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 Certificate of Insurance

Goods Carrying Vehicle Liability Policy: UIN-IRDAN123RP0012V01200203

Policy Number - 3372/60448002/000/01 Certificate Number - 3372/60448002/000/01 Period of Insurance: From 31/07/24 20:17 to midnight 30/07/25 23:59

Name & Communication Address:

Registration Address:
JAGSIR SINGH VILL LADBANJARA KHURD TEH SUNAM Sangrur Punjab VILL LADBANJARA KHURD TEH SUNAM Sangrur Punjab-148001
-148001
Mobile number: 91******** | Email id: ******@gmail.com
Business / Profession : Date of Registration : 08-Jul-2014 | Place of Registration : SANGRUR
EIA : Geographical Area : India
Nominee Name : | Nominee Relationship : Financier Name & Address:
PARTICULARS OF VEHICLE INSURED
Registration Mark PB13BH9451 Engine No. 57961 Chassis Number 04608
Make TATA Model LPT 3118 Variant LPT 3118 Year of Mfg 2014 Cubic Capacity NA
Total Seating Capacity 1
Fuel used DIESEL Contract No.
Including Driver
Driver 1 Cleaner 0 Vehicle Colour NA K.Watt
Licensed Passenger Carrying Capacity 0 Type of Body HGV
Premium COMPUTATION TABLE
Sum Insured
A. LIABILITY IMT Premium (Rs.)
(Rs.)
Basic TP 30,309.68
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 Registration (j1) Department, Tamil Nadu TOTAL PREMIUM
30,359.68
dated 21/12/2023 (A)

B. PERSONAL ACCIDENT COVERS

CPA for owner driver 15,00,000 0

PA Cover for other than

1,00,000
Owner-driver

TOTAL PREMIUM
(B)

TOTAL PREMIUM (A+B) 30,359.68

IGST(18%)
CGST(9%)(Rs.) 0 SGST(9%)(Rs.) 0 6,664.32
(Rs.)

TOTAL
KERALA CESS(1%) 0 37,024
AMOUNT 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 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:Under Section 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 Section 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
Warranties: 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.
As per GR36 A, PA for Owner-driver refers to the Owner of the Insured Vehicle holding an effective driving license.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.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 has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of commencement of the Policy
Intermediary Name: Direct
Code : 200195804475 Contact No.: 044- 43995400
Business Location : Chennai Head Office,2nd Floor, "Dare House" No.2,NSC Bose Road, Chennai - 600 001
GST Invoice No.: 3371/00314415/000/00 | GSTIN: 33AABCC6633K1ZQ | SAC Code: 997134 | SAC Description: Motor Vehicle Insurance Services

for Cholamandalam MS General Insurance Company Limited

Place: Chennai Date: 31/07/2024

Authorised Signatory

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.

Refer our 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

Policy Schedule cum Certificate 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 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.

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

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 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

Refer our 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.