Motor Policy Schedule Cum Certificate of Insurance

(See Rule 51 of Central Motor Vehicles Rules, 1989 of Motor Vehicles Act,1988.) CHOLAMANDALAM MS GENERAL INSURANCE COMPANY LTD.

ADDRESS: VIJAYAWADA BRANCH OFFICE

DOOR NO.- 40-1-48/1, 2ND FLOOR,

BEHIND KOTAK MAHINDRA BANK, MG ROAD,

VENKATESWARAPURAM S.O

CITY: KRISHNA STATE: ANDHRA PRADESH

GSTIN: 37AABCC6633K5ZE

GST Invoice No.: 336**********

DATE: 22/03/2019

PAN: AABCC6633K

SAC Code: 997134

SAC Description: Motor vehicle insurance services

Business Location: VIJAYAWADA BRANCH OFFICE Cover Note No: - Policy Number: 3361/01002004/000/00 Customer Code: 101********* Policy Type: Two Wheeler Name&Communication Address:

MADABATTULA DEVIPRASAD

6-45-162, SATYANARAYANAPETA,TAGARAPUVALASA,

BHEEMUNIPATNAM,VISAKHAPATNAM,

BHEEMUNIPATNAM S.O,VISAKHAPATNAM

ANDHRA PRADESH,PIN- 531163 Mobile-888-***-****

Name and Registration Address:

6-45-162, SATYANARAYANAPETA,TAGARAPUVALASA,

BHEEMUNIPATNAM,VISAKHAPATNAM,

BHEEMUNIPATNAM S.O,VISAKHAPATNAM

ANDHRA PRADESH,PIN- 531163 Mobile-888-***-****

Aadhar No.: - PAN No.:-

Period of Insurance: from 22/03/2019 11:50 hours to midnight on 21/03/2020 Business or Profession: Individual Geographical Area: No Extension Certificate Number: 3361/01002004/000/00 Issue Date: 22/03/2019 PARTICULARS OF THE VEHICLE INSURED

Date of Registration: 06/10/2017 Place of Registration: VISAKHAPATNAM Registration Mark: AP-31-EA-7424 Make: HONDA Model: CB UNICORN - CB Variant: CB Year of Mfg: 2017 Type of Body: Two wheeler Fuel Used: PETROL Engine No: KC31E80116374 Chassis No: ME4KC311JH8116312 Cubic Capacity: 149 Watts : - Gross Vehicle Weight(GVW): - Public/Private Carrier: - Registration Mark(Trailer): - Contract No: ATV01910S Licensed Passenger Carrying Capacity: 2 Driver 0 Cleaner: - Conductor: - Total Seating Capacity Including Driver: Chassis No.(Trailer): - IDV (Insured Declared Value)

Value of Chassis (Rs): 0.00 Value of Body (Rs): 0.00 For Vehicle (Rs): 55000 For Trailer (Rs): 0 Non-Electrical Accessories (Rs): 0 Electrical/Electronic Accessories (Rs): 0 Value of CNG/LPG Kit (Rs): 0 Total Value (Rs): 55000 A. OWN DAMAGE

SI No. of PersonIMTPremium (Rs)

Basic OD 55,000.00 922.00

TOTAL 922.00

Own Damage Premium 922.00

Detariff Discount (10%) 92.00

TOTAL(A) 830.00

D.ADD-ON COVERS(BENEFITS)

Benefit

No. Option No.

ADD-ON COVERS PREMIUM 0.00

Add-On Covers Loading 0

TOTAL ADD-ON-COVERS PREMIUM (D) 0.00

E.OTHER CHARGES (NON PREMIUM)

Chola value added services 0.00

TOTAL OTHER CHARGES (NON PREMIUM) (E) 0.00

B. LIABILITY

SI No. of PersonIMTPremium (Rs)

Basic TP 720.00

Conductor

TOTAL 720.00

TOTAL PREMIUM(B) 720.00

C.PERSONAL ACCIDENT COVERS

TOTAL PREMIUM(C) .00

TOTAL (A+B+C+D+E) 1,550.00

TOTAL CONSIDERATION 1,550.00

CGST (9%) 139.00

SGST (9%) 140.00

IGST (0%) 0.00

AMOUNT COLLECTED 1,829.00

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 testing f)Reliability Trials g)Use in connection with motor trade. DRIVER CLAUSE:

LIMITS OF LIABILITY:Under Section II-1 (1) of the Policy - Death or bodly 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.100000 P.A. Cover for the Owner cum Driver Under Section III (CSI)- Rs..00 Deduction Under Section 1: Rs.100 Additional compulsory deductibles under Section 1 Rs.0.00 Additional Imposed deductibles under Section 1 Rs. 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 wordings 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 22/03/2019.

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. lt is hereby warranted the coverage under this Policy commences only from the Risk Start time and Date as mentioned in the Policy schedule. No Liability shall attach under this Policy in respect of any Accident/Loss prior to the time and date of commencement of Period of insurance No claim bonus is applicable at the end of the policy period. CVAS NEW :

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

Financier Name & Address: Indusind Bank Ltd,VIZIANAGARAM,VIZIANAGARAM Intermediary Name: IBL-CFD-PPD-ANDHRA COASTAL-MADANPALLI NORTH ANI Code: 200*********

Contact No: 180*******

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.

Place: CHENNAI Date:22/03/2019 Receipt No: Receipt Date: For Cholamandalam MS General Insurance Company Ltd.

@CholaSign1

Consolidated Stamp Duty Paid Vide G.O Rt No G.O.No.105, Commercial Taxes and Registration (j1) Department, Tamil Nadu dated 27/02/2019 Duly Constituted Attorney(s) 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 vehicles 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 1-800-***-****: sms "CHOLA" to 56677 For CARE contact 180*-***-**** E-mail: adae0l@r.postjobfree.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-600 001, India Product

Name : TWOWHEELER_CHOLA

UIN : IRDAN123P0002V02100001

CHOLA MS

Digitally signed by P

KRISHNAN

Date: 2019.03.22 12:12:06 IST

Reason: Approved

Location: Chennai

Signature Not Verified

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