 15,588.00

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TOTAL OTHER CHARGES (NON PREMIUM) (E) 0.00 CGST (9%) 1,403.00
SGST (9%) 1,403.00
IGST (0%) 0.00
AMOUNT COLLECTED 18,394.00

Testing. f)Use for the carriage of passengers for hire or reward.

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LIMITATIONS AS TO USE: The Policy covers use of the vehicle for any purpose other than: a)Organised Racing. b)Use while drawing a Trailer,except the towing(other than for reward) of any one disabled mechanically propelled vehicle. c)Pace Making. d)Reliability Trial. e)Speed

DRIVER CLAUSE: 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 (1) of the Policy - Death or bodly injury such amount as is necessary to meet the requirements of the Motor Vehicle Act, 1988. Under Section II - 1 (ii) of the Policy - Damage to Third Party Property - Rs.750000 P.A. Cover for the Owner cum
Driver Under Section IV (CSI)- Rs..00 Deduction Under Section 1: Rs.11000 Additional compulsory deductibles under Section 1 Rs.0.00
Additional Imposed deductibles under Section 1 Rs.0
Subject to I.M.T. Endt. Nos. and Memorandum: 23,21,40,47,7 .
Coverage Under this policy is subject to realisation of premium cheque(s). Incase of dishonor of cheque(s). No separate intimation will be given and the policy stands cancelled from inception.

Date and Signature of the proposal 22/09/2023.

Warranties: -

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The policy wordings with detailed terms, conditions,warranties exclusions and the list of Ombudsman details are available on our website www.cholainsurance.com.

This policy has been issued upon declaration by the Assured that a valid Pollution Under Control (PUC) Certificate is held on the date of commencement of the Policy
lt is hereby warranted the coverage under this Policy commences only from the Risk Start time and Date as mentioned in the Policy schedule. No Liability shall attach under this Policy in respect of any Accident/Loss prior to the time and date of commencement of Period of insurance

No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
CVAS NEW :
As per GR 36A-PA for Owner driver refers to the Owner of the insured vehicle holding an effective drving licence.
Nominee Details:
Financier Name & Address: INDUSIND BANK LTD,NAGPUR,NAGPUR
Intermediary Name: TURTLEMINT INSURANCE BROKING SERVICES
POSP Name:
PRIVATE LIMITED
Code: 2013965725280018 POSP PAN No.:
POSP Aadhaar
Contact No: 9820797956
No.:
Note: The Motor Policy Schedule cum Certificate of Insurance is an important document issued based on your declaration. We request you to verify the details and ensure that everything is in order. In case of any discrepancies, please contact us within 15 days from the date of issuance of
policy.
For Cholamandalam MS General Insurance Company Ltd.
Place: CHENNAI Date:22/09/2023 Receipt No: Receipt Date:
@CholaSign1
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1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
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Digitally signed by:

KANCHIPURAM
SRIDHAR HARISH
Consolidated Stamp Duty Paid Vide G.O Rt No , Commercial Taxes and Registration (j1) Department, Tamil Nadu dated Duly Constituted Attorney(s)

I/We hereby certify that the policy to which this certificate relates as well as this certificate of insurance are issued in accordance with the provisions of Chapter X and Chapter XI of the Motor Vehicles Act, 1988.
IMPORTANT NOTICE: The insured is not indemnified if the vehicles 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 Information/Claims: Contact Toll Free Helpline at 1800 208 5544: sms "CHOLA" to 56677 For CARE contact 1800 103 5354;
E-mail: [email protected]: www.cholainsurance.com
Note:UIN for this product and the related add on covers availed under this policy are as mentioned in the attached sheet ,which forms part of the Policy Schedule.

Whether tax is payable under reverse charge basis - No.

Cholamandalam MS General Insurance Company Ltd.

Regd.&Head Office:Dare House, 2nd Floor, No.2, N.S.C Bose Road, Chennai-600 001, India
CIN: U66030TN2001PLC047977 | IRDAI Reg. No. 123

To : DATE : 22/09/2023
Customer Name : KGN TRADERS
Address :
PROP MUSHTAQ MOHAMMAD ALI QURESHI 431, NEAR OLD BUS STAND, WARDHA ROAD, BUTIBORI CHOTIBURI DIST NAGPUR
-,INDUSTRIAL AREA BUTIBORI S.O,NAGPUR,MAHARASHTRA,PIN- 441122
Mobile- 8087922168

Dear Sir/Madam

Ref: Vehicle details updation in your Motor Insurance Policy 3380/02466881/000/00

On behalf of Chola MS we would to thank you for choosing us as your preferred insurer. Your vehicle details are updated in our records as per the details below.We request
you to confirm the correct / missing information and send this letter back to the address given, to update the same in our records. If there are any corrections, we request
you to provide the Registration Certificate (RC) for our records and future reference.

Vehicle Registration : NEW

Engine : AE4312C3AE3738247
Chassis : ECE01195PP0901512

Documents to be sent to:

Manager (Operations),
Cholamandalam MS General Insurance Ltd
1st Floor, Hari Nivas Tower, 163, Thambu Chetty Street,
Parrys Corner,
Chennai - 600001

We request you to reply within 7 days of receipt of this letter. Alternatively, request you to e-mail your above Vehicle details with scanned copy of Registration Certificate to
the following e-mail ID, quoting your policy number. [email protected]

For any further clarifications please feel free to call our toll free # 1800 208 5544.

Yours faithfully,
For Cholamandalam MS General Insurance Company Ltd.
@CholaSign1

S
% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q

Digitally signed by:

KANCHIPURAM
SRIDHAR HARISH

Motor Commercial Vehicle

Product Package Policy -
: M Authorised Signatory

A
Name Miscellaneous and Special
Type of Vehicles
UIN : IRDAN123RP0007V03100001

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