10/14/24, 7:44 PM Policy Schedule Certificate Motor

Motor Commercial Vehicle Liability Policy - For Miscellaneous and

Special Type of Vehicles
(See Rule 51 of Central Motor Vehicles Rules, 1989 of Motor Vehicles Act,1988.)

CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.

ADDRESS: RAJKOT BRANCH OFFICE GST Invoice No.: 3382543251260
BLOCK 11, SHIVAGNA, MADHUVAN SOCIETY, 150 FEET RING ROAD, DATE: 14/10/2024
RAIYA TELEPHONE EXCHANGE, RAJKOT - 360 005. PAN: AABCC6633K
RAJKOT H.O SAC Code: 997134
CITY: RAJKOT STATE: GUJARAT SAC Description: Motor vehicle insurance services
GSTIN: 24AABCC6633K7ZJ
Business Location: RAJKOT BRANCH OFFICE Cover Note No: -
Policy Customer Policy Type: Liability Only - Miscellaneous & Special
Number: 3382/00371782/000/00 Code: 190000018447972 Type Vehicle
Name&Communication Address: Name and Registration Address:
CHAVDA JAYESHBHAI MANUBHAI
C-4984, SHANTINAGAR-1, OPP. AYODHYANAGAR, KALIYABID, C-4984, SHANTINAGAR-1, OPP. AYODHYANAGAR, KALIYABID,
BHAVNAGAR, BHAVNAGAR,
BHAVNAGAR TAKHTESHWAR S.O,BHAVNAGAR BHAVNAGAR TAKHTESHWAR S.O,BHAVNAGAR
GUJARAT,PIN- 364002 Mobile-9825364547 GUJARAT,PIN- 364002 Mobile-9825364547
Period of Insurance: from 17/10/2024 00:00 hours to midnight Business or Geographical Area: No
on 16/10/2025 Profession: Individual Extension
Certificate Number: 3382/00371782/000/00 Issue Date: 14/10/2024
PARTICULARS OF THE VEHICLE INSURED
Date of Registration: 13/08/2012 Place of Registration: RAJKOT Registration Mark: GJ-03-HE-4040
Make: ASHOK LEYLAND Model: 2516IL Variant: TUSKER Vehicle Colour: - Year of Mfg: 2012
Type of Body: TRANSIT MIXER Fuel Used: DIESEL Engine No: CWHZ411135 Chassis No: MB1DTJJC8CRWG2811
Cubic K.Watts Gross Vehicle GVW as per Public/Private Registration Contract
Capacity: 6538 : - Weight(GVW)/HP: - RC: - Carrier: - Mark(Trailer): - No: -
Licensed Passenger Carrying Capacity: 0 Driver 2 Cleaner: 0 Conductor: 0 Total Seating Capacity Including Driver: Chassis No.(Trailer): -
IDV (Insured Declared Value)
Value of Chassis (Rs): 0 Value of Body (Rs): 0 For Vehicle (Rs): 0 For Trailer (Rs): 0 Non-Electrical Accessories (Rs): 0
Electrical/Electronic Accessories (Rs): 0 Value of CNG/LPG Kit (Rs): 0 Total Value (Rs): 0
A. OWN DAMAGE B. LIABILITY
SI No. of Person IMT Premium (Rs) SI No. of Person IMT Premium (Rs)
TOTAL .00 Basic TP 7,267.00
Own Damage Premium .00 Paid Driver 1 40 50.00
TOTAL(A) .00 Conductor
Add-On Covers Discount .00 LL to Paid Driver 1
E.OTHER CHARGES (NON PREMIUM) TOTAL 7,317.00
Chola value added services 0.00 TOTAL PREMIUM(B) 7,317.00
TOTAL OTHER CHARGES (NON PREMIUM) (E) 0.00 C.PERSONAL ACCIDENT COVERS
TOTAL PREMIUM(C) .00

TOTAL (A+B+C+D+E) 7,317.00

TOTAL CONSIDERATION 7,317.00
CGST (9%) 658.50
SGST (9%) 658.50
IGST (0%) 0.00
AMOUNT COLLECTED 8,634.00

LIMITATIONS AS TO USE: The Policy covers use of the vehicle for any purpose other than: a)Organised Racing. b)Use while drawing a Trailer,except the towing(other than for reward) of any one disabled mechanically
propelled vehicle. c)Pace Making. d)Reliability Trial. e)Speed Testing. f)Use for the carriage of passengers for hire or reward.

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.
LIMITS OF LIABILITY:Under Section II-1 (1) of the Policy - Death or bodly injury such amount as is necessary to meet the requirements of the Motor Vehicle Act, 1988. Under Section II - 1 (ii) of the Policy - Damage to
Third Party Property - Rs.750000 P.A. Cover for the Owner cum Driver Under Section IV (CSI)- Rs..00 0
Additional Imposed deductibles under Section 1 Rs.
Subject to I.M.T. Endt. Nos. and Memorandum: 21,40 .
Coverage Under this policy is subject to realisation of premium cheque(s). Incase of dishonor of cheque(s). No separate intimation will be given and the policy stands cancelled from inception.

The policy wordings with detailed terms, conditions,warranties exclusions and the list of Ombudsman details are available on our website www.cholainsurance.com.
Date and Signature of the proposal 14/10/2024.
Warranties: -

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.
CVAS NEW :
As per GR 36A-PA for Owner driver refers to the Owner of the insured vehicle holding an effective drving licence.
Nominee Details:
Financier Name & Address:

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10/14/24, 7:44 PM Policy Schedule Certificate Motor

Intermediary Name: D2C INSURANCE

POSP Name:
BROKING PRIVATE LIMITED
POSP PAN
Code: 200030225115
No.:
POSP
Contact No: 8004197852
Aadhaar No.:
Note: The Motor 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.
For Cholamandalam MS General Insurance Company Ltd.
Place: CHENNAI Date:14/10/2024 Receipt No: Receipt Date:
@CholaSign1

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) Duly Constituted Attorney(s)
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 , Commercial Taxes and Registration (j1) Department, Tamil Nadu dated

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 vehicles 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, is recoverable from the insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY"
For Information/Claims: Contact Toll Free Helpline at 1800 208 5544: sms "CHOLA" to 56677 For CARE contact 1800 103 5354;
E-mail: customercare@cholams.murugappa.com: www.cholainsurance.com
Note:UIN for this product and the related add on covers availed under this policy are as mentioned in the attached sheet ,which forms part of the Policy Schedule.

Whether tax is payable under reverse charge basis - No.

Cholamandalam MS General Insurance Company Ltd.
Regd.&Head Office:Dare House, 2nd Floor, No.2, N.S.C Bose Road, Chennai-600 001, India
CIN: U66030TN2001PLC047977 | IRDAI Reg. No. 123

Motor Commercial Vehicle

Product Liability Policy - For
:
Name Miscellaneous and Special
Type of Vehicles
IRDAN123RP0017V01200203
UIN :
NA

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