Motor Policy Schedule Cum Certificate of Insurance

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

GST Invoice No.:3 3 8 0 2 0 1 7 5 4 6 3 7

CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.
DATE: 2 6 / 0 3 / 2 0 1 9
ADDRESS: BARH CIE

PAN: A A B C C 6 6 3 3 K
GANESH NAGAR, THANA ROAD, BARH
SAC Code: 9 9 7 1 3 4
LANDMARK -GANESH IN TERNATIONAL HOTEL
SAC Description: Motor vehicle insurance services
BARH S.O

CITY:
PATNA
STATE: BIHAR

GSTIN:
10AABCC6633K7ZS

Business Location:
BARH CIE

Cover Note No:

0
Policy Number:3380/01556100/000/00
Customer Code:10106126800008

Policy Type:Package - Miscellaneous & Special Type Vehicle

Name & Communication Address:

Name and Registration Address:

MANOJ KUMAR SINGH

S/O VISHUN DEO NARAYAN SINGH, AT + P.O - BAKAWAN, P.S - BHADAUR,,

S/O VISHUN DEO NARAYAN SINGH, AT + P.O - BAKAWAN, P.S - BHADAUR,,

,BAKAWA B.O ,PATNA ,BIHAR ,PIN - 803306

,BAKAWA B.O ,PATNA ,BIHAR ,PIN - 803306

Mobile- 6201276059,Landline- 91-

Mobile- 6201276059,Landline- 91-

Aadhar No.: -
PAN No.:-

Certificate Number:
3380/01556100/000/00

Geographical Area: Indi a

Period of Insurance: From 27/03/2019 00:00 hours to midnight on 26/03/2020

Business or Profession: Individual

PARTICULARS OF THE VEHICLE INSURED

Date of Registration:06/12/2017

Place of Registration:PATNA
Registration Mark:BR-01-GG-2867

Make: NEW HOLLAND

Model:
3510

Variant: T R A C T O R

Year of Mfg:
2017

Type of Body: OPENBODY

Fuel Used: DIESEL

Engine No:
S324E53460

Chassis No:
NHN35100ZHH399527

Cubic Capacity:1350
Watts:

Gross Vehicle Weight(GVW)/HP:-

Public/Private Carrier:-

Registration Mark(Trailer):-

Contract No:-

Licensed passenger Carrying Capacity:1

Driver:1

Cleaner:0

Conductor:0

Total Seating Capacity Including Driver:1

Chassis No.(Trailer):-

IDV (Insured Declared Value)

Value of Chassis (Rs): 490000

Value of Body (Rs): 0

For Vehicle (Rs): 4,90,000.00

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
Total Value (Rs):
4,90,000.00

A.OWN DAMAGE
B.LIABILITY

SI
No.of
IMT
Premium(Rs)

SI

No.of
IMT
Premium(Rs)
Person

Person
Basic OD

4,90,000.00

5,890
.00

Basic TP

6,115
.00
IMT 23

23
884 . 00

Paid Driver Cover

1
40
50
. 00

TOTAL

6,774
.00

TOTAL
6,165
.00

Own Damage Premium

6,774
.00

TOTAL PREMIUM(B)

6,165
.00

Detariff Discount
4,366
.66

C.PER ONAL ACCIDENT COVERS

GST Discount (5 %)

338
. 70

PA for owner driver

15,00,000.00

750
. 00

TOTAL(A)

2,068
.00

TOTAL PRE IU
(C)

750
. 00
E.OTHER CHARGES(NON PREMIUM)

TOTAL (A+B+C+E)

8,983
.00

Chola value added services

0
. 00

TOTAL PACKAGE PRE

IUM
8,983
.00

CVAS New

0
. 00

CGST (9%)

808
. 53

Break In Loading
0
. 00

SGST (9%)

808
. 47

TOTAL-OTHER CHARGES(NON PREMIUM)(E)

. 00

IGST (0%)
0
. 00

MOUNT COLLECTED
10,600
.00

MS

As per GR 36A - PA for Owner driver refers to the Owner of the insured vehicle holding an effective driving licence.

LIMITATIONS AS TO USE: The Policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988. Falling under the Sub sector 3 of the Section 66 of Motor Vehicles Act
1988. Agricultural and Forestry Vehicles: Use only for agricultural and forestry purposes. The Policy does not cover : (1) Use for hire or reward or for racing pace making reliability trial or speed
testing. (2) Use for the carriage of passengers for hire or reward. (3) Use whilst drawing a greater number of trailers in all than is permitted by law.
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 .7,50,000.00 P.A. Cover for the Owner cum Driver Under Section IV (CSI)- R s .15,00,000.00

Deduction Under section 1: Rs.2450

Additional compulsory deductibles under Section 1 Rs.0 Additional Imposed deductibles under Section 1 Rs.0

Subject to I.M.T. Endt. Nos. and Memorandum: 21,23,40,7 .

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.

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 26/03/2019. In witness where of this policy has been signed in lieu of the Cover Note No.:- Date:-

No Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.

Financier Name & Address: MAHINDRA AND MAHINDRA FINANCIAL SERVICES LIMITED,patna

Intermediary Name: CHOLA INSURANCE DISTRIBUTION CHOLA SERVICES PRIVATE LIMITED

C o d e : 200572295173 Contact No: 9955594268

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.

Signature Not Verified

Place: CHENNAI Date:26/03/2019 Receipt No:201903260033
Receipt Date:26/03/2019
For Cholamandalam MS General
Company Ltd.

Digitally signed by P

KRISHNAN

Date: 2019.03.26 19:57:37 IST

Reason: Approved

Location: Chennai

Consolidated Stamp Duty Paid Vide G.O. Rt No.G.O.No.105,Commercial Taxes and Registration (j1) Department, Tamil Nadu Duly Constituted Attorney(s) d a t e d27/02/2019.

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, Indi a

Product Name
:
Motor Commercial Vehicle Package Policy - Miscellaneous and Special Type of Vehicles
UIN
:
IRDAN123P0007V02100001
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