Cholamandalam MS General Insurance Company Limited

Registered Office: 2nd Floor, "Dare House" No.2,NSC Bose Road, Chennai - 600 001. India
T: +91 044 4044 5400 | Fax: F: +91 044 4044 5500 |
E: customercare@cholams.murugappa.com Website: www.cholainsurance.com
CIN: U66030TN2001PLC047977 PAN AABCC6633K IRDAI Regn. No.123

Policy Schedule cum Cer ficate of Insurance

Motor Two Wheeler Liability Policy - UIN: IRDAN123RP0011V01200203

Policy Number 3372/60275581/000/00 Cer ficate Number 3372/60275581/000/00

Name & Communica on Address: Registra on Address:
Mrs SHAKILA H NO 188 RAGHUNATHPUR HAPUR HAPUR 999999 , GHAZIABAD,
H NO 188 RAGHUNATHPUR HAPUR HAPUR 999999 , GHAZIABAD, UTTAR PRADESH, 201201 UTTAR PRADESH, 201201
Mobile : 8882822544 | Landline :
Mail : kddeepanshu555@gmail.com
Aadhar No:
Cover Note Number: Geographical Area : India
Period of Insurance: From 01/09/2022 00:01 hours to midnight on 31/08/2023 23:59 Business / Profession :

PARTICULARS OF VEHICLE INSURED

Place of
Date of Registra on 28/09/2015 HAPUR Registra on Number UP37C9763
Registra on
Model /
Make HERO PASSION XPRO - DRUM Type of Body Solo with pillion
variant
Year of Manufacture 2015 Total Sea ng Capacity 2 Fuel used PETROL
Cubic Capacity 109 Engine No. HA10EVFHF80913 Chassis No. MBLHA10BSFHF90646
Licensed Passenger Carrying Capacity 2 Total Sea ng Capacity including Driver 2

IDV (Insured's Declared Value)

Value of Chassis (Rs.) 0 Value of Body (Rs.) 0 For Trailer (Rs.) 0
For Vehicle (Rs.) 0 Non-Electrical Accessories (Rs.) 0 Electrical/Electronic Accessories (Rs.) 0
Value of CNG/LPG Kit (Rs.) 0 Total Value (Rs.) 0 Contract No. 0

Premium
A. LIABILITY
Sum Insured (Rs.) IMT Premium (Rs.)
Basic TP 714
CNG Kit - TP 25 0
LL to Paid Driver
Less TPPD Discount
TOTAL PREMIUM (A) 714
B. PERSONAL ACCIDENT COVERS

TOTAL PREMIUM (B) 0

TOTAL PREMIUM (A+B) 714
CGST(9%) 0
SGST(9%) 0
IGST(18%) 129
Kerala Cess(1%) 0
TOTAL AMOUNT COLLECTED 843

Refer our website for Policy Wordings and detailed Terms & Condi ons, Exclusions and the Ombudsman list. Call Toll Free: 1800 208 5544 SMS CHOLA to 512777 | Visit
www.cholainsurance.com | Email customercare@cholams.murugappa.com Disclaimer: The Company may contact you for ma ers related to your policy or to provide details of products &
services offered. To opt out from the facility, please register under Do Not Call sec on on our website.
Cholamandalam MS General Insurance Company Limited
Registered Office: 2nd Floor, "Dare House" No.2,NSC Bose Road, Chennai - 600 001. India
T: +91 044 4044 5400 | Fax: F: +91 044 4044 5500 |
E: customercare@cholams.murugappa.com Website: www.cholainsurance.com
CIN: U127030TN2001PLC0127977 PAN AABCC12733K IRDAI Regn. No.123

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 tes ng f) Reliability Trials g) Any purpose in connec on with motor trade.
DRIVER CLAUSE: Any person including insured provided that a person driving holds an effec ve driving license at the me of the accident and is not disqualified from holding or obtaining
such a license. Provided also that the person holding an effec ve learner's license may also drive the vehicle and that such a person sa sfies the requirements of Rule 3 of the Central Motor
Vehicles Rules 1989.
LIMITS OF LIABILITY:Under Sec on 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 Sec on 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 Sec on IV (CSI)- Rs.15,00,000.00
Deduc on Under Sec on 1: Rs.100
Addi onal compulsory deduc bles under Sec on 1 Rs.
Addi onal Imposed deduc bles under Sec on 1 Rs.0
Subject to I.M.T. Endt. Nos. and Memorandum :
Coverage Under this policy is subject to realisa on of premium cheque(s). In case of dishonor of cheque(s), no separate in ma on will be given and the policy stands cancelled from
incep on.
Date and Signature of the proposal 29/08/2022 In witness where of this policy has been signed in lieu of the Cover Note No.:- Date:-
Warran es: lt is hereby warranted the coverage under this Policy commences only from the Risk Start me and Date as men oned in the Policy schedule. No Liability shall a ach under
this Policy in respect of any Accident/Loss prior to the me and date of commencement of Period of Insurance.

This policy has been issued upon declara on by the Assured that a valid Pollu on Under Control (PUC) Cer ficate is held on the date of commencement of the Policy.

As per GR36 A, PA for Owner-driver refers to the Owner of the Insured Vehicle holding an effec ve driving license
Sl. No. Name of the Nominee Rela onship Age of the Nominee %age of share Name of the Guardian Guardian rela onship with Nominee

NOTE: The Policy Schedule CUM Cer ficate of Insurance is an important document issued based on your declara on. 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.
Financier Name and Address: -
Intermediary Name: Girnar Insurance Brokers Pvt Ltd
Code : 2020777215360001 Contact No.: 7551196989

for Cholamandalam MS General Insurance Company Limited

Place: Chennai Date: 29/08/2022

Duly Cons tuted A orney(s)

Business Loca on : Chennai Head Office
Business Loca on Address: Chennai

GST invoice no.: 3372/60275581/000/00 | GSTIN: 33AABCC12733K1ZQ| SAC Code: 997134| SAC Descrip on: Motor Vehicle Insurance Services
Consolidated Stamp Duty Paid to Commercial Taxes and Registra on (j1) Department, Tamil Nadu.
I/We hereby cer fy that the policy to which this cer ficate relates as well as this cer ficate 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 Cer ficate 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 interpreta on, English Version will hold good.

Refer our website for Policy Wordings and detailed Terms & Condi ons, Exclusions and the Ombudsman list. Call Toll Free: 1800 208 5544 SMS CHOLA to 512777 | Visit
www.cholainsurance.com | Email customercare@cholams.murugappa.com Disclaimer: The Company may contact you for ma ers related to your policy or to provide details of products &
services offered. To opt out from the facility, please register under Do Not Call sec on on our website.