CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED

MOTOR TWO - WHEELERS POLICY BUNDLED - CERTIFICATE CUM POLICY SCHEDULE

(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES *,1989)
UIN No: IRDAN123RP0017V01201819 GSTIN: PAN No: AABCC6633K
IRDAI Registration No: 123
Description of Services: Motor Vehicle insurance services
Toll Free No.: 1800 208 5544 Contact No.: 044 4044 5400 SAC Code: 997134
Website: www.cholainsurance.com Email: customercare@cholams.murugappa.com

Policy & Owner Details Policy Type- New Product Name- Motor Two - Wheelers Policy Bundled

Policy Number Proposal Number & Date Insured GSTIN Number

3397/60239959/000/00 PR000015964978 & 16/05/2022
Policy Tenure (OD Tenure) Policy Tenure (TP Tenure) Policy Issued On
1 YEAR 5 YEAR 16/05/2022 17:10:34
Period Of Insurance (OD Tenure) Period Of Insurance (TP Tenure)
From: 16/05/2022 17:10:34 16/05/2022 17:10:34 To
To: 15/05/2023 23:59:59 15/05/2027 23:59:59
Insured Name Insured Address
Mr. CHELLADURAI J no 1/51 north street kanarpatti Tirunelvel tamilnadu 627201
Nominee Name Nominee Relationship Appointee Name Relation with Appointee
Mrs. mallika Spouse - -
CPA Start Date CPA End Date CPA Tenure CPA Sum Insured
16/05/2022 17:10:34 15/05/2027 23:59:59 1 ₹ 1500000
Tax Invoice Number

Vehicle Details

Make Model Variant Cubic Capacity Seating Capacity Body Type

TVS JUPITER 125 DRUM BSVI- ALLOY WHEEL TVS JUPITER 125 - ALLOY 125 2 SOLO
HQ.P.BL - -
Manufacturing Year Registration Date Fuel Type RTO Registration Number Chassis Number
2022 16/05/2022 PETROL TN-72 New MD626AK40N1D00048
Engine Number CNG Elec.Accessories Non-Elec.Accessories Carrier Type CNG/LPG Kit
BK4CN1062620 0 0 0 No
Vehicle IDV Hypothecation/Lease/HP* Hypothecation City Hypothecation Bank Financier Branch Geographical area extension
₹ 80204 0 CHENNAI Orange Retail Finance India CHENNAI -
Pvt Ltd
Schedule Of Premium (Amount In Rs.)
OWN DAMAGE PREMIUM (A) LIABILITY PREMIUM (B)
Particular Total Particular Total
Basic Own Damage 671 Basic Third Party Liability 3285
Non-Elec. Accessories 0 Third Party Liability For Bi-Fuel Kit 0
Elec. Accessories (IMT-24) 0 PA Cover For Owner Driver (IMT-15) 325
CNG / LPG Kit (IMT-25) 0 PA Paid Driver 0
Geographical Extension (IMT-1) 0 PA Cover For Unnamed Persons (IMT-16) 0
Sub Total (Basic Premium) 671 Legal liability Paid Driver (IMT-28) 0
ADD ON COVERAGE Legal liability Unnamed Persons (IMT-29) 0
Sub Total (Addons) 0 Geographical Areas Extension (IMT-1) 0
DISCOUNTS TP PD -250
AntiTheft Discount (IMT-10) 0 Net Liability Premium (B) 3360
AA Membership Discount (IMT-8) 0 Total Premium (A+B) 4031
No Claim Bonus 0 IGST Premium (18%) 726
Sub Total (Discounts) 0 Total GST 726
Net Own Damage Premium (A) 671
Gross Premium 4757

• Policy insurance is subject to realization of premium/payment. • Consolidated Stamp Duty Paid Vide G.O. Rt No.157,Commercial Taxes and Registration (j1) Department, Tamil Nadu dated 28/04/2021. The policy is
NOTE: subject to compulsory deductible (IMT-22) of Rs.100. • Geographical Area-India. • You agree to receive the policy document (without enclosing the terms & conditions) from the company and the company will
display terms & conditions on its website which can be accessed by you online. * Subject to IMT Endt. Nos. & Memorandum: 22,15.
Limitations as to use: The policy covers use of the vehicle for any purpose other than
(1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade (8) Tuition.
Drivers Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such license.Provided also that
the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules *, 1989.
Limits of Liability Clause: (a) Under Section II (1)(I) of the Policy-Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicle Act *, 1988. (b) Under Section II (1)(ii) of the Policy-
Damage to property other than property belonging to the insured or held in trust or in the custody of control of the insured up to the limits specified- (TPPD Sum Insured - ` 6,000/-) . (iii) PA cover for owner driver under section
III CSI ₹ 1500000.
No Claim Bonus : No Claim Bonus will only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy. No Claim Bonus is subject to no claim on the previous policy. Benefits under the policy
stands forfeited if claim is/was made in previous policy.
Geographical Area: Any accidental loss damage and/or liabilty caused sustained or insured within India shall be covered subject to policy Terms and Conditions, unless specially agreed and endorsed.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT OF RECOVERY" For legal interruption, English version will hold good.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 Motor Vehicle Act *, 1988. "As per section 146 of
the motor vehicle act *, 1988 it is mandatory to have your vehicle insured against third party risk". As per section 196 of the above act,driving a vehicle without valid insurance is punishable with fine upto Rs 2000/- or
imprisonment upto 3 months or both. Pre-existing Damages: All types of pre-existing damages or cost of rapair of such damage will be excluded at the time of claim settlement. Updating Registration Number of vehicles within
15 days of policy inception is MANDATORY as per IRDAI. Kindly provide the same to your Agent/Our Call centre/Policy issuing Branch (Applicable for policies booked without Registration No of vehicles).
Grievance Clause: Insured is advised to go through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim Bonus
or any other material information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. In the unfortunate
event of a claim, please call quoting your Policy No. on 1800 208 5544 (toll free) and register your claim immediately within 7 days from the date of loss. You may visit company website at www.cholainsurance.com for detailed
benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 208 5544 or customercare@cholams.murugappa.com / GRO@cholams.murugappa.com in case you desire to have a
printed copy of policy wording or any other assistance required. Our grievance redressal procedure and details about ombudsman is also available in our policy wording and company website. Please note that any
misrepresentation, non disclosure or withholding of material facts will lead to cancellation of policy void ab initio with forfeiture of premium and non consideration of claim, if any. In the event of unsatisfactory response from the
Head Grievance Officer, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of Insurance Ombudsman are available at IRDAI website www.irdai.gov.in or on
company website www.cholainsurance.com or on General Insurance Council: http://www.cioins.co.in/ombudsman.html

MISP MISP Code Email/Mobile

SRI KRISHNA AUTOS HIB/TVS/11058 srikrishnaautos.tvl@gmail.com/99******75
DP DP Code Email/Mobile
BALARADHA KRISHNAN B HIB_002000 srikrishnaautos.tvl@gmail.com/9994075375
Broker Name & Address: Harita Insurance Broking LLP, Jayalakshmi Estates, No.29, Haddows Road, Nungambakkam, Chennai,TN-600006
Broker Code : 200672238619
For & On Behalf of
CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LIMITED

Authorized Signatory

For Renewal/Claims assistance - please contact Insurance.Co./HIB through : SRI KRISHNA AUTOS at 9994075375