Cholamandalam MS General Insurance Company Limited

Registered Office: 2nd Floor, "Dare House" No.2, NSC Bose Road, Chennai - 600 001.
Toll Free: 1800 208 5544 | Ph: 044 4044 5400 | Fax: 044 4044 5500 |
PAN AABCC6633K CIN: U66030TN2001PLC047977 IRDAI Regn. No.123
REACH US THROUGH WHATSAPP 7305234433

Policy Schedule cum Certificate of Insurance

Motor Two Wheeler Liability Policy UIN IRDAN123RP0011V01200203
Policy cum Certificate Number 3372/60688403/000/00 Period of Insurance: From 00:01 hrs. on 05/12/2024 To: Midnight of 04/12/2025
Registration Address: MARATHA GALLI GOKAK TQ GOKAK,Belgaum
Name & Communication Address: NABEELA B JAMAKHANDI
Karnataka,BELGAUM-591307,KARNATAKA
MARATHA GALLI GOKAK TQ GOKAK,Belgaum Karnataka
Mobile/Landline No :9481178658
Email ID :irshadahmedbellary1996@gmail.com
Business / Profession: -
KA49-GOK
Customer ID: - EIA: - Date of Registration 30/10/2022 Place of Registration
AK
GSTIN - Geographical Area: India Financier Name -
Nominee Name - Nominee Relationship - Financier Address -
PARTICULARS OF VEHICLE INSURED
Registration Mark KA49EB1366 Engine Number AK1GN2X02618 Chassis Number MD626AK17N2G03005Cubic Capacity / KW 88
Make TVS Model SCOOTY PEP Variant PLUS Year of Manufacturing 2022
Licensed Passenger Carrying
Type of Body Solo with pillion Fuel Used PETROL Driver 1 Capacity 2
Total seating capacity
Fast Tag No. - Colour - Contract No. - including driver 2

PREMIUM COMPUTATION TABLE

Premium Sum Insured Premium
LIABILITY IMT PERSONAL ACCIDENT (PA) COVER IMT
(Rs.) (Rs.) (Rs.)
Basic TP 714
CNG Kit - TP 25 0 TOTAL PREMIUM (PA) 0
LL to Paid Driver 28 0 CGST (9%) Rs. 0
Geographical Extension - TP 1 0 SGST (9%) Rs. 0
TOTAL PREMIUM (LIABILITY) 714 IGST (18%) Rs. 129
TOTAL PREMIUM (LIABILITY + PA) 714 TOTAL AMOUNT Rs. 843
Consolidated Stamp Duty Paid Vide G.O. Rt No627, Commercial Taxes and Registration
(j1) Department, Tamil Nadu dated 2024-11-08
Subject to I.M.T. Endt. Nos. and Memorandum: 22,21
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.
1. As Per Sec 147 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 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 as amended from time to time.
LIMITS OF LIABILITY: Under 1(i) of the Policy - Death or bodily injury such amount as is necessary to meet the requirements of the Motor Vehicle Act, 1988 as amended from time to time. Under 1(ii)
of the Policy - Damage to Third Party Property - Rs.1,00,000.00 Compulsory P.A. Cover for the Owner - Driver under Section III (CSI)- Rs.15,00,000.00
Warranties: It 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.
As per GR36 A, PA for Owner-driver refers to the Owner of the Insured Vehicle holding an effective driving license.
If this policy is preceded by break-in insurance, 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.
Coverage under this policy is subject to realisation of premium cheque(s). In case of dishonor of cheque(s), no separate intimation will be given and the policy stands cancelled from inception.
PUC: This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of commencement of the Policy. The insured undertakes to
renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of the Policy.
Grievance clause: For resolution of any query or grievance, you may contact the respective branch office of the Company or may call 1800 208 5544 or may write an email to
customercare@cholams.murugappa.com. If you are not satisfied with the response of the office, you may email to Grievance Officer at GRO@cholams.murugappa.com. In the event of unsatisfactory
response from the Grievance Officer, you may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of the offices of the Insurance Ombudsman
are available at IRDAI website www.irdai.gov.in or General Insurance Council:https://www.cioins.co.in/ombudsman or on company website www.cholainsurance.com
NOTE: The 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.
Intermediary Name: Girnar Insurance Brokers Pvt Ltd
Contact No : 7551196989
Code: 2019651528730001

Business Location: Chennai Head Office,DARE HOUSE,2ND FLOOR,NO 2,N.S.C BOSE ROAD,CHENNAI-600001,TAMIL NADU

GST Invoice No.: | GSTIN: 33AABCC6633K1ZQ | SAC Code:997134 | SAC Description:Motor Vehicle Insurance Services
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 as amended from time to time, is recoverable from the insured. See the clause headed "AVOIDANCE OF CERTAIN
TERMS AND RIGHT OF RECOVERY". For legal interpretation, English Version will hold good.
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 as amended from time to time.

Refer our website www.cholainsurance.com for Policy / Add-on Wordings and the Ombudsman list. For claims Assistance Contact Toll Free: 1800 208 5544 SMS CHOLA to 56677 |Visit
www.cholainsurance.com | Email customercare@cholams.murugappa.com. Disclaimer: The Company may contact you for matters related to your policy or to provide details ofproducts & services
offered. To opt out from the facility, please register under Do Not Call section on our website.
Cholamandalam MS General Insurance Company Limited
Registered Office: 2nd Floor, "Dare House" No.2, NSC Bose Road, Chennai - 600 001.
Toll Free: 1800 208 5544 | Ph: 044 4044 5400 | Fax: 044 4044 5500 |
PAN AABCC6633K CIN: U66030TN2001PLC047977 IRDAI Regn. No.123
REACH US THROUGH WHATSAPP 7305234433

Policy Schedule cum Certificate of Insurance

Motor Two Wheeler Liability Policy UIN IRDAN123RP0011V01200203
Date and Signature of the proposal 02/12/2024. In witness where of this policy has been signed at Chennai Head Office on 02/12/2024.
for Cholamandalam MS General Insurance Company Limited,

Signature Not Verified

Signed by: DS CHOLAMANDALAM MS
GENERAL INSURANCE COMPANY LIMITED
4
Reason: KANCHIPURAM SRIDHAR HARISH
Location: Chennai
02-12-2024 20:14:30
Receipt No. PY000004674242 Receipt Date: 02-12-2024

Duly Constituted Attorney(s)

Whether tax is payable under reverse charge basis - No

"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 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.

Refer our website www.cholainsurance.com for Policy / Add-on Wordings and the Ombudsman list. For claims Assistance Contact Toll Free: 1800 208 5544 SMS CHOLA to 56677 |Visit
www.cholainsurance.com | Email customercare@cholams.murugappa.com. Disclaimer: The Company may contact you for matters related to your policy or to provide details ofproducts & services
offered. To opt out from the facility, please register under Do Not Call section on our website.