Motor Policy Schedule Cum Certificate of Insurance

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

CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.

ADDRESS: CHANDIGARH - BRANCH GST Invoice No.: 3 3 7 93 09 5 65 6 6 2
S.C.O , 2463- 2464, DATE: 25/07/2023
II FLOOR SECTOR 22 - C,, CHANDIGARH PAN: A A B C C 6 6 3 3
NEW SECTT CHANDIGARH S.O P SAC Code: 9 9 7 12
CITY: C H A N D I GA R H STATE: C H A N D I G A R H 4
GSTIN: 04AABCC6633K3ZP SAC Description: Motor vehicle insurance services
Business Location: CHANDIGARH - BRANCH Cover Note No: -
Policy Number: 3362/02679670/000/00 Customer Code: 1010039123510001 Policy Type: Package - Goods Carrying Vehicle
Name&Communication Address: Name and Registration Address:
MANGAT RAM MANGAT RAM
S/O GURBHAKASH LAL W.NO. 07 S/O GURBHAKASH LAL W.NO. 07
MALLANWALA DIST FEROZEPUR, MALLANWALA DIST FEROZEPUR,
MALLANWALA S.SO. FIROZEPUR PUNJAB, PIN-152021 MALLANWALA S.SO. FIROZEPUR PUNJAB, PIN-
Mobile-9876543210 152021
Mobile-9876543210
Aadhar No.: - PAN No.:-
Period of Insurance: from 25/07/2023 16:49 hours to midnight on 24/07/2024 Business or Profession: Individual Geographical Area: No Extension
Certificate Number: 3362/02679670/000/00 Issue Date: 25/07/2023
PARTICULARS OF THE VEHICLE INSURED
Date of Registration: 15/07/2016 Place of Registration: FEROZEPUR Registration Mark: PB-05-AE-6699
Make: INNOVA CRYSTA Model: CRYSTA-TC(VX-7S) MT Variant: TC(VX-7S) MT Vehicle Colour: - MET SILVER Year of Mfg: 2016
Type of Body: SALOON Fuel Used: DIESEL Engine No: 016764 Chassis No: 003830
Cubic K.Watts Gross Vehicle GVW as per Public/Private Registration Contract
Capacity: 2523 :0 Weight(GVW): 2880 RC: 0 Carrier: PUBLIC Mark(Trailer): - No: XSHUAHR000041369877
Licensed Passenger Carrying Capacity: 2 Driver 1 Cleaner: 0 Conductor: 0 Total Seating Capacity Including Driver: 3 Chassis No.(Trailer): -
IDV (Insured Declared Value)
Value of Chassis (Rs): 10,50,000.00 Value of Body (Rs): 0 For Vehicle (Rs): 10,50,000.00 For Trailer (Rs): 0 Non-Electrical Accessories (Rs): 0
Electrical/Electronic Accessories (Rs): 0 Value of CNG/LPG Kit (Rs): 0 Total Value (Rs): 10,50,000.00
A. OWN DAMAGE B. LIABILITY
SI No. of Person IMT Premium (Rs SI No. of Person IMT Premium (Rs)
Basic OD 10,50,000.00 21,358.00 Basic TP 7,987.00
IMT 23 . Paid Driver 1 28 50.00
TOTAL 21,358.00 TOTAL 7,947.00
Own Damage Premium 21,358.00 TOTAL PREMIUM(B) 7,947.00
Experience Based Discount (69%) 11,533.00 C.PERSONAL ACCIDENT COVERS
TOTAL(A) 9,825.00 PA for owner driver 15,00,000.00 425.00
D.ADD-ON COVERS(BENEFITS) TOTAL PREMIUM(C) 425.00
Benefit
Option No. TOTAL (A+B+C+E) 18,197.00
No.
ADD-ON COVERS PREMIUM 0.00 TOTAL CONSIDERATION 18,197.00
Add-On Covers Discount .00 CGST 0.00
TOTAL ADD-ON-COVERS PREMIUM (D) 0.00 SGST 0.00
E.OTHER CHARGES (NON PREMIUM) IGST(18%) 3,275.00
Chola value added services 0.00 AMOUNT COLLECTED 21,472.00
TOTAL OTHER CHARGES (NON PREMIUM) (E) 0.00

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
Testing. f)Use for carrying passengers in vehicles;except employees not exceeding the number permitted in the registration document and coming under the purview of Workmen's Compensation Act 1923.
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 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.
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 III (CSI)- Rs.1,500,000.00 Deduction Under Section 1: Rs.500 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: 23,21,40,7 .
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.
Product Plan:
Applicable benefits:-
The policy wordings with detailed terms, conditions,warranties exclusions and the list of Ombudsman details are available on our website www.cholainsurance.com.
Date and Signature of the proposal 21/05/2021.
Warranties: -
Warranted that NCB under this Policy is based on representation regarding NCB and absence of claim under the previous Policy. If the information be found incorrect or false in any aspect, this Policy shall be void ab initio and no benefit shall be payable by the company.
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:
S.No Name of the Nominee RelationShip Age of the Nominee % of Share Name of the Guardian Relationship With Guardian
1
Financier Name & Address: AU SMALL FINANCE BANK

Intermediary Name: CHOLAMANDALAM HOME FINANCE

POSP Name:
LIMITED- ABOHAR-PUNJAB AND J&K
Code: 2013488820150001 POSP PAN No.:
POSP Aadhaar
Contact No: 9872801074
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:24/07/2023 Receipt No: Receipt Date:

Digitally signed by:

KANCHIPURAM
SRIDHAR HARISH
Consolidated Stamp Duty Paid Vide G.O Rt No 426, Commercial Taxes and Registration (j1) Department, Tamil Nadudated 24/07/2023 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

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