Motor Endorsement Schedule

CHOLAMANDALAM MS GENERAL INSURANCE CO MPANY LTD. GST Invoice No.:3379407525089

ADDRESS: HYDERABAD - BRANCH DATE: 21/05/2023

1-2-73/2 1-2-63 TO 64,
PAN: AABCC6633K
NO.302, 3RD FLOOR,S R ARCADE, PARKLANE
PARKLANE SAC Code: 997134
SAC Description: Motor vehicle insurance services
CITY: HYDERABAD STATE: TELANGANA

GSTIN: 36AABCC6633K1ZK

Insured Name : MAHAMMAD NASIRODDIN

HNO:17-21/1/A, 2,1 MARKET YARDS NEAR MARKET, JADCHERLA,

Address : MAHABUBNAGAR,
STN. JADCHERLA H.O, MAHABUB NAGAR
TELANGANA PIN-509301

Aadhar No.: - PAN No.: -

Policy Number : 3379/03175176/000/00 [ UIN:IRDAN123RP0003V03100001]
Period of Insurance : From 21/05/2023 10:18 Hours To Midnight on 20/05/2024
Endorsement Number : 3379/03175176/001/00
Endorsement Date : 21/05/2023 16:40 Hours
Reason for Endorsement : Name Transfer Endorsement
IMT 3-NAME TRANSFER ENDORSEMENT.
Notwithstanding anything to the contrary contained or endorsed under the within mentioned policy, it is hereby declared and agreed that with effect from
21/05/2023 16:40 Hours(endorsement effective date), ownership of the vehicle is transferred from JATAMONI VENKATAIAH,PLOT NO:7, SRIPURAM
COLON Y, SAGAR HOUSE COMPLEX, B N REDD Y,, ,HYDERABAD G.P.O., HYDERABAD,TELANGANA PIN-500001 (name and address) to
MAHAMMAD NASIRODDIN,HNO:17-21/1/A, 2,1 MARKET YARDS NEAR MARKET, JADCHERLA, MAHABUBNAGAR, ,STN. JADCHERLA
H.O, MAHABUB NAGAR,TELANGANA PIN-509301(new name and address).
Provided always that for the purpose of the no claim bonus, no period during which the interest in this policy has been vested in any previous insured shall
accrue to the benefit of MAHAMMAD NASIRODDIN .
Subject otherwise to the terms exceptions conditions and limitations of this policy.

Consequent to this a premium amount of Rs. 3609 is collected from the Insured.
Endorsement Premium: CGST (9%) : SGST (9%) : IGST (0%) : Total Premium:
3,061.00 274.00 274.00 0.00 3,609.00

All other terms and conditions remain unaltered.

Whether tax is payable under reverse charge basis - No.

Place : MALAKPET CIE

For Cholamandalam MS General Insurance Company Ltd.
% DSU nknown
q
1G
1g
0. 100 0.1 90cm
0 J0j 4 M[ ] 0d
1i
0g
313 292m
313 404325 453 432 529
c
478 561504 597 504 645
c
504 736440 760 391 760
c
286 760271 681 265 626
c
265 625l
100 625l
100 828253 898 381 898
c
451 898679 878 679 650
c
679 55628 499 538 435
c
488 399467 376 467 292
c
313 292l
h
308 214170-164re
f
0. 44G
1. 2w
1 10.4 rg
287 318m
287 430299 479 406 555
c
451 587478 623 478 671
c
478 762414 786 365 786
c
260 786245 707 239 652
c
239 651l
74 651l
74 854 27 924355 924c
425 924653 904 653 676
c
653 581602 525 512 461
c
462 425441 402 41 318
c
287 318l
h
282 240170-164re
B
Q

Digitally signed by:

KANCHIPURAM
SRIDHAR HARISH

Date : 21/05/2023

Duly Constituted Attorney(s)

Regd.&Head Office:Dare House, 2nd Floor, No.2, N.S.C Bose Road, Chennai-600 001, India
CIN: U66030TN2001PLC047977 | IRDAI Reg. No. 123