PrivateCarPackagePolicy

CERTIFICATECUMPOLICYSCHEDULE
CertificatecumPolicyNo:3001/10220910/00/000
Foranyassistancepleasecall18002666Pleasesavethenumberforyourreference
ForRENEWALS:Visitwww.icicilombard.comorcall18002666
POLICYDETAILS

DETAILSOFTHEPOLICYHOLDER

M/S GOLD STAR FOUNDERY

InsuredName

PolicyIssuingOffice

CIRCULAR RAOD, BATALA, GURDASPUR

GURDASPUR PUNJABPIN
143505,
TELEPHONENO.:91

InsuredAddress

ICICILombardGeneralInsurance
CompanyLTD,ICICILOMBARD
HOUSE,414,VeerSavarkarMarg,
NearSiddhiVinayakTemple,
Prabhadevi,Mumbai400025

From16:09 07/06/2014
06/06/2015midnight

PeriodofInsurance

ContactNo.(s)

EmailAddress

10220910

CoverNoteNo:

BANKOF
INDIA,JALANDHAR

HypothecatedTo

VEHICLEDETAILS

Registrationno&RTOLocation
PB18-BR-6000&PUNJABJALANDHAR

Make&Model
EngineNo.
CHEVROLET/SPARK1.0 49187KC2

ChassisNo.
631019

MFGYear CC
2008

Seatingcapacity Typeofbody
5
Saloon

INSUREDDECLAREDVALUE

VehicleIDV(InRs.)
1,20000

Elec/ElectronicAccessories(inRs.)
0.00

NonElecAccessories(inRs.)
0.00

CNG/LPGunit(inRs.)
0.00

Trailer(inRs.)
0.00

TotalValue(inRs.)
1,20,000

SCHEDULEOFPREMIUM(INRS.)

OwnDamage(A)
BasicOwnDamage
ZeroDepreciation(ZD)
NCB (20%)
Total

SubTotal(Deductions)
Total

Liability(B)
3,676.00 BasicThirdPartyLiability
00.00 PaidDriver(IMT28)
765.00 PACoverForOwnerDriverOfRs.2,00,000
2,910.00Total
00.00
00.00
2,910.00

TotalLiabilityPremium

941.00
50.00
100.00
1,091.00

ServiceTax(InclEdu.CessAndHigherEdu.Cess)
Totalpremium(inRs.)

1,091.00
3,901.00
482.16
4,383.00

GeographicalArea:India
CompulsoryDeductibles:Rs.1000 VoluntaryDeductible:Rs.0

LIMITSOFLIABILITY:(a)UnderSectionII1(i)ofthepolicy>Deathoforbodilyinjury:Suchamountasisnecessarytomeetthererequirementsofthe
MotorVehiclesAct,1988.
(b)UnderSectionII1(ii)ofthepolicy>DamagetoThirdPartyPropertyRs7,50,000.00PACoverforOwnerDriverundersectionIII:CSIRs2,00,000.00
LIMITATIONSASTOUSE:Thepolicycoversuseofthevehicleforanypurposeotherthan:Hireorreward,Carriageofgoods(otherthansamplesor
personalluggage),organisedracing,Pacemaking,reliabilitytrailsorspeedtestinganypurposeinconnectionwithMotorTrade.
DRIVER'SCLAUSES:Anypersonincludingtheinsured:ProvidedthatapersondrivingholdsandeffectiveDrivingLicenseatthetimeoftheaccidentandis
notdisqualifiedfromholdingorobtainingsuchalicense.ProvidedalsothatthepersonholdinganeffectiveLearner'sLicensemayalsodrivethevehicleand
thatsuchapersonsatisfiestherequirementsofRule3oftheCentralMotorVehiclesRules,1989.
IMPORTANTNOTICE:TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisSchedule.Anypaymentmadeby
theCompanybyreasonofwidertermsappearingintheCertificateinordertocomplywiththeMotorVehicleAct,1988isrecoverablefromtheInsured.See
theclauseheaded"AVOIDANCEOFCERTAINTERMSANDRIGHTOFRECOVERY".Forlegalinterpretation,Englishversionwillholdgood
SubjecttoIMTEndorsementNos.&Memorandumprintedherein/attachedhereto:7,10,22,28
PremiumCollectionDetails:[CollectionNo/Amount/ReceiptDate]1034288162/Rs.20,565.00/25/01/2013

AgencyCode:DB27204AgencyName:SMCINSURANCEBROKERSPVTLTDAgent'smobileno.:+911800266636Agent'slandlineno.:
DISCLAIMER:Pleasevisitwww.icicilombard.comforthepolicywordingsforcompletedetailsontermsandconditionsgoverningthecoverageandNCB.This
documentistobereadwiththepolicywordings.
Policyisvalidsubjecttorealizationofcheque.Weacceptpremiumonlyvialegallyrecognizedmodes.
Incaseofdishonourofpremiumcheque(s)thecompanyshallnotbeliableunderthepolicyandpolicyshallbevoidabinitio(frominception).
Incaseofanydiscrepancywithrespecttothepolicy,pleaserevertwithin15daysfrompolicystartdate.
GrievanceClause:
Forresolutionofanyqueryorgrievance,InsuredmaycontacttherespectivebranchofficeoftheCompanyormaycalltollfreeno.18002666ormay
approachusatthesubsection"GrievanceRedressal"onourwebsitewww.icicilombard.com(CustomerSupportsection).However,iftheresolutionprovided
byusisnotsatisfactoryyoumayapproachInsuranceRegulatoryandDevelopmentAuthority(IRDA)throughtheIntegratedGrievanceManagementSection
(IGMS)orIRDAGrievanceCallCentre(IGCC)attheirtollfreeno.155255.YoumayalsoapproachInsuranceOmbudsman,subjecttovestedjurisdiction,for
theredressalofgrievance.DetailsofInsuranceOmbudsmanofficesareavailableatIRDAwebsite:www.irdaindia.org,orontheCompany'swebsiteat
www.icicilombard.com.
Forinformationonombudsmanyoumayvisitourwebsitewww.icicilombard.com
I/Weherebycertifythatthepolicytowhichthecertificaterelatesaswellasthecertificateofinsuranceare ForICICILombardGeneralInsurance
CompanyLtd
issuedinaccordancewiththeprovisionofchapterX,XIofM.V.Act1988.
ServiceTaxRegistrationNo.:GIS/MUMBAII/1528/2001
ServiceTaxCodeNumber:AAACI7904GST001

Category:GeneralInsuranceBusinessServices00440005.
DulyConstitutedAttorney(s)
InWitnesswhereofthisPolicyhasbeensignedatMumbaithis31d a y o f Januaryof2013inlieuof
CopyOfPolicy
covernoteNo77220910
ThestampdutyofRs.0.5paidincashorbydemanddraftorbypayorder,videreceipt/challanno.
29168dated30/11/2012
MailingAdd.Office:
CorporateOffice:

DearSir/Madam,
WethankyouforplacingyourconfidencewithICICILombardforyourmotorinsuranceneeds.Pleasefindattachedherewithpolicyno.3001/77220910/00/000,whichhas
beenissuedbasedonthedetailsfurnishedbytheapplicant.
Basedonthecoverselected,belowisabriefonthecover
1.Discountforantitheftdevices(IMT10):
ItisherebyagreedandunderstoodthatthediscountforantitheftdeviceRs.285inconsiderationofcertificationbyhasbeengiveninthepolicy3001/77220910/00/000.The
insurediseligibleforadiscountof2.5%ontheODComponentofpremiumsubjecttoamaximumofRs.500/.Henceitisherebyunderstood&agreedthattheinsuredshall
ensureatalltimesthatantitheftdeviceinstalledinthevehicleinsuredismaintainedinefficientconditiontilltheexpiryofthepolicy.Ifatthetimeofclaim,insuredisaskedto
providesupportingdocumentsthenthesamehastobesubmittedmandatorily,failureofwhichwillresultinnonadmissibilityofclaim.