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:

Ramani Krishna Marvel,First floor, Old No. 140 & New. No.137,DB Road, RS Puram,C3-Coimbatore ,COIMBATORE - 641 002.

Jan 09, 2019

M/s.BRAHMA CONCRETE BLOCKS

NO 7/513-A KUMARAN NAGAR
Your policy is
POLLACHI MAIN ROAD due for renewal
SULTANPET SULUR TK
COIMBATORE, TAMILNADU
on 03/01/2020
641033
Telephone :
Mobile : 8883268688

Certificate of Insurance and Policy No. Policy Period: Period of insurance

VGC0490801000101 From 00:00:00 hours on 04/01/2019 To Midnight of 03/01/2020

Dear Customer,

Thank you for choosing Royal Sundaram as the Insurer of your vehicle. We are
delighted to have you as our customer.
We are enclosing the following
1. Certificate of Insurance & Policy Schedule pertaining to the insurance of your
vehicle
2. Claims Guide for preferring a claim for your vehicle loss or damage
The Certificate of Insurance & Policy Schedule is an important document that
you may be required to produce whilst your vehicle is in use. We request you to
verify the above documents and ensure everything is in order. In case of any
discrepancies, please contact us immediately.
To read the “policy” & “add on” terms, conditions, exceptions and applicable
endorsement, please log on to our website www.royalsundaram.in
Should you have any queries, please contact our Customer Service helpline
number 1860-425-0000. You may also write to
customer.services@royalsundaram.in
Assuring you of our best services at all times.
Yours sincerely,

Authorized Signatory

Note:
Please read through the claims guide provided in this pack to understand the claim process. For better understanding you can refer or
download the vernacular claims guide available in our website.
To download the claim form and to know more about Royal Sundaram products please log on to www.royalsundaram.in

6b2a3164ce9ba626e29c1c71b627e9d8
 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:

Ramani Krishna Marvel,First floor, Old No. 140 & New. No.137,DB Road, RS Puram,C3-Coimbatore ,COIMBATORE - 641 002.

Jan 09, 2019

M/s.BRAHMA CONCRETE BLOCKS Intermediary OA000177

NO 7/513-A KUMARAN NAGAR
POLLACHI MAIN ROAD Code:
SULTANPET SULUR TK
COIMBATORE TAMILNADU Intermediary Sundaram Finance
641033
Telephone: Name: Ltd.
Mobile: 8883268688
Contact: -4428558072
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Goods Carrying Vehicle Policy
Certificate of Insurance and Policy No. Policy Period:Period of insurance
VGC0490801000101 From 00:00:00 hours on 04/01/2019 To Midnight of 03/01/2020
INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date

M/s.BRAHMA CONCRETE BLOCKS India select COIMBATORE 04/01/2018

INSURED'S DECLARED VALUE (IDV) (in Rs.)

For the For Value of Total
Non Electrical Accessories Electrical / Electronic Accessories
Vehicle Trailers CNG Kit IDV
783,720 0 0 0 0 783,720
VEHICLE DETAILS
Registration Number TN37DZ6288 Type of Body Tipper
Engine Number 4SPCR11ESY614875 Public Carrier/Private Carrier Public Carrier
Chassis Number MAT505551H8E09027 Year of Manufacture 2017
Make of the Vehicle Tata Motors Ltd. Gross Vehicle Weight (Kgs) 62,50
Model Description LPK 407 Tipper (Open) Total Premium (in Rs.) 25,835
LIMITATIONS AS TO USE: As per Motor Vehicles Rules, 1989 Persons or Classes of Persons entitled to Drive:
The Policy covers use only under a Permit within the meaning of the Any person including the Insured
Motor Vehicles Act, 1988 or such a carriage falling under Sub-section 3 • Provided that a person driving holds an effective driving licence at
of Section 66 of the Motor Vehicles Act, 1988. the time of the accident and is not disqualified from holding or
The Policy does not cover use for obtaining such a License.
a) Organised racing b) Pace Making c) Speed testing • Provided also that the person holding an effective learner's license
d) Reliability Trials 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 (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 - Rs 750000 (as per IMT 20) - In respect of any one claim or series of claims
arising out of one event.
Personal Accident cover for Owner - Driver under section IV: CSI - Rs.0
Note: Warranted that at no time the gross laden weight of the vehicle exceeds the gross vehicle weight mentioned in the schedule of the policy.
Deductible under Section -I : Rs. 500/- (Compulsory Deductible [Rs.500] and Imposed Deductible [Rs. 0])

Document Code: Certificate of insurance & policy schedule continued in Page 2

6b2a3164ce9ba626e29c1c71b627e9d8

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 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

CERTIFICATE OF INSURANCE & POLICY SCHEDULE (CONTINUED)

(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Goods Carrying Vehicle Policy

Policy No. VGC0490801000101

Premium in Premium in
A - OWN DAMAGE B - LIABILITY
Rs. Rs.
1. Basic premium on Vehicle and Non-Electrical Accessories 6,290.00 1. Basic premium including premium for TPPD 14,390.00
2. Additional GVW over 12,000 Kgs 0.00 2. Reduction in TPPD to Rs.6000/- 0.00
3. Electrical & Electronic Accessories @ 4% (IMT 24) 0.00 3. Trailers Endt. IMT-30 0.00
4. Bi-Fuel Kit (CNG/LPG) @ 4% (IMT 25) 0.00 4. Bi – Fuel Kit (CNG/LPG) IMT-25 0.00
ADD: ADD::
5. Trailer 0.00 Personal Accident Benefits
6. Overturning Risk 0.00 6. Geographical Area Extn. Endt.IMT-1 0.00
7. Geographical Area Extn.Endt.IMT-1 0.00 7. Under Section IV- Rs.0 0.00
8. Cover for Lamps, Bumpers, etc. Endt. IMT – 23 943.51 8. PA to Paid Driver/ Cleaners Endt. IMT-17 6.00
9. Fibre Glass Tanks 0.00 Legal Liability:
10. Additional Towing Charges. Rs.0 0.00
11. 60% on OD Premium for Driving Tuition 0.00 9. To Paid Driver/Cleaner(not exceeding 7 persons)
12. For any other extra 0.00 Endt. IMT-28 150.00
10. To Paid Driver/Cleaner/Coolies(exceeding 7 persons)
LESS: 0.00
Endt. IMT-39A
13. 50% Discount for vehicles specially designed/modified 11. To Coolies Endt. IMT-39 100.00
for blind, handicapped and mentally challenged 0.00
12. NFPP - Employees Endt. IMT-37 0.00
persons
14. Discount for Anti-theft Devices Endt. IMT-10 0.00 13. NFPP Other than Employees Endt. IMT-37A 0.00
15. Discount for vehicles plying within insured own premises 0.00 14. For any other extra 0.00
16. 20% NCB -1,446.71 15. TOTAL LIABILITY PREMIUM (B) 14,646.00
16. ADD: Discount moderation 0.00 16. ADD: Underwriting Loading% 0.00
17. Confined to own sites 0.00
18. Total Premium (A+B) 22,627.00
Add: Additional Cover for Package Policies ADD: SGST 1,604.00
17. Depreciation Waiver Clause (IRDAN102A0001V01201011) 2,194.00
18. Windshield Glass (IRDAN102A0002V01201011) 0.00
ADD: CGST 1,604.00

25. TOTAL OWN DAMAGE PREMIUM (A) 7,981.00 19. TOTAL PREMIUM PAYABLE 25,835.00
No Claim Bonus:
a) No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous year. b) The insured is entitled for a No Claim Bonus (NCB)
on the Own Damage Section of the policy, if no claim is made or pending during the preceding year(s), as per the details given below:
Subject to IMT Endt. Nos. & memorandum 39,28,23,17,7,21 & RSMOAC 301 (refer
Period of Insurance % of NCB on OD Premium
Terms & Conditions for relevant wording)
Under Hire Purchase/Lease Agreement /Hypothecated with SFL
The preceding year 20
Nominee Name Nominee Age Relationship with
Preceding two consecutive years 25
0
Preceding three consecutive years 35 Guardian Name Guardian Age Guardian Relation
0
Preceding four consecutive years 45
Date and Signature of Proposal/Renewal notice 04/01/2019
Preceding five consecutive years 50

In Witness whereof this Policy has been signed at Chennai on 09/01/2019 in lieu of Cover note No. dated Receipt No. CBCMOR4194999. 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

Consolidated Stamp Duty Paid to Govt of TamilNadu

Authorised Signatory

This document is digitally signed, hence counter signature / stamp is not required.

GSTIN : 33AABCR7106G1ZQ UIN: IRDAN102P0005V02201617 PAN Number : AABCR7106G

For Legal interpretation, English version will hold good.
6b2a3164ce9ba626e29c1c71b627e9d8
Signature Not
Verified
Digitally signed by
THIRUNAVUKKARASU S
You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm Date: 2019.01.09
08:33:11 IST
Call:1860 425 0000 SMS:type <MOTORCLAIMS> and send to 567675 Reason: For
RoyalSundaram
Location: Chennai
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
C3:C3-Coimbatore
Address: Ramani Krishna Marvel,First floor, Old No. 140 & New. No.137,DB Road, RS Puram,C3-Coimbatore ,COIMBATORE -
641 002.
GSTIN: 33AABCR7106G1ZQ

Policy Number : VGC0490801000101

GST Invoice Number : VGC049080101000
Invoice Date : 04/01/2019

Address of insured:
Insured Name: M/s.BRAHMA CONCRETE BLOCKS
NO 7/513-A KUMARAN NAGAR
POLLACHI MAIN ROAD
SULTANPET SULUR TK
COIMBATORE
State:TAMILNADU
Pincode: 641033
GSTIN : 33AARFB2477R1ZP

HSN Taxable CGST SGST/UTGST IGST Total

SAC Value Rate Amount Rate Amount Rate Amount Amount

997134 8,237.00 9.00% 741.00 9.00% 741.00 9,719.00

9971 14,390.00 6.00% 863.00 6.00% 863.00 16,116.00

Indication if tax payable under reverse charge - No

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 SMS:type <MOTORCLAIMS> and send to 567675

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