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
Chola Standalone Own Damage Policy for Two Wheeler UIN IRDAN123RP0003V01201920
Policy cum Certificate Number 3406/60401904/000/00 Period of Insurance: From 12:30 hrs.on 27/08/2024 To: Midnight of 26/08/2025
Registration Address: HOUSE NO DAYANATPUR DAYANATPUR,KHERI,UTTAR
Name & Communication Address: RASHPAL SINGH
PRADESH,262804
HOUSE NO DAYANATPUR DAYANATPUR,
Mobile/Landline No:9452121702
Email ID :UNNATIINSURANCE2022@GMAIL.COM
Business / Profession: -
Customer ID: - EIA: - Date of Registration 08/06/2023 Place of Registration UP31-KHERI
GSTIN - Geographical Area: India Financier Name -
Financier Address -
PARTICULARS OF VEHICLE INSURED
Registration Mark UP31CA7033 Engine Number PFXPPA32119 Chassis Number MD2A76AX5PPA30298 Cubic Capacity / KW 102
Make BAJAJ Model PLATINA 100 Variant ES BS VI Year of Manufacturing 2023
Type of Body Solo with pillion Fuel used PETROL Driver 1 Licensed passenger Carrying Capacity 2
Fast Tag No. - Colour - Contract No. - Total seating capacity including driver 2
IDV (Insured's Value of Chassis - Value of Body - For Vehicle 54000
Declared Value) For Trailers - Non-Electrical Accessories - Value of CNG/ LPG kit -
in Rupees (Rs.)
Electrical/Electronic Accessories - Total Value 54000
Details of Motor Third Party Insurance Policy covering the vehicle insured under this Policy
Name of Insurer - Policy Number - Start Date 13/05/2023 End Date 12/05/2028

The coverage hereunder is only for Own Damage of the vehicle insured under this policy. No other liability in connection with the vehicle
including Third party liability for Personal injury / Property damage is payable under this Policy.
PREMIUM COMPUTATION TABLE
Premium
A. OWN DAMAGE Sum Insured (Rs.) IMT Premium (Rs.) A1. ADD-ON COVER UIN Sum Insured (Rs.) Options Time Excess (Rs.)
Basic OD 54000 906 Full
IRDAN123RP
CNG Kit - OD 0 Depreciation
0003V01201
Electrical or Electronic Waiver Cover 54000 100% 162
24 0 920/A0032V
Accessories for Standalone
02201920
Non Electrical Accessories 0 Two Wheeler OD
Geographical Extension OD 1 TOTAL PREMIUM (A1) 162
Less: Anti-Theft Device 10 0 CGST (9%) Rs. 0 SGST (9%) Rs. 0 IGST (18%)Rs. 193
Less: Bonus Discount (0%) 0
Less: Experience based discount
0
(0%)
Experience based loading 0
TOTAL PREMIUM (A) 906
TOTAL PREMIUM (A + A1) 1068
Consolidated Stamp Duty Paid Vide G.O. Rt No 397, Commercial Taxes and Registration (j1)
TOTAL AMOUNT Rs. 1261 Department, Tamil Nadu dated2024-05-24
.Subject to I.M.T. Endt. Nos. and Memorandum: 22,21
Compulsory deductible under Section 1 Rs. 100
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 tat it was obtained by, non disclousure 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 time to time.
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.
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.
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 Preceding Two consecutive years- 25 % No claim is made or pending during Preceding Three consecutive years-35 % No claim is made or
pending during Preceding Four consecutive years-45 % No claim is made or pending during 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.

Refer our website www.cholainsurance.com for Policy Wordings and detailed Terms & Conditions, Exclusions and the Ombudsman list. For Claims Assistance Call Toll Free: 1800 208 5544 Visit
www.cholainsurance.com | SMS CHOLA to 56677 | 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 faci lity, 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
Chola Standalone Own Damage Policy for Two Wheeler UIN IRDAN123RP0003V01201920
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
Code: 2020777215360001
Contact No. 7551196989

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

GST Invoice 3406/60401904/000/00 |GSTIN: 33AABCC6633K1ZQ |SAC Code: 997134 |SAC Description: Motor Vehicle Insurance Services
No.:
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.

Date and Signature of the proposal 27/08/2024. In witness where of this policy has been signed at Chennai Head Office on 27/08/2024.

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
27-08-2024 12:30:31

Receipt No. PY000004438524 Receipt Date: 27-08-2024 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 Wordings and detailed Terms & Conditions, Exclusions and the Ombudsman list. For Claims Assistance Call Toll Free: 1800 208 5544 Visit
www.cholainsurance.com | SMS CHOLA to 56677 | 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 faci lity, please register under Do Not Call section on our website.