TWOWHEELERVEHICLEPACKAGEPOLICY

CertificatecumPolicySchedule
CertificatecumPolicyNo:3005/W29653783/00/000
ForCLAIMS:Call18002666(Tollfreefromallphones)
ForRENEWALS:Visitwww.icicilombard.comorcall18002666
DETAILSOFPOLICYHOLDER
InsuredName

POLICYDETAILS

VISHALRAVINDRADHEKALE

SHUBAHMCOPRATIVEHOUSINGSOCIETYROOMNO
PolicyIssuingOffice
Insured
21,SEC14,NEARMAHARASTRABYANMANDIRHIGH
Address
SCHOOL,KALAMBOLI,NAVIMUMBAI.MAHARASTRA,410218,
RAIGARH,MAHARASHTRA,410218
PeriodofInsurance
ContactNo.
9987447772
PolicyIssuingon
EmailAddress vishaldhekale@rediffmail.com
CoverNoteNo
RTOLocation
Hypothecatedto
TypeofAgreement

ICICILombardGeneralInsurance
CompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayak
Temple,Prabhadevi,Mumbai400025
From00:00:00hrsof18Aug2014to
Midnightof17Aug2015
15Aug2014
W29653783
NAVIMUMBAI
N/A
None

VEHICLEDETAILS
RegistrationNumber
Make
Model
Typeofbody C C Mfg.Year SeatingCapacity ChassisNumber
EngineNumber
MH43T5669
HONDAMOTORCYCLE
UNICORN Solo
150 2008
2
88063246
4065888
INSUREDDECLAREDVALUE
VehicleIDV(inRs.)
SideCar NonElectricalAcc(inRs.)
Elec/ElectronicAcc(inRs.)
CNG/LPGUnit(inRs.)
TotalValue(inRs.)
30329
0
0
0
0
30329
SCHEDULEOFPREMIUM(INRS.)
OwnDamage(A)
BasicPremium
Total:
Add
Less
Deduct25%forNCB
Total:
TotalOwnDamagePremium

Liability(B)
427 BasicPremiumincludingpremiumforTPPDvehicle
427 Total:
Add
PAcoverforOwnerDriver
107 SubTotal(Additions):
107 Less
SubTotal(Deductions):
320 TotalLiabilityPremium

464
464
50
50
0
514

TotalPackagePremium(A+B)

834

ServiceTax(InclEdu.CessAndHigherEdu.Cess)

103
TotalPremiumPayable(inRs.)937

Compulsorydeductibles:Rs.100/
GeographicalArea:India
LIMITSOFLIABILITY:(a)UnderSectionII1(i)ofthepolicy>Deathoforbodilyinjury:Suchamountasisnecessarytomeetthere
requirementsofthemotorvehiclesAct.1988.
(b)UnderSectionII1(i)ofthepolicy>DamagetoThirdPartyPropertyRs1,00,000PACoverforOwnerDriverundersectionIIICSIRs
1,00,000
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.937/15/08/2014
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.
InWitnesswhereofthispolicyhasbeensignedatMumbaithis18Aug2014inlieuofcovernoteNoW
29653783ThestampdutyofRs.0.50paidincashorbydemanddraftorbypayorder,vide
Receipt/Challanno.2070180dated31Jul2014

ForICICILombardGeneralInsurance
CompanyLtd

DulyConstitutedAttorney(s)