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

Policy Schedule cum Cer ficate of Insurance

Motor Private Car Liability Policy: UIN-IRDAN123RP0012V01200203

Period of Insurance: From 18/05/2023 00:01 to midnight

Policy Number - 3371/60038412/000/00 Cer ficate Number - 3371/60038412/000/00
17/05/2024 23:59
Name & Communica on Address:
Mr. YAR MOHAMMAD Registra on Address:
VILL TRILOKPUR PO JANIYAJOT PS BANSI,,, BASTI,U ar Pradesh,BASTI,U ar Pradesh,272207

Mobile number: 7081634321 | Email

id: riyazahamad2217@gmail.com
Date of Registra on : 12/04/2016 | Place of Registra on : BASTI(U ar Pradesh)
Business / Profession : Geographical Area : India
EIA :
Nominee Name : | Nominee Rela onship : Financier Name & Address:
PARTICULARS OF VEHICLE INSURED
Registra on Mark UP55R9183 Engine No. GHG4B69748 Chassis Number MA1XB2GHKG2B62846
Make MAHINDRA Model BOLERO - DI Variant BOLERO - DI Year of Mfg 2016 Cubic Capacity 2523
Total Sea ng Capacity
Fuel used DIESEL 7 Contract No.
Including Driver
Driver 0 Cleaner 0 Vehicle Colour K.Wa
Licensed Passenger Carrying Capacity 6 Type of Body SUV
Premium COMPUTATION TABLE
Sum Insured
A. LIABILITY IMT Premium (Rs.)
(Rs.)

Basic TP 7,897

CNG Kit - TP 25 0

LL to Paid Driver 1,00,000 28 50

Geographical Extension
1 0
- TP
Consolidated Stamp Duty Paid Vide G.O. Rt No.426, Commercial Taxes and Registra on (j1) Department, Tamil Nadu
dated 21/12/2020 TOTAL PREMIUM (A) 7,947

B. PERSONAL ACCIDENT COVERS

TOTAL PREMIUM (B) 0

TOTAL PREMIUM (A+B) 7947

IGST(18%)
CGST(9%)(Rs.) 0 SGST(9%)(Rs.) 0 1,431
(Rs.)

TOTAL AMOUNT
KERALA CESS(1%) 0 9,378
RS

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 tes ng f) Reliability Trials g) Any purpose in connec on with motor trade.

DRIVER CLAUSE: Any person including the insured provided that a person driving holds an effec ve driving license at the me of the accident and is not disqualified from holding or obtaining such
a license. Provided also that the person holding an effec ve learner's license may also drive the vehicle and that such a person sa sfies the requirements of Rule 3 of the Central Motor Vehicles
Rules 1989.

LIMITS OF LIABILITY:Under Sec on I - 1(i) of the Policy - Death or bodily injury such amount as is necessary to meet the requirements of the Motor Vehicle Act, 1988. Under Sec on I - 1(ii) of the
Policy - Damage to Third Party Property - Rs.7,50,000.00 Personal Accident Cover for the Owner cum Driver Rs.15,00,000.00
Warran es: It is hereby warranted the coverage under this Policy commences only from the Risk Start me and Date as men oned in the Policy schedule. No Liability shall a ach under this Policy in respect
of any Accident/Loss prior to the me and date of commencement of Period of Insurance.
As per GR36 A, PA for Owner-driver refers to the Owner of the Insured Vehicle holding an effec ve driving license.The Policy Schedule CUM Cer ficate of Insurance is an important document issued based on
your declara on. 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.Coverage under
this policy is subject to realisa on of premium cheque(s). In case of dishonor of cheque(s), no separate in ma on will be given and the policy stands cancelled from incep on.
This policy has been issued upon declara on by the Insured that a valid Pollu on Under Control (PUC) Cer ficate is held on the date of commencement of the Policy
Intermediary Name: POLICYBAZAAR INSURANCE BROKERS PVT LTD
Code : 200993652932 Contact No.: 4430445400
Business Loca on : Chennai Head Office,2nd Floor, "Dare House" No.2,NSC Bose Road, Chennai - 600 001

GST Invoice No.: 3371/60038412/000/00 | GSTIN: 33AABCC6633K1ZQ | SAC Code: 997134 | SAC Descrip on: Motor Vehicle Insurance Services

for Cholamandalam MS General Insurance Company Limited

Place: Chennai Date: 15/05/2023

Authorised Signatory

I/We hereby cer fy that the policy to which this cer ficate relates as well as this cer ficate of insurance are issued in accordance with the provisions of Chapter X and Chapter XI of the Motor Vehicles
Act,1988.

Refer our website for Policy Wordings and detailed Terms & Condi ons, Exclusions and the Ombudsman list. 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 ma ers related to your policy or to provide details of products & services offered. To opt out from the facility, please register under Do Not Call sec on 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

Policy Schedule cum Cer ficate of Insurance

Motor Private Car Liability Policy: UIN-IRDAN123RP0012V01200203

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 Cer ficate 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 legal interpreta on,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 No fica ons, this
policy schedule shall be in lieu of Tax Invoice and hence no separate GST invoice required. 3. As per No fica on No. 13/2020-CT dated 21-Mar-2020, Chola MS, being a General Insurance
Company, are exempt from E-Invoicing provisions of GST laws

Grievance Clause: For any grievance or query please call 1800-208-5544 or write to customercare@cholams.murugappa.com. Pls contact Chief Grievance Officer of the insurance
company at GRO@cholams.murugappa.com in case of unsa sfied response. If you are s ll unsa sfied you may, subject to vested jurisdic on, 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

Refer our website for Policy Wordings and detailed Terms & Condi ons, Exclusions and the Ombudsman list.
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 ma ers related to your policy or to provide details of products & services offered. To opt out from the facility, please register under Do Not Call sec on on our website.