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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 Two ‐ Wheelers Package Policy ‐ Schedule cum Certificate of Insurance


[UIN: IRDAN123RP0002V02200203]

Policy Number: 3361/02378287/000/00 Certificate Number: 3361/02378287/000/00


Name & Communication Address: Registration Address:
CHETAN KUMAR
S/O SHRI SUNIL KUMAR R/O H NO 1764/3 BHAIS BAHORA,
MATHURA H.O,MATHURA S/O SHRI SUNIL KUMAR R/O H NO 1764/3 BHAIS BAHORA,
UTTAR PRADESH,PIN‐ 281001 MATHURA H.O,MATHURA
Mobile: 9027518652|Landline: |Mail: CHATURVEDI.POLICY@GMAIL.COM UTTAR PRADESH,PIN‐ 281001
Customer ID: 101343595311 Mobile‐ 9027518652,Landline‐
Aadhar No.: ‐ PAN No.:‐ GSTIN: ‐ Period of Insurance:
from 05/02/2022 00:00 hours to midnight on 04/02/2023
EIA No:
Cover Note Number: ‐ Geographical Area: No Extension
Business / Profession: Individual
PARTICULARS OF VEHICLE INSURED
Date of Registration 18/03/2018 Place of Registration MATHURA Registration Number UP‐85‐BD‐8851
MAESTRO EDGE ‐ SELF START SELF START DRUM BRAKE
Make HERO Model Variant
DRUM BRAKE ALLOY WHEEL ALLOY WHEEL
Year of Mfg 2018 Type of Body Two wheeler Fuel Used PETROL
Cubic Capacity 110 Engine No GA13557 Chassis No GA14576
Licensed passenger Carrying Capacity 2 Driver 0 Contract No ‐
Total Seating Capacity
Vehicle Colour ‐ K.Watt 0 2
Including Driver
IDV (Insured's Declared Value)
Value of Chassis (Rs) 0.00 Value of Body (Rs) 0.00 For Vehicle (Rs) 37,200.00
Non‐Electrical Accessories
For Trailer (Rs) 0.00 0.00 Electrical/Electronic Accessories (Rs) 0.00
(Rs)
Value of CNG/LPG Kit (Rs) 0.00 Total Value (Rs) 37,200.00
PREMIUM
A.OWN DAMAGE B.LIABILITY
Sum Insured
IMT Premium(Rs) Sum Insured No.of Premium
(Rs.) (Rs.)
IMT
Person (Rs)
Basic OD 37,200.00 623.00
Electrical or Electronic Accessories .00 24 .00 Basic TP 752.00
Non Electrical or Electronic Accessories .00 .00
CNG Kit‐OD .00 25 .00 CNG Kit‐TP 0 25 .00
TOTAL 623.00
Geographical Extension‐OD 1 .00 TOTAL 752.00
Sub Total:(additions) .00
Less: .00 Geographical Extension‐
1 .00
Anti‐Theft Device‐OD 10 .00 TP
Bonus Discount .00 Vintage Car Discount‐TP 0
Sub Total:(discounts) .00
Own Damage Premium 623.00 TOTAL PREMIUM(B) 752.00
Experience Based Discount 112.00
GST Discount (5.00 %) 31.00 C.PERSONAL ACCIDENT COVERS
TOTAL(A) 480.00 Unnamed PA cover 1,00,000.00 2 16 140.00
Option
D.ADD‐ON COVERS(BENEFITS) Benefit No Premium(Rs)
No. TOTAL PREMIUM(C) 140.00
Full Depreciation Waiver 112.00
Chola value added services 0.00 TOTAL (A+B+C+D) 1,484.00
CVAS New 0.00
TOTAL CONSIDERATION 1,484.00
ADD‐ON COVERS PREMIUM 112.00
CGST (0%)(Rs.) 0.00
TOTAL ADD‐ON‐COVERS PREMIUM(D) 112.00
Break In Loading 0 SGST (0%)(Rs.) 0.00
TOTAL‐OTHER SERVICE CHARGES(NON IGST (18%)(Rs.) 267.00
.00
PREMIUM)(E) TOTAL AMOUNT
1,751.00
COLLECTED

Refer website for policy wordings and detailed Terms & Conditions, 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 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 Two ‐ Wheelers Package Policy ‐ Schedule cum Certificate of Insurance


[UIN: IRDAN123RP0002V02200203]

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)Use in connection with motor trade.
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(i) of the Policy ‐ Death 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 ‐ Rs.1,00,000.00 P.A. Cover for the Owner cum Driver Under Section III (CSI)‐ Rs.0.00
Deduction Under Section 1: Rs.100
Additional compulsory deductibles under Section 1 Rs.0.00
Additional Imposed deductibles under Section 1 Rs.‐
Subject to I.M.T. Endt. Nos. and Memorandum: .
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.
Applicable benefits:
Please visit our website for Policy terms and conditions
Date and Signature of the proposal 31/01/2022 2:59:21 PM. In witness where of this policy has been signed in lieu of the Cover Note No.:‐ Date:‐
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.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
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.
Sl.No. Name of the Nominee Relationship Age of the Nominee %age of share Name of the Guardian Guardian relationship with Nominee
1 SUNIL KUMAR Spouse 51 100
No claim bonus is applicable at the end of the policy period.
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.
Financier Name & Address:
Intermediary Name: HEUTE AND MORGEN INSURANCE BROKER PRIVATE LIMITED
Code: 201471270629 Contact No: 9935858888

For Cholamandalam MS General Insurance Company Ltd.


@CholaSign1
% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q

Place: CHENNAI Date:31/01/2022 Digitally signed by:


KANCHIPURAM
Receipt No: Receipt Date: SRIDHAR HARISH

Duly Constituted Attorney(s)


Business Location: PUNE BRANCH ‐ 1
3RD FLOOR, WELLESLY COURT,CTS NO 15 B,
DR. AMBEDKAR ROAD CAMP,PUNE
DR.B.A. CHOWK S.O PUNE MAHARASHTRA

GST Invoice No: 3361354909006 | GSTIN: 27AABCC6633K1ZJ | SAC Code:997134 | SAC Description: Motor vehicle insurance services
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 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, 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.
Whether tax is payable under reverse change basis ‐ No
Note: UIN for the related add‐on covers availed under this policy are as mentioned in the attached sheet, which forms part of the policy schedule.

Refer website for policy wordings and detailed Terms & Conditions, 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 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.

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