Cholamandalam MS General Insurance Co. Ltd.

Servicing Office : 4th Floor, SCO 10 & 11, Feroze Gandhi Market, above ICICI Bank, , LUDHIANA, PUNJAB (State Code:03) -
141001
Motor Private Car Package Policy UIN --IRDAN123RP0001V03100001
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCC6633K GSTIN: 03AABCC6633K1ZT CIN :U66030TN2001PLC047977 IRDAI Reg:123

Policy No: 3311/01781794/000/00 Proposal No. & Date: HIIB11771725, 22-OCT-2024

Policy Issued On: 23-OCT-2024 14:08 HRS Previous Policy No.: 80000031230350142838
Insured Name: MR. NIRMAL SINGH Previous Insurer: The New India Assurance Company Limited.
Period of Own Damage : 25-OCT-2024 (00:00) To 24-OCT-2025 (1 YEAR)
S/O SH. SAHIB SINGH, VILL. KOT BALA, PO. NANGAL SIRSA, TEH & Period of Liability Cover: 25-OCT-2024 (00:00) To 24-OCT-2025 (1 YEAR)
Insured Address:
DISTT, ROPAR , PUNJAB (State Code:03) -140113
Period of Compulsory 25-OCT-2024 (00:00) To 24-OCT-2025 (1 YEAR)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL NA VARINDER SINGH 40 SON

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI NEW I20 (IB) I20 SPORTZ + CRDI 1396 2019 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
HATCHBACK PB 12 AF 6079 ROPAR NO DIESEL MALBM51RLKM757480
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
444,835 0 0 0 444,835 D4FCKM887766

Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)

Basic Own Damage Premium Basic Third Party Liability Premium 3,416
Vehicle 7,098 Bi-Fuel Kit 0
Non-Elec. Accessories (IMT-24) 0 Geographical Area Extension (IMT-1) 0
Elec. Accessories (IMT-24) 0 Sub Total (Third Party Liability) 3,416
Bi-Fuel Kit (IMT-25) 0 Personal Accident (PA) Cover
Geographical Area Extension (IMT-1) 0 Compulsory PA Cover for Owner Driver Rs 1500000 (IMT-15) 450
IMT 23 Premium 0 PA Cover for 0 Unnamed Passengers Rs 0 Each (IMT-16) 0
Sub Total (Basic Premium) 7,098 PA cover for Paid Driver of Rs 2 Lac (IMT-17) 0
Discount/Deductibles Sub Total PA Cover 450
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 0 Paid Driver (IMT-28) 50
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT-29) 0

No Claim Bonus (50%) 3,549 Sub Total (Legal Liability) 50

Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 3,916

Sub Total (Deductibles) 3,549 Total Premium (A+B) 11,545
Total Own Damage Premium 3,549 SGST(9%) 1,040
Add On Coverages ( ZD,KP,PB ) 4080 CGST(9%) 1040
Net Own Damage Premium (A) 7,629 Gross Premium Paid 13,625
Add-on Cover Opted in the Policy: Waiver of depreciation(IRDAN123RP0001V01200203/A0003V02200910), Loss of Key Cover(IRDAN123RP0001V01200203/A0006V01201617), Loss of Laptop
and Mobile phone(IRDAN123RP0001V02100001/A0008V01202021)
Notes: 1. Consolidated Stamp Duty Paid Vide G.O. Rt No.157,Commercial Taxes and Registration (j1) Department, Tamil Nadu dated 28/04/2021
2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of
commencement of the Policy. The insured undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, 3.Geographical Area Ext. extended to (IMT-1): NA
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1000
4. Policy issuance is subject to realization of cheque if premium is paid by cheque (IMT-22) & Voluntary Deductible of INR 0
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer website
http://www.cholainsurance.com

*Hypothecation Details: Payment Mode: Online

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 INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 15 Lakhs.
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made or pending during the preceding year(s) - 20%, preceding
two consecutive years - 25%, preceding three consecutive years - 35%, preceding four consecutive years - 45%, preceding five consecutive years - 50% of NCB on OD Premium.
NCB is allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Declaration on Tax Invoice We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4)
of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
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.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.cholainsurance.com/customer-grievance or connect with the respective servicing
office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General Insurance
Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : PUNJAB(State Code : 03), Insurer Invoice Number : HY00778896
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 XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, Scan for Renewal Cholamandalam MS General Insurance Co. Ltd.
Haryana 122001 (Valid from 90 Days Prior to
Expiry)

Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-KOSMO PLASTIC EXPORTS

CIN No.: U67200HR2021PTC098982 PRIVATE LIMITED
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0179
Email ID: connect@hiib.in DP NAME-MAMTA
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (KOSMO HYUNDAI) at +91-8437028958