Royal Sundaram General Insurance Co.

Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

Service Branch Address: Office No 201, 2nd Floor, Zenith Complex, ,K M Gandhi Marg, Opp. Krushi Bhavan, ,Shivaji Nagar, ,M1-Pune ,PUNE - 411005.
Jul 05, 2022
Mr.SANJAY DHONDIRAM KADU .
AT TAMBHERE ROAD SATRAL
PO SONGAON TAL RAHURI Intermediary Code: BR150000
AHMADNAGAR Intermediary Name: Probus Insurance Broker
SRIRAMPUR,MAHARASHTRA
413711 Private Limited
Telephone : Contact: -7506683445
Mobile: 90xxxxxx03
CERTIFICATE OF INSURANCE & POLICY SCHEDULE
(See Form 51 of The Central Motor Vehicles Rules, 1989) Motor Vehicles Act, 1988
Goods Carrying Vehicle Policy – Liability only [Reprint]
Certificate of Insurance and Policy No. Policy Period:Period of insurance
VGT0174995000100 From 14:25 hours on 07/07/2022 To Midnight of 06/07/2023
INSURED DETAILS
Insured Date Geographical Registration Registration
Name of Insured Business/Profession
of Birth Area Authority Date
Mr.SANJAY DHONDIRAM KADU . India SRIRAMPUR 02/11/2020
VEHICLE DETAILS
Registration Number MH17BY6252 Model Description SIGNA 2823.TK BSVI Gross Vehicle Weight(Kgs) 28,000
B56B6A220D06102K6384
Engine Number Type of Body TIPPER Seating Capacity (including Driver) 3
2580
Public Carrier/Private
Chassis Number MAT797015L3K09110 Public Carrier
Carrier
Make of the Vehicle Tata Motors Ltd. Year of Manufacture 2020 Total Premium (in Rs.) 49,773
DRIVER: Persons or class of persons permitted to drive public/private carrier • Provided
LIMITATIONS AS TO USE:The Policy covers use of the vehicle for any purpose that a person driving holds an effective driving license at the time of the accident and is not
other than: a) Organised racing b) Pace making c) Speed testing d) Reliability Trials e) disqualified from holding or obtaining such a license. • Provided also that the person
Any purpose in connection with Motor Trade. holding an effective Learner’s License may also drive the vehicle and that such a person
satisfies the requirements of Rule 3 of The Central Motor Vehicles Rules, 1989.
LIMITS OF LIABILITY:
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 Vehicles Act, 1988.
Under Section II-1 (ii) of the Policy -Damage to Third Party Property - Rs750,000. In respect of any one claim or series of claims arising out of one event.
Nominee Name : Nominee Age : 0 Relationship with :
Guardian Name : Guardian Age : 0 Guardian Relation :
Personal Accident Cover for Owner - Driver under Section IV Capital Sum Insured : Rs. 1,500,000/-
B - LIABILITY
1. Basic premium including premium for TPPD 43,950.00
2. Less: For restricted TPPD cover for Rs.6000/-(IMT 20) 0.00
3. Trailers 0.00
4. Bi-fuel kit (CNG) 0.00
Add:Personal Accident Benefits
5. Geographical Area Extn.Endt.IMT-1 0.00
6. Under Section IV (Owner Driver), CSI Rs.1,500,000 315.00
7. P.A Cover to Paid Driver, CSI Rs. 0(IMT 17) 0.00
Legal Liability
8. To Paid Driver/Cleaner (IMT 28) 50.00 ADD: SGST 2,678.85
9. To Coolies (IMT 39) 100.00 ADD: CGST 2,678.85
10.NFPP to employees (IMT 37) 0.00
11. NFPP to non - employees (IMT 37-A) 0.00
12. Usage of Commercial and Private Purpose - IMT 34 0.00
TOTAL LIABILITY PREMIUM (B) 44,415.00 TOTAL PREMIUM 49,772.70
In Witness whereof this Policy has been signed at Chennai on 05/07/2022 in lieu of Cover note No. dated Receipt No. CBCMOR8956458.Subject to IMT Endt. Nos & Memorandum 39,28. 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 vehicle 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 Vehicles Act, 1988 is recoverable from the Insured. See the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY" under Policy
Terms and Conditions.
For Royal Sundaram General Insurance Co. Not
Signature Limited
Verified
Digitally signed by TAIKAD
MAHADEVAN
SHYAMSUNDER
Date: 2022.07.05 14:25:58 IST
Reason: For RoyalSundaram
Location: Chennai
Consolidated Stamp Duty Paid to Govt of TamilNadu Authorised Signatory
This document is digitally signed, hence counter signature / stamp is not required.
For Legal interpretation, English version will hold good. GSTIN : 27AABCR7106G1ZJ PAN Number : AABCR7106G
cea477eb90251a6859bf023301fffd83

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:[email protected] www.royalsundaram.in
 Royal Sundaram General Insurance Co. Limited
(Formerly known as Royal Sundaram Alliance Insurance Company Limited)
Corporate Office:Vishranti Melaram Towers, No.2/319,
Rajiv Gandhi Salai (OMR), Karapakkam, Chennai – 600097.
Registered Office:21 ,Patullos Road, Chennai - 600 002
Royal Sundaram IRDA Registration No.102 | CIN-U67200TN2000PLC045611

GST Invoice
Royal Sundaram General Insurance Co. Limited
M1:M1-Pune
Address: Office No 201, 2nd Floor, Zenith Complex, ,K M Gandhi Marg, Opp. Krushi Bhavan, ,Shivaji Nagar, ,M1-Pune ,PUNE -
411005.
GSTIN: 27AABCR7106G1ZJ

Policy Number : VGT0174995000100

GST Invoice Number : VGT017499500000
Invoice Date : 07/07/2022

Address of insured:
Insured Name: Mr.SANJAY DHONDIRAM KADU .
AT TAMBHERE ROAD SATRAL
PO SONGAON TAL RAHURI
AHMADNAGAR
SRIRAMPUR
State:MAHARASHTRA
Pincode: 413711

HSN Taxable CGST SGST/UTGST IGST Total

SAC Value Rate Amount Rate Amount Rate Amount Amount

997134 465.00 9.00% 41.85 9.00% 41.85 549.00

9971 43,950.00 6.00% 2,637.00 6.00% 2,637.00 49,224.00

Indication if tax payable under reverse charge - No

Note:“This document is digitally signed”

“This document is electronically generated.This document should be issued along with the Policy document.This document stands
invalid,if issued separately”

You can reach us through the details given below Mon - Sat 8.00am to 9.00pm and Sunday up to 5.00pm
Call:1860 425 0000,1860 258 0000 SMS:type <MOTORCLAIMS> and send to 567675

E-Mail:[email protected] www.royalsundaram.in