Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

Service Branch Address: Old No : 113 & 114 , New No. 18 & 20 ,No.4B, 4th Floor, " A" Block, Mena Kampala Arcade,Sir Theyagaraya Road,T.Nagar,X1-T
Nagar ,CHENNAI - 600017.
Oct 08, 2024
M/s.AMBAL ASSOCIATE Intermediary Code: BR500291
103, BYE PASS ROAD,
REDHILLS Intermediary Name: Policybazaar Insurance
Brokers Private Limited
CHENGALPATTU,TAMILNADU
600052 Contact: 1800 208 1155
Telephone :
Mobile: 97xxxxxx15
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Goods Carrying Vehicle Policy – Liability only [Reprint]
Certificate of Insurance and Policy No. Policy Period:Period of insurance
VGT0493022000100 From 00:00 hours on 09/10/2024 To Midnight of 08/10/2025
INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date
M/s.AMBAL ASSOCIATE 07/07/2022 India CHENGALPATTU 03/10/2018
VEHICLE DETAILS
Registration Number TN19AJ8602 Model Description N 3123 T Gross Vehicle Weight(Kgs) 35,000
Engine Number JCHZ424727 Type of Body TIPPER Seating Capacity (including Driver) 3
Public Carrier/Private
Chassis Number MB1JALHD4JRBY4782 Public Carrier
Carrier
Make of the Vehicle Ashok Leyland Ltd. Year of Manufacture 2018 Total Premium (in Rs.) 49,342
DRIVER: Persons or class of persons permitted to drive public/private carrier • Provided
LIMITATIONS AS TO USE:The Policy covers use of the vehicle for any purpose that a person driving holds an effective driving license at the time of the accident and is not
other than: a) Organised racing b) Pace making c) Speed testing d) Reliability Trials e) disqualified from holding or obtaining such a license. • Provided also that the person
Any purpose in connection with Motor Trade. 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 (i) of the Policy - Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988.
Under Section II-1 (ii) of the Policy -Damage to Third Party Property - Rs750,000. In respect of any one claim or series of claims arising out of one event.
Nominee Name : Nominee Age : 0 Relationship with :
Guardian Name : Guardian Age : 0 Guardian Relation :
Personal Accident Cover for Owner - Driver under Section IV Capital Sum Insured : Rs. 0
B - LIABILITY
1. Basic premium including premium for TPPD 43,950.00
2. Less: For restricted TPPD cover for Rs.6000/-(IMT 20) 0.00
3. Trailers 0.00
4. Bi-fuel kit (CNG) 0.00
Add:Personal Accident Benefits
5. Geographical Area Extn.Endt.IMT-1 0.00
6. Under Section IV (Owner Driver), CSI Rs.0 0.00
7. P.A Cover to Paid Driver, CSI Rs. 0(IMT 17) 0.00
Legal Liability
8. To Paid Driver/Cleaner (IMT 28) 50.00 ADD: SGST 2,646.00
9. To Coolies (IMT 39) 50.00 ADD: CGST 2,646.00
10.NFPP to employees (IMT 37) 0.00
11. NFPP to non - employees (IMT 37-A) 0.00
12. Usage of Commercial and Private Purpose - IMT 34 0.00
TOTAL LIABILITY PREMIUM (B) 44,050.00 TOTAL PREMIUM 49,342.00
In Witness whereof this Policy has been signed at Chennai on 08/10/2024 in lieu of Cover note No. dated Receipt No. CBCEAP2188350.Subject to IMT Endt. Nos & Memorandum 39,28. 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 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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY" under Policy
Terms and Conditions.
For Royal Sundaram General Insurance Co. Limited
Signature Not Verified
Digitally signed by TAIKAD
MAHADEVAN SHYAMSUNDER
Date: 2024.10.08 15:35:52 IST
Reason: For RoyalSundaram
Location: Chennai
Consolidated Stamp Duty Paid to Govt of TamilNadu Authorised Signatory
This document is digitally signed, hence counter signature / stamp is not required.
For Legal interpretation, English version will hold good. GSTIN :33AABCR7106G1ZQ PAN Number:AABCR7106G
38acd4d1f7a6ec82090ddc0727c8f1da

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:customer.services@royalsundaram.in www.royalsundaram.in
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

GST Invoice
Royal Sundaram General Insurance Co. Limited
X1:X1-T Nagar
Address: Old No : 113 & 114 , New No. 18 & 20 ,No.4B, 4th Floor, " A" Block, Mena Kampala Arcade,Sir Theyagaraya
Road,T.Nagar,X1-T Nagar ,CHENNAI - 600017.
GSTIN: 33AABCR7106G1ZQ

Policy Number : VGT0493022000100

GST Invoice Number : VGT049302200000
Invoice Date : 09/10/2024

Address of insured:
Insured Name: M/s.AMBAL ASSOCIATE
KIDZEE F1 25 GROUND FLOOR
AGATHISHWARAR NAGAR
GANDHI ST POZHICHALUR
CHENNAI
State:TAMILNADU
Pincode: 600074
GSTIN : 33BUPPM8959N1ZI

HSN Taxable CGST SGST/UTGST IGST Total

SAC Value Rate Amount Rate Amount Rate Amount Amount

997134 100.00 9.00% 9.00 9.00% 9.00 118.00

9971 43,950.00 6.00% 2,637.00 6.00% 2,637.00 49,224.00

Indication if tax payable under reverse charge - No

“I/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) of rule 48, we are not required to prepare an invoice in terms of the provisions of the
said sub-rule.”:
Note:“This document is digitally signed”
“This document is electronically generated.This document should be issued along with the Policy document.This document stands
invalid,if issued separately”

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:customer.services@royalsundaram.in www.royalsundaram.in