TWOWHEELERVEHICLEPACKAGEPOLICY

CertificatecumPolicySchedule
CertificatecumPolicyNo:3005/W20283584/00/000
ForCLAIMS:Call18002666(Tollfreefromallphones)
ForRENEWALS:Visitwww.icicilombard.comorcall18002666
DETAILSOFPOLICYHOLDER

POLICYDETAILS

InsuredName

VARNITBISHT

InsuredAddress

FlatNo.142U.PResidencyApartment
PolicyIssuingOffice
Sector42NoidaOppositeSector46Mother
Dairy,NOIDA,201301,UTTARPRADESH

PolicyIssuingon

ICICILombardGeneralInsurance
CompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayak
Temple,Prabhadevi,Mumbai400025
From00:00:00hrsof10Sep2013to
Midnightof09Sep2014
09Sep2013

ContactNo.
EmailAddress

8527416607
varnit.bisht@gmail.com

CoverNoteNo
RTOLocation
Hypothecatedto

W20283584
ALMORA
N/A

TypeofAgreement

None

PeriodofInsurance

VEHICLEDETAILS
RegistrationNumber
Make
Model
Typeofbody
C C Mfg.Year SeatingCapacity ChassisNumber
EngineNumber
UA014868
HEROHONDA CBZCBZStar SoloWithPillion
150 2005
2
O5G46C00470
O5G41M00774
INSUREDDECLAREDVALUE
VehicleIDV(inRs.)
SideCar NonElectricalAcc(inRs.)
Elec/ElectronicAcc(inRs.)
CNG/LPGUnit(inRs.)
TotalValue(inRs.)
20300
0
0
0
0
20300
SCHEDULEOFPREMIUM(INRS.)
OwnDamage(A)
BasicPremium
Total:
Add
Less
Deduct20%forNCB
Total:
TotalOwnDamagePremium

Liability(B)
502 BasicPremiumincludingpremiumforTPPDvehicle
502 Total:
Add
PAcoverforOwnerDriver
100 SubTotal(Additions):
100 Less
SubTotal(Deductions):
402 TotalLiabilityPremium

422
422
50
50
0
472

TotalPackagePremium(A+B)

874

ServiceTax(InclEdu.CessAndHigherEdu.Cess)

108
TotalPremiumPayable(inRs.)982

Compulsorydeductibles:Rs.100/
GeographicalArea:India
LIMITSOFLIABILITY:(a)UnderSectionII1(i)ofthepolicy>Deathoforbodilyinjury:Suchamountasisnecessarytomeetthere
requirementsofthemotorvehiclesAct.1988.
(b)UnderSectionII1(i)ofthepolicy>DamagetoThirdPartyPropertyRs1,00,000PACoverforOwnerDriverundersectionIIICSIRs
1,00,000VoluntaryDeductibleRs.0
LIMITATIONSASTOUSE:Thepolicycoversuseofthevehicleforanypurposeotherthan:Hireorreward,Carriageofgoods(otherthansamples
orpersonalluggage),Organizedracing,Pacemaking,Speedtesting,Reliabilitytrials,AnypurposeinconnectionwithMotorTrade.
DRIVER'SCLAUSES:Anypersonincludingtheinsured:ProvidedthatapersondrivingholdsaneffectiveDrivingLicenseatthetimeofthe
accidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.ProvidedalsothatthepersonholdinganeffectiveLearner'sLicensemay
alsodrivethevehicleandthatsuchapersonsatisfiestherequirementsofRule3oftheCentralMotorVehiclesRules,1989.
IMPORTANTNOTICE:TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisschedule.Anypayment
madebythecompanybyreasonofwidertermsappearinginthecertificateinordertocomplywiththeMotorVehicleAct,1988isrecoverablefrom
theinsured.Seetheclauseheaded'AVOIDANCEOFCERTAINTERMSANDRIGHTOFRECOVERY'.Forlegalinterpretation,Englishversionwillhold
good.
SubjecttoIMTEndorsementNos.&Memorandumprintedherein/attachedhereto:22
PremiumCollectionDetails:[CollectionNo/Amount/ReceiptDate]NA/Rs.982/09/09/2013
DISCLAIMER:Pleasevisitwww.icicilombard.comforthepolicywordingsforcompletedetailsontermsandconditionsgoverningthecoverageand
NCB.Thisdocumentistobereadwiththepolicywordings.
GrievanceClause
Forresolutionofanyqueryorgrievance,InsuredmaycontacttherespectivebranchofficeoftheCompanyormaycalltollfreeno.18002666ormay
approachusatthesubsection"GrievanceRedressal"onourwebsitewww.icicilombard.com(CustomerSupportsection).However,iftheresolution
providedbyusisnotsatisfactoryyoumayapproachInsuranceRegulatoryandDevelopmentAuthority(IRDA)throughtheIntegratedGrievance
ManagementSection(IGMS)orIRDAGrievanceCallCentre(IGCC)attheirtollfreeno.155255.YoumayalsoapproachInsuranceOmbudsman,
subjecttovestedjurisdiction,fortheredressalofgrievance.DetailsofInsuranceOmbudsmanofficesareavailableatIRDAwebsite:
www.irdaindia.org,orontheCompany'swebsiteatwww.icicilombard.com.
Policyisvalidsubjecttorealizationofcheque.Weacceptpremiumonlyvialegallyrecognizedmodesexceptforcash.Ifourrepresentative
requestyoutopayincash,kindlyreportittous.
Forinformationonombudsmanyoumayvisitourwebsitewww.icicilombard.com
I/Weherebycertifythatthepolicytowhichthecertificaterelatesaswellasthecertificateofinsurance
areissuedinaccordancewiththeprovisionofchapterX,XIofM.VAct1988
ServiceTaxRegistrationNo.:GIS/MUMBAII/1528/2001
ServiceTaxCodeNumber:AAACI7904GST001
Category:GeneralInsuranceBusinessServices00440005.
InWitnesswhereofthispolicyhasbeensignedatMumbaithis10Sep2013inlieuofcovernoteNoW
20283584ThestampdutyofRs.0paidincashorbydemanddraftorbypayorder,vide
Receipt/Challanno.341498dated14Aug2013

ForICICILombardGeneralInsurance
CompanyLtd

DulyConstitutedAttorney(s)