3/18/24, 1:20 PM Policy Schedule Certificate Motor

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Motor Private Car Package Policy

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

CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.

ADDRESS: FORT BRANCH OFFICE GST Invoice No.: 3362504034412
DASTOR HOUSE, 2ND FLOOR,ABOVE UNION BANK OF INDIA, DATE: 18/03/2024
PERIN NARIMAN STREET, P. M. RD.FORT MUMBAI - 400001 PAN: AABCC6633K
MUMBAI G.P.O. SAC Code: 997134
CITY: MUMBAI STATE: MAHARASHTRA SAC Description: Motor vehicle insurance services
GSTIN: 27AABCC6633K1ZJ
Business Location: LATUR CIE Cover Note No: -
Policy Number: 3362/02906297/000/00 Customer Code: 100612079383 Policy Type: package - private car policy
Name&Communication Address: Name and Registration Address:
MANGALA SARJERAO PAWAR
YESHLAXMI WAKHAN ROAD NEAR RUKMINI PARK KARAD TAL YESHLAXMI WAKHAN ROAD NEAR RUKMINI PARK KARAD TAL
KARAD DIST SATARA KARAD MAHARASHTRA,, KARAD DIST SATARA KARAD MAHARASHTRA,,
KARAD H.O,SATARA KARAD H.O,SATARA
MAHARASHTRA,PIN- 415110 Mobile-- MAHARASHTRA,PIN- 415110 Mobile--
Period of Insurance: from 18/03/2024 13:03 hours to midnight on Business or Geographical Area: No
17/03/2025 Profession: Individual Extension
Certificate Number: 3362/02906297/000/00 Issue Date: 18/03/2024
PARTICULARS OF THE VEHICLE INSURED
Date of Registration: 23/12/2016 Place of Registration: LATUR Registration Mark: MH-50-A-7124
Make: MARUTI SUZUKI Model: CELERIO - ZXI O AMT Variant: ZXI O AMT Vehicle Colour: - Year of Mfg: 2016
Type of Body: HATCHBACK Fuel Used: PETROL Engine No: K10BN7845635 Chassis No: MA3ETDE1S00370956MG
Cubic K.Watts Gross Vehicle GVW as per Public/Private Registration Contract
Capacity: 998 : 0 Weight(GVW): - RC: - Carrier: - Mark(Trailer): - No: -
Licensed Passenger Carrying Capacity: 4 Driver 1 Cleaner: 0 Conductor: 0 Total Seating Capacity Including Driver: Chassis No.(Trailer): -
IDV (Insured Declared Value)
Value of Chassis (Rs): 0.00 Value of Body (Rs): 0.00 For Vehicle (Rs): 255000 For Trailer (Rs): 0 Non-Electrical Accessories (Rs): 70000
Electrical/Electronic Accessories (Rs): 0 Value of CNG/LPG Kit (Rs): 0 Total Value (Rs): 325000
A. OWN DAMAGE B. LIABILITY
SI No. of Person IMT Premium (Rs) SI No. of Person IMT Premium (Rs)
Basic OD 255,000.00 8,137.00 Basic TP 2,094.00
Non Electrical or Electronic Accessories 70,000.00 2,234.00 Paid Driver 1 28 50.00
TOTAL 10,371.00 Conductor
Own Damage Premium 10,371.00 TOTAL 2,144.00
Experience Based Discount (50%) 5,186.00 TOTAL PREMIUM(B) 2,144.00
TOTAL(A) 5,185.00 C.PERSONAL ACCIDENT COVERS
D.ADD-ON COVERS(BENEFITS) PA for owner driver 1,500,000.00 450.00
Benefit TOTAL PREMIUM(C) 450.00
Option No.
No.
ADD-ON COVERS PREMIUM 0.00 TOTAL (A+B+C+D+E) 7,779.00
Add-On Covers Discount .00 TOTAL CONSIDERATION 7,779.00
TOTAL ADD-ON-COVERS PREMIUM (D) 0.00 CGST (9%) 700.00
E.OTHER CHARGES (NON PREMIUM) SGST (9%) 700.00
Chola value added services 0.00 IGST (0%) 0.00
TOTAL OTHER CHARGES (NON PREMIUM) (E) 0.00 AMOUNT COLLECTED 9,179.00

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)Use in connection with motor trade.

1.As per Sec 147 of MV Act issued policy the premium received only to an extent of liability fixed by IRDA/Central Govt
2.Sec 150 (2) (b) that the policy is void on the ground that it was obtained by, nondisclosure of any material fact or by representation of any fact which was, false in some material particular;
i.Or
ii.(c) that there is non-receipt of premium as required under section 64VB of, the Insurance Act, 1938.
3.No Application for compensation shall be entertained unless it is made within 6 Months from the date of occurrence of the Accident
4.No Sum shall be payable by an Insurer incase a person driving the vehicle does not have a valid driving license or is under the influence of Alcohol or Drug.
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.
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.1000 Additional compulsory deductibles under Section 1 Rs.0
Additional Imposed deductibles under Section 1 Rs.0
Subject to I.M.T. Endt. Nos. and Memorandum: 22,28 .
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:Private car package policy with chosen Add-on covers.
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 18/03/2024.
Warranties: -
This policy is preceded by break-in insurance and hence it is expressly agreed and understood that there will be no liability for any loss or damage that has occurred prior to the date of commencement mentioned in the schedule
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 is applicable at the end of the policy period.

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:

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3/18/24, 1:20 PM Policy Schedule Certificate Motor

Intermediary Name: CHOLA POSP Name:

INSURANCE DISTRIBUTION YUNUS ILAHI
SERVICES PRIVATE LIMITED SAYYED
POSP PAN No.:
Code: 200572295173
EYSPS5705J
Contact No: 9421991000 POSP Aadhaar 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:18/03/2024 Receipt No: Receipt Date:
@CholaSign1

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) Duly Constituted Attorney(s)
of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule and also as per Notification No. 13/2020-CT dated 21-03-2020. This policy
schedule shall be in lieu of Tax Invoice and hence no separate GST invoice required In compliance with Rule 54(2) of CGST Rules, 2017.

Consolidated Stamp Duty Paid Vide G.O Rt No 505, Commercial Taxes and Registration (j1) Department, Tamil Nadu dated 20/12/2023

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.
In the event of a claim under Compulsory personal accident cover (CPA), the intimation of the claim to the Insurer shall be within 30 days of its occurrence
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

Product Motor Private Car Package

:
Name Policy
UIN : IRDAN123RP0001V03100001

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