Professional Documents
Culture Documents
Chola MS: Motor Policy Schedule Cum Certificate of Insurance
Chola MS: Motor Policy Schedule Cum Certificate of Insurance
(See Rule 51 of Central Motor Vehicles Rules, 1989 of Motor Vehicles Act,1988.)
GST Invoice No.:3397220443225 CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.
DATE: 20/09/2019 ADDRESS: MADURAI- BRANCH
PAN: AABCC6633K NO 3 AND 4,
SAC Code: 997134 DINDIGUL NATIONAL HIGH ROAD, NH -7,KALAVASAL
SAC Description: Motor vehicle insurance services ARASARADI H.O
CITY: MADURAI STATE: TAMIL NADU
GSTIN: 33AABCC6633K1ZQ
Business Location: TIRUNELVELI CIE Cover Note No: 0
Policy Number:3397/00469204/000/00 Customer Code:100911362913 Policy Type:Package - Two Wheeler Policy
Name & Communication Address: Name and Registration Address:
VELSAMY C S/O.CHELLADURAI, 88 SOUTH STREET KEELA SALAIPUDHUR , NANGUNERI .
S/O.CHELLADURAI, 88 SOUTH STREET KEELA SALAIPUDHUR , NANGUNERI . ,KOVILAMMALPURAM B.O,TIRUNELVELI,TAMIL NADU PIN - 627107
,KOVILAMMALPURAM B.O,TIRUNELVELI,TAMIL NADU,PIN - 627107 Mobile- 9894807530,Landline- 91-
Mobile- 9894807530,Landline- 91-
Aadhar No.: - PAN No.:-
Certificate Number: 3397/00469204/000/00 Geographical Area: India
Period of Insurance: From 20/09/2019 15:26 hours to midnight on 19/09/2024 Business or Profession: Individual
PARTICULARS OF THE VEHICLE INSURED
Date of Registration:20/09/2019 Place of Registration:TIRUNELVELI Registration Mark:NEW
Make: BAJAJ Model: CT 100 Variant: ALLOY ES CBS Year of Mfg: 2019
Type of Body: STREET Fuel Used: PETROL Engine No: PFYWKE17084 Chassis No: MD2B37AY0KWE36440
Cubic Capacity:99 Watts: 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: 39994 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): 39,994.00 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: 20/09/2019 20/09/2020 20/09/2021 20/09/2022 20/09/2023
Period Of Insurance
End Date: 19/09/2020 19/09/2021 19/09/2022 19/09/2023 19/09/2024
S
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 670 0* 0* 0* 0* 670
Own Damage Premium 670 0 0 0 0 670
M
Detariff Discount 158 0 0 0 0 158
GST Discount (5 %) 34 0 0 0 0 34
TOTAL(A1) 478 0 0 0 0 478
A2.ADD-ON COVERS(BENEFITS)
Option 1st year 2nd year 3rd year 4th year 5th year Total
Benefit No IMT
A
No. Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs) Premium(Rs)
Full Depreciation Waiver Cover Bundled 200 0 0 0 0 200
TOTAL ADD-ON-COVERS PREMIUM(A2) 200 0 0 0 0 200
B.LIABILITY
L
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
TOTAL PREMIUM(B) 657 657 657 657 657 3285
O
C.PERSONAL ACCIDENT COVERS
PA for owner driver 1500000 325 0 0 0 0 325
TOTAL PREMIUM(C) 325 0 0 0 0 325
TOTAL (A1+A2+B+C) 1660 657 657 657 657 4288
H
CGST (9%) 386
SGST (9%) 386
IGST (0%) 0
TOTAL CONSIDERATION AFTER TAX 5060
C
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 Trial g) Tuition h) Use
only with side car if attached.
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)- R s .15,00,000.00
Compulsory Deductibles Under Section 1: Rs.100 Per claim
Voluntary deductibles under Section 1 Rs.0 Per claim
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 20/09/2019. 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 Warranted that the vehicle should possess a valid POLLUTION UNDER CONTROL certificate during the policy period, failing which assessment of own damage claims will be
repudiated.
As per GR 36A - PA for Owner driver refers to the Owner of the insured vehicle holding an effective driving licence.
* This refers to NIL OD coverage for the period.
No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy. No claim bonus is applicable at the end of the policy
period.
Financier Name & Address: SHRI RAM CITY UNION FINANCE LTD,.
Intermediary Name: CHOLA INSURANCE DISTRIBUTION SERVICES PRIVATE LIMITED
Code: 200572295173 Contact No: 8220421333
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:20/09/2019 Receipt No:
@CholaSign1
Signature Not Verified
Digitally signed by P
KRISHNAN
Date: 2019.09.20 15:34:37 IST
Reason: Approved
Location: Chennai
Receipt Date:
Consolidated Stamp Duty Paid Vide G.O. Rt No.G.O.No.173,Commercial Taxes and Registration (j1) Department, Tamil Nadu Duly Constituted Attorney(s)
dated29/03/2019.
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 Information/Claims: Contact Toll Free Helpline at 1800 200 5544; SMS "CHOLA" to 56677; For CARE contact 1800 103 5354;
E-mail: customercare@cholams.murugappa.com; 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
S
M
L A
O
C H