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Motor Two - Wheelers Policy Bundled

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

GST Invoice No.:3397484616186 CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.

DATE: 10/12/2023 ADDRESS: TRICHY BRANCH OFFICE
PAN: AABCC6633K 41, IIND FLOOR,
SAC Code: 997134 TABS COMPLEX, BHARADHIDASAN SALAI,
SAC Description: Motor vehicle insurance services TIRUCHIRAPPALLI H.O
CITY: TIRUCHIRAPPALLI STATE: TAMIL NADU
GSTIN: 33AABCC6633K1ZQ
Business Location: SIVAGANGA CIE Cover Note No: 86390738
Policy Number:3397/03209613/002/00 Customer Code:1015070944240001 Policy Type:Package - Two Wheeler Policy
Name & Communication Address: Name and Registration Address:
VAISHALI G 45A/1 MUTHU KARUPPA PILLAI STREET SOUTHVELI VEETHI MADURAI SOUTH
45A/1 MUTHU KARUPPA PILLAI STREET SOUTHVELI VEETHI MADURAI SOUTH ,MADURAI H.O,MADURAI,TAMIL NADU PIN - 625001
,MADURAI H.O,MADURAI,TAMIL NADU,PIN - 625001 Mobile- 9600777291,Landline- -
Mobile- 9600777291,Landline- -
Certificate Number: 3397/03209613/002/00 Geographical Area: India
Period of Insurance: From 16/12/2021 13:12 hours to midnight on 15/12/2026 Business or Profession: Individual
PARTICULARS OF THE VEHICLE INSURED
Date of Registration:16/12/2021 Place of Registration:MADURAI (CENTRAL) Registration Mark:NEW
Make: SUZUKI Model: ACCESS 125 Variant: DISC BRAKE WITH CBS BS VI Vehicle Colour: - Year of Mfg: 2021
Type of Body: SCOOTER Fuel Used: PETROL Engine No: AF216819599 Chassis No: MB8DP12DLM8953239
Cubic Capacity:125 K.Watt:0 Gross Vehicle Weight(GVW):- Public/Private Carrier:- Registration Mark(Trailer):- Contract No:-
Licensed passenger Carrying Capacity:2 Driver:0 Cleaner:- Conductor:- Total Seating Capacity Including Driver:2 Chassis No.(Trailer):-
IDV (Insured Declared Value)
IDV (Insured Declared Value) 1st Year: 82266 2nd Year: 0 3rd Year: 0 4th Year: 0 5th Year: 0
Value of Chassis (Rs): 0.00 Value of Body (Rs): 0.00 For Vehicle (Rs): 82,266.00 For Trailer (Rs): 0.00 Non-Electrical Accessories (Rs): 0.00
Electrical/Electronic Accessories (Rs): 0.00 Value of CNG/LPG Kit (Rs): 0.00
Period Of Insurance
Start Date: 16/12/2021 16/12/2022 16/12/2023 16/12/2024 16/12/2025
Period Of Insurance
End Date: 15/12/2022 15/12/2023 15/12/2024 15/12/2025 15/12/2026
A1.OWN DAMAGE
No.of 1st year 2nd year 3rd year 4th year 5th year Total
Sum Insured IMT
Person Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs)
Basic OD 1379 0* 0* 0* 0* 1379
Own Damage Premium 1379 0 0 0 0 1379
Experience Based Discount 565 0 0 0 0 565
TOTAL(A1) 745 0 0 0 0 745
A2.ADD-ON COVERS(BENEFITS)
Option 1st year 2nd year 3rd year 4th year 5th year Total
Benefit No IMT
No. Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs)
Full Depreciation Waiver Cover Bundled 247 0 0 0 0 247
Hydrostatic Lock Cover 165
Chola Value Added Services - Two Wheeler Package Policy
150 0 0 0 0 150
Bundled
TOTAL ADD-ON-COVERS PREMIUM(A2) 397 0 0 0 0 562
B.LIABILITY
No.of 1st year 2nd year 3rd year 4th year 5th year Total
Sum Insured IMT
Person Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs)
Basic TP 657 657 657 657 657 3285
TPPD Discount 20 250.00
TOTAL PREMIUM(B) 657 657 657 657 657 3035
C.PERSONAL ACCIDENT COVERS
PA for owner driver 1500000 375 375 0 0 0 750
TOTAL PREMIUM(C) 375 375 0 0 0 750
TOTAL (A1+A2+B+C) 2174 1032 657 657 657 5092
CGST (9%) 458.50
SGST (9%) 458.50
IGST (0%) 0
TOTAL CONSIDERATION AFTER TAX 6009

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) in
connection with any trade or business or use for any purpose in connection with motor trade c) Organized racing d) Pace making e) Speed Testing f) Reliability Trials g) Use only with
side car if attached h) Tuition.

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(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.6,000.00 P.A. Cover for the Owner cum Driver Under Section III (CSI)- R s .15,00,000.00
Compulsory Deductibles Under Section 1: Rs.100 Per claim
Voluntary deductibles under Section 1 Rs.0 Per claim
Additional Imposed deductibles under Section 1 Rs.0
Subject to I.M.T. Endt. Nos. and Memorandum: 7 .
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.
Product Plan:
Applicable benefits:
The policy wording 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 16/12/2021. 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. lt 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 lnsurance
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.

As per GR 36A - PA for Owner driver refers to the Owner of the insured vehicle holding an effective driving licence.
S.NO NAME OF THE NOMINEE RELATIONSHIP AGE OF THE NOMINEE % AGE OF SHARE NAME OF THE GUARDIAN GUARDIAN RELATIONSHIP WITH NOMINEE
1 VAIRAPRAKASH Husband 31 100
No claim bonus is applicable at the end of the policy period.
Financier Name & Address: INDUSIND BANK LTD,MADURAI
Intermediary Name: CHOLA INSURANCE DISTRIBUTION SERVICES PRIVATE LIMITED
Code: 200572295173 Contact No: 6478546547
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:10/12/2023 Receipt No: @CholaSign1

Receipt Date:
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the Duly Constituted Attorney(s)
aggregate turnover notified under sub-rule (4) 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.
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.
In the event of a claim under Compulsory personal accident cover (CPA), the intimation of the claim to the Insurer shall be within 30 days of its occurrence
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 Information/Claims: Contact Toll Free Helpline at 1800 208 5544; SMS "CHOLA" to 56677; For CARE contact 1800 103 5354;
E-mail: [email protected]; 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-600001, India
CIN: U66030TN2001PLC047977 | IRDAI Reg. No. 123

Product Name : Motor Two - Wheelers Policy Bundled

UIN : IRDAN123RP0017V01201819

UIN for Add-on Covers

Sl.No Add on cover Name IRDA BAP UIN UIN

1 Full Depreciation Waiver Cover Bundled IRDAN123RP0017V01201819/A0079V02201819
Chola Value Added Services ‐ Two Wheeler Package Policy
2 IRDAN123RP0017V01201819/A0084V01201819
Bundled
To : DATE : 12/10/2024
Customer Name : VAISHALI G
Address :
45A/1 MUTHU KARUPPA PILLAI STREET SOUTHVELI VEETHI MADURAI SOUTH
,MADURAI H.O,MADURAI,TAMIL NADU,PIN ‐ 625001
Mobile‐ 9600777291,Landline‐ ‐

Dear Sir/Madam

Ref: Vehicle details updation in your Motor Insurance 3397/03209613/002/00

On behalf of Chola MS we would to thank you for choosing us as your preferred insurer. Your vehicle details are updated in our records as per the
details below.We request you to confirm the correct / missing information and send this letter back to the address given, to update the same in
our records. If there are any corrections, we request you to provide the Registration Certificate (RC) for our records and future reference.

Vehicle Registration : NEW

Engine : AF216819599
Chassis : MB8DP12DLM8953239

Documents to be sent to:

Manager (Operations),
Cholamandalam MS General Insurance Ltd
1st Floor, Hari Nivas Tower, 163, Thambu Chetty Street,
Parrys Corner,
Chennai ‐ 600001

We request you to reply within 7 days of receipt of this letter. Alternatively, request you to e‐mail your above Vehicle details with scanned copy
of Registration Certificate to the following e‐mail ID, quoting your policy number. [email protected]

For any further clarifications please feel free to call our toll free # 1800 200 5544.

Yours faithfully,
For Cholamandalam MS General Insurance Company Limited

Authorised Signatory