Cholamandalam MS General Insurance Co. Ltd.

Servicing Office : OPTIONZ, 2nd Floor, OPP Hotel Nest, 18, S. P. Colony, Off C G Road, AHMEDABAD, GUJARAT (State
Code:24) -380009
Chola Standalone Own Damage Policy for Private Car UIN --IRDAN123RP0002V01201920
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCC6633K GSTIN: 24AABCC6633K7ZJ CIN :U66030TN2001PLC047977 IRDAI Reg:123

Policy No: 3408/00643808/000/00 Proposal No. & Date: HIIB14417395, 11-MAR-2025

Policy Issued On: 11-MAR-2025 11:25 HRS Previous Policy No.: 201140020123800352300000
Insured Name: MR. FRENILKUMAR PANKAJKUMAR MODI Previous Insurer: Liberty General Insurance Ltd.
Period of Own Damage : 22-MAR-2025 (00:00) To 21-MAR-2026 (1 YEAR)
EDEN I - 704, GODREJ GARDEN CITY, JAGATPUR, , AHEMDABAD , Period of Liability Cover: NA
Insured Address:
GUJARAT (State Code:24) -382470
Period of Compulsory NA
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX9433C NA

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI VENUE 1.2 KAPPA MT S 1197 2024 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SUV GJ 01 WQ 3538 AHMEDABAD NO PETROL MALFB81BLRM560293
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
778,770 0 0 0 778,770 G4LARM833659

Own Damage Premium (A) Amount(INR) Pre-Existing Third-Party Policy Details

Basic Own Damage Premium TP Insurance Company Name Liberty General Insurance Ltd.
Vehicle 3,836 TP Policy No 201140020123800352300000
Non-Elec. Accessories (IMT-24) 0 TP Risk Inception Date 22 Mar 2024
Elec. Accessories (IMT-24) 0 TP Risk Expiry Date 21 Mar 2027
Bi-Fuel Kit (IMT-25) 0
Geographical Area Extension (IMT-1) 0
IMT 23 Premium 0
Sub Total (Basic Premium) 3,836
Discount/Deductibles
Voluntary Deductibles (0) (IMT-22A) 0
Anti Theft Device (IMT-10) 0
AA Membership (IMT-8) 0

No Claim Bonus (20%) 768

Handicapped Discount (IMT-12) 0

Notes: 1. Consolidated Stamp Duty Paid Vide G.O. Rt No.157,Commercial Taxes and Registration
Sub Total (Deductibles) 768
(j1) Department, Tamil Nadu dated 28/04/2021
[Link] policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC)
Total Own Damage Premium 3,068 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, during the subsistence of the Policy.
Add On Coverages ( ZD,CM,EP,KP,PB ) 5362 [Link] Area Ext. extended to (IMT-1): NA
Net Own Damage Premium (A) 8,430 4. Policy issuance is subject to realization of cheque if premium is paid by cheque
SGST(9%) 759 [Link] policy is subject to compulsory deductible of INR 1,000 (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
CGST(9%) 759 website [Link]
7. The Coverage under this policy is only for Own Damage and no other liability in connection with the
Gross Premium Paid 9,948 vehicle.
Add-on Cover Opted in the Policy: Waiver of Depreciation for Standalone Private Car OD(IRDAN123RP0002V01201920/A0005V01201920), Consumables Plus Cover for Standalone Private Car OD
(IRDAN123RP0002V01201920/A0024V01201920), Hydrostatic Lock Plus Cover for Standalone Private Car OD(IRDAN123RP0002V01201920/A0027V01201920), Loss of Key Cover for Standalone
Private Car OD(IRDAN123RP0002V01201920/A0023V01201920), Loss of Laptop and Mobile phone(IRDAN123RP0002V01201920/A0004V01202021)

*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 [Link] 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 0.
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 [Link] 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 [Link] or on website of General Insurance
Council: [Link]
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : GUJARAT(State Code : 24), Insurer Invoice Number : HY01042548
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-CONCEPT MOTORS INDIA

CIN No.: U67200HR2021PTC098982 PVT LTD
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0059
Email ID: connect@[Link] DP NAME-JINMAY MAYANK SHAH
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (CONCEPT HYUNDAI) at +91-7575003994