Cholamandalam MS General Insurance Company Limited

Registered Office: 2nd Floor "DARE HOUSE", 2, N.S.C. Bose Road, Chennai ‐ 600 001.
Toll free: 1800 208 5544, T: +91(0) 44 4044 5400, F: +91(0) 44 4044 5550
E‐mail: customercare@cholams.murugappa.com; website: cholainsurance.com
IRDAI Regn. No.123 | PAN AABCC6633K | CIN: U66030TN2001PLC047977

Motor Private Car Package Policy Schedule cum Certificate of Insurance

[UIN:IRDAN123RP0001V03100001]

Policy Cum Certificate Number:3362/02805183/000/00 Period of Insurance: From 06/12/2024 00:00 to 05/12/2025 23:59
Name & Communication Address:
Mr. Rabi Kundu,BINNAGURI DEPO PARA

SILIGURI WEST BENGAL, 735203 Registration Address:

Mobile: 7908580386 Landline: Mail:rabikundu82@gmail.com C/O. SUJAY BASU RABINDRA SARANI DARJILING WEST BENGAL, 734006

Customer ID : 610466984
PAN No: GSTIN:
EIA No: Geographical Area: India
Business / Profession:
PARTICULARS OF VEHICLE INSURED
Date of Registration 19/01/2018 Place of Registration HOWRAH Registration Number WB12AT4368
Make MAHINDRA AND MAHINDRA Model / Variant BOLERO POWER PLUS ZLX
Year of Mfg 2017 Type of Body Fuel Used Diesel
Cubic Capacity 1493 Engine No WJH6K73861 Chassis No K47194
Licensed passenger Carrying Capacity 6 Driver 1 Cleaner -
Total Seating Capacity
Conductor - K.Watt 0 7
Including Driver
IDV (Insured's Declared Value)
Value of Chassis (Rs) 0.00 Value of Body (Rs) 0.00 For Trailer 0.00
For Vehicle (Rs.) 2,98,577.00 Non-Electrical Accessories (Rs.) (Rs) 0.00 Electrical/Electronic Accessories (Rs.) 0.00
Value of CNG/LPG Kit (Rs.) 0.00 Total Value (Rs.) 2,98,577.00 Contract number
Premium
A.OWN DAMAGE B.LIABILITY
Sum insured (Rs.) IMT Premium(Rs) Sum Insured No.of Person IMT Premium(Rs)
Basic OD 2,98,577.00 10,006.00 Basic TP 3,416.00
Electrical or Electronic Accessories 0.00 24 0.00 CNG Kit‐TP 25 0.00
Non Electrical or Electronic Accessories 0.00 0.00 Paid Driver Cover 28 0.00
CNG Kit‐OD 0.00 25 0.00 TOTAL 3,416.00
TOTAL 10,006.00 Geographical Extension‐ TP 1 0.00
Geographical Extension‐OD 0.00 TOTAL PREMIUM(B) 3,416.00
Sub Total:(additions) 10,006.00 C.PERSONAL ACCIDENT COVERS
Less: PA for owner driver 0.00
Anti‐Theft Device‐OD 10 0.00 Unnamed PA cover 16 0.00
Voluntary Excess 22(a) 0.00 TOTAL PREMIUM(C) 0.00
Bonus Discount(0%) 0.00 TOTAL (A+B+C+D) 6,418.00
Sub Total:(discounts) 0.00 TOTAL CONSIDERATION 6,418.00
Total 10,006.00 CGST(9%)(Rs.) 0.00
Own Damage Premium 10,006.00 SGST(9%)(Rs.) 0.00
Experience Based Discount (70%) 7,004.00 KERALA CESS(1%)
TOTAL(A) 3,002.00 IGST(18%)(Rs.) 1,155.00
D.ADD‐ON COVERS(BENEF ITS) Benefit No Option No. Premium(Rs) TOTA L AMOU NT 7,573.00
COLLECTED
TOTAL ADD‐ON‐COVERS
PREMIUM(D) 0.00

R efer our web s i t e for P o l i cy Wo rd i n g s and d et ai l ed T erm s & C o n d i t io n s , E x cl u si o n s and the Om b u d s m an li st.
Call 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.
Cholamandalam MS General Insurance Company Limited
Registered Office: 2nd Floor "DARE HOUSE", 2, N.S.C. Bose Road, Chennai ‐ 600 001.
Toll free: 1800 208 5544, T: +91(0) 44 4044 5400, F: +91(0) 44 4044 5550
E‐mail: customercare@cholams.murugappa.com; website: cholainsurance.com
IRDAI Regn. No.123 | PAN AABCC6633K | CIN: U66030TN2001PLC047977

Motor Private Car Package Policy Schedule cum Certificate of Insurance

[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.
DRIVER CLAUSE: Any person including the 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.
LIMITS OF LIABILITY: U: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 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
Deduction Under Section 1: Rs. 1000
Additional compulsory deductibles under Section 1 Rs.0
Additional Imposed deductibles under Section 1 Rs.0 Subject to I.M.T. Endt. Nos. and Memorandum :
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.
Date and Signature of the proposal 04/ 12/ 2024
Warranties: 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.
This policy has been issued upon declaration by the Assured that a valid Pollution Under Control (PUC) Certificate is held on the date of commencement of the Policy.
No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy. 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.
This policy is preceded by break-in insurance and hence it is expressly agreed and understood that there will be no liability for any loss or damage that has occured prior to the date of
commencement mentioned in the schedule.
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.
Notwithstanding anything contained in the policy, it is warranted that Maximum Liability of the company under Nil Dep cover shall not exceed 2 claims during the Policy Period.
As per GR36 A, PA for Owner-driver refers to the Owner of the Insured Vehicle holding an effective driving license
Sl.No. Name of the Nominee Relationship Age of the Nominee %age of share Name of the Guardian Guardian relationship with Nominee
1 JHUMA KUNDU Spouse 32 100
No Claim Bonus is applicable at the end of the policy period
Grievance Clause: For any grievance or query please call 1800-208-5544 or write to customercare@cholams.murugappa.com. Please contact Chief Grievance Officer of the insurance company
at GRO@cholams.murugappa.com in case of unsatisfied response. If you are still unsatisfied you may, subject to vested jurisdiction, approach Insurance Ombudsman for redressal whose details
are available at IRDAI website www.irdai.gov.in or GI council website www.gicouncil.in
For Claims, please contact 1800-208-5544 or mail to customercare@cholams.murugappa.com or visit our 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.
Financier Name & Address: CHORSIYA FINVEST PRIVATE LIMITED SILIGURI
Intermediary Name: Policybazaar Insurance Brokers Private Limited
Code: 2009936529320003 Contact No: 1800-258-5970
For Cholamandalam MS General Insurance Company Limited

Place: CHENNAI Date:04/ 12/ 2024

Duly Constituted Attorney(s)

Business Location : Chennai Head Office,
2nd Floor, "Dare House" No.2,NSC Bose Road, Chennai - 600 001

GST Invoice No.: 3362/02805183/000/00 | GSTIN: 33AABCC6633K1ZQ | SAC Code: 997134| SAC Description: Motor Vehicle Insurance Services
Consolidated Stamp Duty Paid Vide G.O Rt No.426, Commercial Taxes and Registration (j1) Department, Tamil Nadu dated 21/12/2020
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.
IMP ORT ANT 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.
GST – 1. Whether tax is payable under reverse charge basis – No. 2. In compliance with the provisions of Sub Rule (2) of Rule 54 of CGST Rules, 2017 along with relevant Notifications, this
policy schedule shall be in lieu of Tax Invoice and hence no separate GST invoice required. 3. As per Notification No. 13/2020-CT dated 21-Mar-2020, Chola MS, being a General Insurance
Company, are exempt from E-Invoicing provisions of GST laws.

R efer our web s i t e for P o l i cy Wo rd i n g s and d et ai l ed T erm s & C o n d i t io n s , E x cl u si o n s and the Om b u d s m an li st.
Call 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.