Cholamandalam MS General Insurance Co. Ltd.

Servicing Office of Insurer: #1-2-73/2 and 1-2-63 to 64, No.302, 3rd Floor, S R Arcade, Parklane,
Secundrabad, Telangana (State Code:36) -500003, PH-- Website: www.cholainsurance.com
PAN: AABCC6633K . GSTIN: 36AABCC6633K1ZK Insurer's IRDA Registration Number: 123
Tollfree Helpline Email: CIN : U66030TN2001PLC04977

Motor Private Car Policy Bundled-CERTIFICATE CUM POLICY SCHEDULE CUM RECEIPT
(UIN-IRDAN123RP0018V01201819)
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 3311/00243170/000/00 Policy Issued On 08-MAY-2019 (12:30)

Insured Name MR. DEEPAK GOUD RAMARAM
Own Damage Period 08-MAY-2019(12:30) To 07-MAY-2020(Midnight) Motor Liability Period 08-MAY-2019(12:30) To 07-MAY-2022(Midnight)

Proposal No. & Date PPVBU7129415, 08-MAY-2019 CPA Cover Period 08-MAY-2019(12:30) To 07-MAY-2022(Midnight)
Insured Add. S/O:RAMARAM YADAIAH GOUD PLOT NO:184.P S RAO NAGAR DAMMAI GUDA,KEESARA, MEDCHAL , TELANGANA (State Code:36) -
500083
Previous Insurer NA Previous Policy No. NA
Broker Details
IRDA Lic. No.: 375, CIN No.: U50300MH1997PLC149349 Broker Category: Composite Broker, Validity: 13-MAY-17 To 12-MAY-20
Name & Add.: TATA MOTORS INSURANCE BROKING & ADVISORY SERVICES LTD, 1ST FLOOR, AFL HOUSE, LOK BHARATI COMPLEX, MAROL MAROSHI ROAD,
ANDHERI (EAST), MUMBAI 400 059, INDIA

Make Model Sub Model Cubic Capacity Manufacturing Year Seating capacity

TATA MOTORS HARRIER HARRIER XZ 1956 2019 5

Body Type Registration No. RTO Invoice Date Engine No. Chassis No.

CLOSED UPPAL 07-MAY-2019 46336890-4037458 MAT631111KPD56515

Vehicle IDV CNG/LPG Kit Elec. Accessories Non-Elec. Accessories Total IDV

1,549,203 0 0 0 1,549,203

Schedule of Premium (Amount in Rs.)

Own Damage Premium (A) Liability Premium (B)
Basic Premium Basic Third Party Liability 24,305

Vehicle 51,790 Third Party Liability For Bi-Fuel Kit 0

Non-Elec. Accessories 0 Third Party Liability For Geographical Area Extension 0

Elec. Accessories (IMT-24) 0 PA Cover For Owner Driver Of Rs. 1500000 (IMT-15) 975

CNG/LPG Kit (IMT-25) 0 PA Cover For 0 Persons of Rs. 200000 Each (IMT-16) 0
Sub Total (Basic Premium) 51,790 PA cover for Paid Driver of Rs 2,00,000 (IMT± 0

Add On Coverages (Refer Note 5) 6,197 Legal Liability For Paid Driver (IMT-28) 150

Geographical Area Extension (IMT-1) 0 Legal Liability for Employees (for 0 persons) (IMT± 0

IMT 23 Premium 0 Net Liability Premium (B) 25,430

Sub Total-Addition 57,987 Total Premium (A+B) 83,417

CGST (9%) 7508

Deductibles SGST (9%) 7508
Voluntary Deductibles (0) (IMT-22A) 0 Gross Premium Paid 98,433
Note: 1.Warning that in case of dishonour of the premium cheque, this document stands automatically
Anti Theft Device (IMT-10) 0 cancelled 'ab-initio

AA Membership (IMT-8) 0 2.Consolidated stamp duty paid to state exchequer

3.The policy is subject to compulsory deductible of Rs.2000 (IMT-22)
No Claim Bonus (0%) 0

Sub Total (Deductibles) 0 5.Add-on: Nil Depreciation:6197

6.The insurance company will display terms & conditions on its website www.cholainsurance.com which can
be accessed by you online.
Net Own Damage Premium (A) 57,987 *Subject to IMT Endt. Nos.& Memorandum:7,22,28,23
Nominee Details
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
DIVYA JYOTHI 24 SPOUSE --N.A-- --N.A--
Payment Details : UTR No.: 700201912849391423, Payment Date: 08-MAY-2019, Bank Name: HDFC BANK LTD, Bank City:
Hypothecation Details: VIMAL HIRE PURCHASE INVESTMENT - RANGAREDDY - L B NAGAR
MISP Name: CONCORDE MOTORS INDIA LIMITED, MISP PAN No: AAACM0154A, MISP Code: TMIBASL/MISP/AAACM0154A
SAC:997134, Description of Service :Motor Vehicle Insurance Services, Place of Supply :TELANGANA(State Code:36), Receipt No/Invoice No:3311/00243170/00
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
For & On Behalf of Cholamandalam MS General Insurance Co. Ltd.

Dealer Code : CONCORDE MOTORS INDIA LIMITED KHAIRATABAD - 300555000

Authorized Signatory
In case of any claim or assistance required please contact our help line at 1800 209 0060 and you may also reach us at support@tatamotorsinsurancebrokers.com
 Cholamandalam MS General Insurance Co. Ltd.
Servicing Office of Insurer: #1-2-73/2 and 1-2-63 to 64, No.302, 3rd Floor, S R Arcade, Parklane,
Secundrabad, Telangana (State Code:36) -500003, PH-- Website: www.cholainsurance.com
PAN: AABCC6633K . GSTIN: 36AABCC6633K1ZK Insurer's IRDA Registration Number: 123
Tollfree Helpline Email: CIN : U66030TN2001PLC04977

Motor Private Car Policy Bundled-CERTIFICATE CUM POLICY SCHEDULE CUM RECEIPT
(UIN-IRDAN123RP0018V01201819)
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 3311/00243170/000/00 Policy Issued On 08-MAY-2019 (12:30)

Insured Name MR. DEEPAK GOUD RAMARAM
Own Damage Period 08-MAY-2019(12:30) To 07-MAY-2020(Midnight) Motor Liability Period 08-MAY-2019(12:30) To 07-MAY-2022(Midnight)

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.

Driver¶s 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: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.Under Section II-1 (ii) of the policy-Damage to third party property is
Rs.7.5lakhs PA Cover Under Section III for Owner-Driver is Rs. 1500000

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 ³AVOIDANCE OF CERTAIN TERMS &
RIGHT OF RECOVERY´For legal interpretation English version will hold good.

Note: This Schedule, the attached Policy and Endorsements mentioned herein above shall read together and word or
expression to which a specific meaning has been attached in any part of this policy or of the Schedule shall bear the same
meaning wherever it may appear. Any amendments/modifications/alterations made on this system generated policy document
is not valid and Company shall not be liable for any liability whatsoever arising from such changes. Any changes required to
be made in the policy once issued would be valid and effective, only after written request is made to the Company and
Company accepts the requested amendments/modifications/alterations and records the same through separate endorsement to
be issued by the company.
In Witness whereoff this policy has been signed at HYDERABAD on 08-MAY-2019 12:30
 Cholamandalam MS General Insurance Co. Ltd.
Servicing Office of Insurer: #1-2-73/2 and 1-2-63 to 64, No.302, 3rd Floor, S R Arcade, Parklane,
Secundrabad, Telangana (State Code:36) -500003, PH-- Website: www.cholainsurance.com
PAN: AABCC6633K . GSTIN: 36AABCC6633K1ZK Insurer's IRDA Registration Number: 123
Tollfree Helpline Email: CIN : U66030TN2001PLC04977

Motor Private Car Policy Bundled-CERTIFICATE CUM POLICY SCHEDULE CUM RECEIPT
(UIN-IRDAN123RP0018V01201819)
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No. 3311/00243170/000/00 Policy Issued On 08-MAY-2019 (12:30)

Insured Name MR. DEEPAK GOUD RAMARAM
Own Damage Period 08-MAY-2019(12:30) To 07-MAY-2020(Midnight) Motor Liability Period 08-MAY-2019(12:30) To 07-MAY-2022(Midnight)

PRIVATE CAR PACKAGE POLICY: ADD ON COVERS

"

Notwithstanding anything to the contrary contained in the policy, and provided additional premium has been paid, it is
hereby understood and agreed that in the event of a Partial Loss Claim for damages to the vehicle insured under the policy
where liability is admitted, the insurer will indemnify the insured the full value of expenses incurred for replacement of
damaged parts of insured vehicle without application of depreciation thereon. However, an excess of 1% vehicle without
application of depreciation thereon.However, an excess of 1% of admissible claim amount or 0.5% of the IDV of the vehicle
whichever is less subject to a minimum of Rs, 2000/- will be deducted from the claim at the time of settlement in addition to
any other excess/ deductibles applicable under the policy

"