Page 1 of 3

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 |
E-mail: customercare@cholams.murugappa.com | www.cholainsurance.com
PAN AABCC6633K CIN: U66030TN2001PLC047977 IRDAI Regn. No.123

Policy Schedule cum Certificate of Insurance

Motor Private Car Package Policy UIN IRDAN123RP0001V03100001
Policy cum Certificate Number 3362/01384937/000/07 Period of Insurance: From 11:02 hrs. on 27/10/2024 To: Midnight of 26/10/2025
Name & Communication Address: Registration Address:
ELAMPARTHI K
NO 2716,PERIYAR STREET,T.K.PATTU,
NO 2716,PERIYAR STREET,T.K.PATTU,
REDHILLS S.O,CHENNAI,TAMIL NADU, PIN - 600052 REDHILLS S.O,CHENNAI,TAMIL NADU, PIN - 600052
Mobile: 9840873060 Landline: Mail:
Mobile: 9840873060 Landline: Mail:

Business/ Profession: Individual

Customer ID 101649973382 EIA Date of Registration 05/07/2012 Place of Registration CHENNAI NORTH
GSTIN Geographical Area: India Financier Name KOTAK MAHINDRA PRIME LTD.
Nominee Name Nominee Relationship Financier Address CHENNAI
PARTICULARS OF VEHICLE INSURED
Registration Mark TN09BQ0964 Engine Number GRC4F15553 Chassis Number MA1PS2GRKC6F64830 Type of Body SUV

Make MAHINDRA Model BOLERO Variant SLX, Year of Manufacturing 2012 Colour
Cubic Capacity 2523 K. Watt 0 Fuel used DIESEL Registration Mark (Trailer)
Driver 1 Cleaner 0 Conductor Licensed passenger Carrying Capacity 9 Total Seating Capacity including Driver 9
Public / Private Carrier Chassis No.(Trailer) Contract No

Value of Chassis Value of Body For Vehicle 1,42,500

IDV (Insured's Declared For Trailer Value of CNG/ LPG kit
Non-Electrical Accessories 0 0.00
Value) in Rupees (Rs.)
Electrical/Electronic Accessories 0.00 Total Value 1,42,500

PREMIUM COMPUTATION TABLE

A. OWN DAMAGE Sum Insured No of Premium B. LIABILITY Sum Insured No of Premium
IMT IMT
(Section-I) (Rs.) Person (Rs.) (Section-II) (Rs.) Person (Rs.)
Basic - OD 1,42,500.00 5,270.00 Basic - TP 7,897.00
Total Own Damage Premium 5,270.00 Paid Driver 1 28 50.00
Bonus Discount(50%) 2,635.00 TOTAL PREMIUM (B) 7,947.00
Experience Based Discount 1,054.00
C.PERSONAL ACCIDENT COVERS
Sub Total(Discounts) 3,689.00
PA Cover for Owner- 1500000 650.00
Total 3,689.00
Driver (Section-III)
TOTAL PREMIUM (A) 1,581.00 TOTAL PREMIUM (C) 650.00
Sum Insured Time Premium TOTAL PREMIUM (A+B+C+A1) 10,178.00
A1. ADD-ON COVERS (Rs.) Options
Excess (Rs.) CGST(9%) 916.00
Total Premium (A1) 0.00 SGST(9%) 916.00
IGST(0%) 0.00
TOTAL AMOUNT Rs. 12,010.00

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.
Consolidated Stamp Duty Paid Vide G.O. Rt No.397, Commercial Taxes and Registration (j1) Department,Tamil Nadu dated 24/05/2024
Subject to I.M.T. Endt. Nos. and Memorandum:22,28,7
Compulsory deductible under Section 1 Rs. 2000

Refer our Website for the Policy/Add-on wording 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 of products & services offered. To opt out from the facility,please register under Do Not Call section on our website.
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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 |
E-mail: customercare@cholams.murugappa.com | www.cholainsurance.com
PAN AABCC6633K CIN: U66030TN2001PLC047977 IRDAI Regn. No.123

Policy Schedule cum Certificate of Insurance

Motor Private Car Package Policy UIN IRDAN123RP0001V03100001
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 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 as amended from to time.
LIMITS OF LIABILITY: Under Section II-1(i) of the Policy - Death of or bodily injury - Such amount as is necessary to meet there requirements of
the Motor Vehicle Act, 1988 as amended from time to time. Under Section II - 1(ii) of the Policy -Damage to Third Party Property - Rs. 7,50,000.00
P.A. Cover Under Section III for Owner Driver (CSI) : Rs. 15,00,000.00
Warranties: It is hereby warranted that 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.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.As per GR36 A, PA for Owner-driver refers to the Owner of the Insured Vehicle
holding an effective driving license.
No Claim Bonus: 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
- 20 % No Clam is made or pending during the Preceding Two consecutive years- 25 % No claim is made or pending during the Preceding Three consecutive years -35 %
No claim is made or pending during Preceding Four consecutive years-45 % No claim is made or pending during the Preceding Five consecutive years-50% No Claim
Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.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.
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.

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.
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.
Intermediary Name: SATHYA S Code: 201957821918 Contact No.: 8655878007
Business Location: AMBATTUR BRANCH OFFICE

GST Invoice No. 2024103300541846 GSTIN: 33AABCC6633K1ZQ SAC Code: 997134 SAC Description: Motor vehicle insurance services
Place: CHENNAI Date: 27/10/2024 for Cholamandalam MS General Insurance Company Limited

Receipt No. 1087340804 Receipt Date: 27/10/2024

Signature Not Verified
Signed by: DS CHOLAMANDALAM MS GENERAL
INSURANCE COMPANY LIMITED 4
Reason: KANCHIPURAM SRIDHAR HARISH
Location: Chennai
27-10-2024 11:16:22
Duly Constituted Attorney(s)

Refer our Website for the Policy/Add-on wording 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 of products & services offered. To opt out from the facility,please register under Do Not Call section on our website.
 Page 3 of 3

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 |
E-mail: customercare@cholams.murugappa.com | www.cholainsurance.com
PAN AABCC6633K CIN: U66030TN2001PLC047977 IRDAI Regn. No.123

Policy Schedule cum Certificate of Insurance

Motor Private Car Package Policy UIN IRDAN123RP0001V03100001
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 as per tariff: 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 wider AND RIGHT OF
RECOVERY''. For legal interpretation, English Version will hold good.
For Claims: please call 1800-208-5544 or mail to customercare@cholams.murugappa.com. or visit our website www.cholainsurance.com.

Whether tax is payable under reverse charge basis - No

Refer our Website for the Policy/Add-on wording 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 of products & services offered. To opt out from the facility,please register under Do Not Call section on our website.