Cholamandalam MS General Insurance Co. Ltd.

Servicing Office of Insurer: 04 , Marygold Building , 2nd Floor, Shahnazaf Road , Hazratganj, Lucknow, Uttar
Pradesh (State Code:09) -226001, PH-0522-3085200 Website: www.cholainsurance.com
PAN: AABCC6633K , GSTIN: 09AABCC6633K7ZB Insurer's IRDA Registration Number:123
Tollfree Helpline 0522308520 Email: customercare@cholams.murugappa.com CIN :
U66030TN2001PLC04977
GOODS CARRYING VEHICLE PACKAGE POLICY-CERTIFICATE CUM POLICY
SCHEDULE CUM RECEIPT
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Policy No. 3313/00236570/000/00 Policy Issued On 17-DEC-2019 (12:59)
Insured Name MR. HIMANSHU
Own Damage Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight) Motor Liability Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight)

Proposal No. & Date PCVBU3631475, 17-DEC-2019 CPA Cover Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight)
Insured Add. S/O-MR UMESH CHANDRA R/O- SURIR , MATHURA , UTTAR PRADESH (State Code:09) -281205 GSTIN - 09AIQPH1127H1Z9
Previous Insurer NA Previous Policy No. NA
Broker Details
IRDA Lic. No.: 375, CIN No.: U50300MH1997PLC149349 Category: Composite Broker, Validity: 13-MAY-17 To 12-MAY-20
Name & Add.: TATA MOTORS INSURANCE BROKING & ADVISORY SERVICES LTD, 1ST FLOOR, AFL HOUSE, LOK BHARATI COMPLEX, M AROL MAROSHI ROAD, ANDHERI
(EAST), MUMBAI 400 059, INDIA
Make Model Sub Model Cubic Capacity Manufacturing Year Seating capacity
IRISH_CREAMACE GOLD
TATA MOTORS ACE BSIV 720 2019 2

Registration No. RTO Invoice Date GVW Chassis No. Engine No.
NEW ALIGARH 17-DEC-2019 1550 MAT445075KVK59401 275IDI07KPYSD9638
Vehicle Type Vehicle Sub Class Built Type IDV of Chassis IDVof Body Elec. Accessories
A2- Private Carrier-GCV Truck Semi Built 378,423 0 0
Non-Elec. Accessories CNG/LPG Kit IDV of Trailer Total IDV
0 0 0 378,423
Schedule of Premium (Amount in Rs.)
Own Damage Premium (A)
Basic Premium Deductibles
Vehicle 2,835 Voluntary Deductibles (0) (IMT-22A) 0
Additional GVW Loading 0 Anti Theft Device (IMT-10) 0
Trailer 0 AA Membership (IMT-8) 0
Non-Elec. Accessories 0 No Claim Bonus (0%) 0
Elec. Accessories (IMT-24) 0 Sub Total (Deductibles) 0
CNG/LPG Kit (IMT-25) 0
Sub Total (Basic Premium) 2,835
Add On Coverages (Refer Note 6) 1,793
Geographical Area Extension (IMT-1) 0
IMT -23 426
IMT -34 0
Overturn Cover 0
Sub Total-Addition 5,054 Net Own Damage Premium (A) 5,054
Liability Premium (B)
Basic Third Party Liability 8,438 PA Cover For 5 Persons of Rs. 200000 Each (IMT-16) 0
Third Party Liability For Bi-Fuel Kit 0 Legal Liability For Paid Driver (IMT-28) 50
Legal Liability For Cleaner / Conductor / Helper (for 1 persons)
Third Party Liability For Geographical Area Extension 0 (IMT–29) 50
Third Party Liability For IMT -34 0 Legal Liability For 0 Non Fare Paying Passenger 0
Third Party Liability For Trailer 0 Legal Liability for Employees (for 0 persons) (IMT–29) 0
PA Cover For Owner Driver Of Rs. 1500000 (IMT-15) 750
PA Cover For Cleaner / Conductor / Helper 200000 0
Each (IMT-17)
PA cover for Paid Driver of Rs 200000 (IMT–17) 0 Net Liability Premium (B) 9288
Note: 1. In case of dishonour of the premium cheque, this document stands automatically cancelled 'ab-
initio Total Premium (A+B) 14342
2. Consolidated stamp duty paid to state exchequer CGST (6% of Basic TP + 9% of rest of Premium) 1039
3. The policy is subject to compulsory deductible of Rs.500 IMT? 21 SGST (6% of Basic TP + 9% of rest of Premium) 1039
4. Geographical Area-India
5. The insurance company will display terms & conditions on its website www.cholainsurance.com
which can be Gross Premium Paid 16420
accessed by you online.
6. Add-on: CHOLA NIL DEP 0 TO 2(Nil Depreciation:1793)
*Subject to IMT Endt. Nos.& Memorandum:7,21,23,28
0
Nominee Details
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
MRS. KANCHAN 25 SPOUSE --N.A-- --N.A--
Payment Details : Cheque No.: 700201933729049886, Cheque Date: 17-DEC-2019, Bank Name: HDFC BANK LTD, Bank City: Mumbai
Hypothecation Details: CHOLAMANDALAM INVESTMENT AND FINANCE CO.LTD. - MATHURA - MATHURA
MISP Name: ASHOK AUTO SALES LTD, MISP PAN No: AABCA3711C, MISP Code: TMIBASL/MISP/AABCA3711C
SAC:997134, Description of Service :Motor Vehicle Insurance Services, Place of Supply :UTTAR PRADESH(State Code:09), Receipt No/Invoice No:3313/00236570/00
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 Motor Vehicle
Act, 1988
For & On Behalf of Cholamandalam MS General Insurance Co. Ltd.
Dealer Code : ASHOK AUTO SALES LTD - 100910000
Authorized Signatory
In case of any claim or assistance required please contact our help line at 1800 209 0060 and you may reach us at support@tatamotorsinsurancebrokers.com .
 Cholamandalam MS General Insurance Co. Ltd.
Servicing Office of Insurer: 04 , Marygold Building , 2nd Floor, Shahnazaf Road , Hazratganj, Lucknow, Uttar
Pradesh (State Code:09) -226001, PH-0522-3085200 Website: www.cholainsurance.com
PAN: AABCC6633K , GSTIN: 09AABCC6633K7ZB Insurer's IRDA Registration Number:123
Tollfree Helpline 0522308520 Email: customercare@cholams.murugappa.com CIN :
U66030TN2001PLC04977
GOODS CARRYING VEHICLE PACKAGE POLICY-CERTIFICATE CUM POLICY
SCHEDULE CUM RECEIPT
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Policy No. 3313/00236570/000/00 Policy Issued On 17-DEC-2019 (12:59)
Insured Name MR. HIMANSHU
Own Damage Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight) Motor Liability Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight)

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(s)-20%, preceding two consecutive years-25%, preceding three consecutive years-35%,
preceding four consecutive years-45%, preceding five consecutive years-50% of NCB on OD Premium. NCB is allowed provided
the policy is renewed within 90 days of the expiry date of the previous policy.

Limitations as to use: The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a
carriage falling under Sub-section 3 of Section 66 of the Motor Vehicles Act 1988 The Policy does not cover: 1. Use whilst drawing
a trailer except the towing (other than for reward) of any one disabled mechanically propelled vehicle. 2. Use for carrying passengers
in the vehicles; except employees (other than the driver) not exceeding the number permitted in the registration document and
coming under the purview of Workmen's Compensation Act 1923. 3. Use for a) Organized racing, b) Pace-making, C) Reliability
Trials, d) Speed Testing.

Driver’s Clause: Any person including insured: Provided that a person driving hold 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 Learners
license 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 Clause: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.Under Section II-1 (ii) of the policy-Damage to third party property is Rs.7.5lakhs PA
Cover Under Section III for Owner-Driver is Rs. 1500000.

Important Notice:The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule.
Any payment made by the company by reasons 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 & RIGHT OF
RECOVERY”. For legal interpretation English version will hold good
Note: This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or expression to
which a specific meaning has been attached in any part of this policy or of the Schedule shall bear the same meaning wherever it
may appear. Any amendments/modifications/alterations made on this system generated policy document is not valid and Company
shall not be liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy once issued
would be valid and effective, only after written request is made to the Company and Company accepts the requested
amendments/modifications/alterations and records the same through separate endorsement to be issued by the company.
In Witness whereoff this policy has been signed at AGRA on 03-DEC-2019 12:59
 Cholamandalam MS General Insurance Co. Ltd.
Servicing Office of Insurer: 04 , Marygold Building , 2nd Floor, Shahnazaf Road , Hazratganj, Lucknow, Uttar
Pradesh (State Code:09) -226001, PH-0522-3085200 Website: www.cholainsurance.com
PAN: AABCC6633K , GSTIN: 09AABCC6633K7ZB Insurer's IRDA Registration Number:123
Tollfree Helpline 0522308520 Email: customercare@cholams.murugappa.com CIN :
U66030TN2001PLC04977
GOODS CARRYING VEHICLE PACKAGE POLICY-CERTIFICATE CUM POLICY
SCHEDULE CUM RECEIPT
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Policy No. 3313/00236570/000/00 Policy Issued On 17-DEC-2019 (12:59)
Insured Name MR. HIMANSHU
Own Damage Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight) Motor Liability Period 17-DEC-2019(12:59) To 16-DEC-2020(Midnight)

GOODS CARRYING VEHICLE: ADD ON COVERS