TWOWHEELERVEHICLEPACKAGEPOLICY

CertificatecumPolicySchedule
CertificatecumPolicyNo:3005/W21413195/00/000
ForCLAIMS:Call18002666(Tollfreefromallphones)
ForRENEWALS:Visitwww.icicilombard.comorcall18002666
DETAILSOFPOLICYHOLDER
InsuredName
InsuredAddress
ContactNo.
EmailAddress

POLICYDETAILS

RAJABHASKERBSNARAYANA
GovtQuaterNoB19/3,NewAirport
ColonySaharRoad,OppParsiwadaVile
ParleEast,MUMBAI,MAHARASHTRA,
400022
9869287225
rajabhasker555@gmail.com

PolicyIssuingOffice

ICICILombardGeneralInsurance
CompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayak
Temple,Prabhadevi,Mumbai400025

PeriodofInsurance

From00:00:00hrsof29Oct2013to
Midnightof28Oct2014

PolicyIssuingon
CoverNoteNo
RTOLocation

24Oct2013
W21413195
MUMBAI

Hypothecatedto
TypeofAgreement

N/A
None

VEHICLEDETAILS
RegistrationNumber
Make
Model Typeofbody
C C Mfg.Year SeatingCapacity ChassisNumber
EngineNumber
MH02BV3011
HONDAMOTORCYCLE
SHINE SoloWithPillion 125 2010
2
DKA8052701
E2167616
INSUREDDECLAREDVALUE
VehicleIDV(inRs.)
SideCar NonElectricalAcc(inRs.)
Elec/ElectronicAcc(inRs.)
CNG/LPGUnit(inRs.)
TotalValue(inRs.)
32824
0
0
0
0
32824
SCHEDULEOFPREMIUM(INRS.)
OwnDamage(A)
BasicPremium
Total:
Add
Less
Deduct35%forNCB

TotalOwnDamagePremium

Liability(B)
393 BasicPremiumincludingpremiumforTPPDvehicle
393 Total:
Add
PAcoverforOwnerDriver
138 PAcoverforUnnamedPassenger
SubTotal(Additions):
Less
SubTotal(Deductions):

422
422
50
140
190
0

0 TotalLiabilityPremium

TotalPackagePremium(A+B)

867

ServiceTax(InclEdu.CessAndHigherEdu.Cess)

107
TotalPremiumPayable(inRs.)974

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:22,16
PremiumCollectionDetails:[CollectionNo/Amount/ReceiptDate]NA/Rs.974/24/10/2013
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.
IRDARegistrationNo.115
InWitnesswhereofthispolicyhasbeensignedatMumbaithis29Oct2013inlieuofcovernoteNoW
21413195ThestampdutyofRs.0.50paidincashorbydemanddraftorbypayorder,vide
Receipt/Challanno.627977dated28Oct2013

ForICICILombardGeneralInsurance
CompanyLtd

DulyConstitutedAttorney(s)

ICICILombardGeneralInsuranceCompanyLtd.
MailingAdd.Office:
CorporateOffice:
ICICILombardGeneralInsuranceCompanyLtd.ICICILombardHouse,
ICICILombardGeneralInsuranceCompanyLtd.ICICILombardHouse,
414,VeerSavarkarMarg,NearSiddhiVinayakTemple,Prabhadevi,
414,VeerSavarkarMarg,NearSiddhiVinayakTemple,Prabhadevi,
Mumbai400025
Mumbai400025

TwoWheelerPAProposalForm
VehicleDetails
Registrationlocation(RTO)

MUMBAI

Registrationnumber

MH02BV3011

Manufacturer

HONDAMOTORCYCLE

Enginenumber

E2167616

Model
Manufacturingyear

SHINE
2010

Chassisnumber
Purchase/Registrationdate

DKA8052701
29Oct2010

Registrationtype

Individual

Color
Currentshowroomprice(Rs.)

54707

Detailsofdiscounts&additionalcovers
Electricalaccessories(Rs.)

Voluntarydeductible(Rs.)

Nonelectricalaccessories(Rs.)
Automobileassociationmembership

ARAIapprovedantitheftdevice
Consumables

No
No

ValueofLPG/CNGkitifany(Rs.)

Returntoinvoicecover

No

Noclaimbonusprotectioncover
Garagecashcover

No
No

Relationship

City

MUMBAI

Insureddetails
NameoftheInsured

RAJABHASKERBSNARAYANA

GovtQuaterNoB19/3,
AddressofTwoWheelerOwner(Policywill NewAirportColonySahar
besenthere)
Road,OppParsiwadaVile
ParleEast
Pincode
400022
Newpolicydetails
Insurancevalue(IDV)(Rs.)

32824

NoClaimBonus(%)

35

Policystartdate

29Oct201312:00:00

Policyenddate

Midnightof28Oct2014

TotalPremiumAmount:

974

I.OwnDamage
Thisproductprotectsyouagainstlossordamagetoyourmotorvehicleand/oraccessoriesdueto*Fire*SelfIgnition*Explosion*Lightning*Theft
*Burglary*Housebreaking*Riot*Strike*Earthquake*Floodandalliedperils*Accidentalexternalmeans*Maliciousacts*Terroristactivity*Transit
*Landslide/rockslide
II.ThirdPartyLiability
Inadditiontothecoveragenotedabove,thisproductcoversyouagainstlegalliabilitytowardsthirdparty,inrespectofthefollowing:*Deathofor
bodilyinjurytoanyperson*damagetopropertyaspertheprovisionsofMotorVehicleAct.Wearepleasedtoinformyouthatinaddition,the
productalsoincludesthefollowing:
l
l
l
l

PersonalaccidentbenefitsforownerdriveruptoavalueofRs.200,000.
Legalliabilitytowardsthepaiddriver.
CoverforRs.7.5Lacsthirdpartypropertydamage.
PAcoverforUnnamedpassengers.

SignificantExclusions:
Wewouldlikeyoutoknowthatthepolicydoesnotcoverconsequentialloss,depreciation,normalwearandtear,mechanicalorelectrical
breakdownfailuresorbreakages.Thevehicleisnotheldcoveredifusedforcommercialpurposesorifdrivenbyanunauthorizeddriver.Note:The
foregoingisonlyanindicationofthecoveroffered.Fordetailspleaserefertothepolicy.Itisourendeavortoprovideconsistentqualityserviceto
allourcustomers.WewouldliketoletyouknowthatinsuranceisacontractofUtmostGoodFaithrequiringthecustomertodiscloseallmaterial
facts.Ifinyouropinionanyfactismaterialandisnotcoveredbytheinformationsoughtintheapplicationform,werequestyoutodiscloseit.
Itisimportanttonotethatourliabilitywillcommenceonlyafterwehaveacceptedyourproposalandthepremiumhasbeenreceivedinfull.
Declaration:
I/Weherebydeclarethatthestatementsmadebyme/usinthisProposalFormaretruetothebestofmy/ourknowledgeandbeliefandnomaterial
information,whichmayberelevant,hasbeenwithheldornotdisclosedI/Weherebyagreethatthisdeclarationshallformthebasisofthecontract
betweenme/usandthe"ICICILombardGeneralInsuranceCo.Ltd."
I/Wealsodeclarethatanyadditionsoralterationsarecarriedoutafterthesubmissionofthisproposalformthenthesamewouldbeconveyedto
theinsurersimmediately.
I/WeagreethatthePolicyshallbecomevoidableattheoptionoftheInsurer,intheeventofanyuntrueorincorrectstatement,misrepresentation,
nondescriptionornondisclosureinanymaterialparticularintheproposalform/personalstatement,declarationandconnecteddocuments,or
anymaterialinformationhasbeenwithheldbymeoranyoneactingonmybehalftoobtainanybenefitunderthispolicy.I/Weherebydeclareand
warrantthattheabovestatementsaretrue,accurateandcomplete.I/WedesiretoeffectaninsuranceasdescribedhereinwiththeCompanyand
I/Weagreethatthisproposalanddeclarationsshallbethebasisofcontractbetweenme/usandtheCompanyandI/Weagreetoacceptapolicy
subjecttotheconditionsprescribedbytheCompany.

INSURANCEACT1938,SECTION41PROHIBITIONOFREBATES
1.Nopersonshallalloworoffertoallow,eitherdirectlyorindirectlyasaninducementtoanypersontotakeoutorreneworcontinueaninsurance
inrespectofanykindorriskrelatingtolivesorpropertyinIndia,anyrebateofthewholeorpartofthecommissionpayableoranyrebateofthe
premiumshownonthepolicy,norshallanypersontakingoutorrenewingorcontinuingapolicyacceptanyrebateexceptsuchrebateasmaybe
allowedinaccordancewiththeprospectusortablesoftheInsurer.
2.Anypersonmakingdefaultincomplyingwiththeprovisionsofthissectionshallbepunishablewithfine,whichmayextendtofivehundred
rupees.

AGEOFTHEVEHICLE

SCHEDULEOFDEPRECIATIONFORARRIVINGATIDV
%OFDEPRECIATIONFORFIXINGIDV

Notexceeding6months
5%
Exceeding6monthsbutnotexceeding1
15%
year
Exceeding1yearbutnotexceeding2years20%
Exceeding2yearsbutnotexceeding3
30%
years
Exceeding3yearsbutnotexceeding4
40%
years
Exceeding4yearsbutnotexceeding5
50%
years
Note.IDVofobsoletemodelsofvehicles(ie.Modelswhichthemanufacturershavediscontinuedtomanufacture)andvehiclesbeyond5yearsof
agewillbedeterminedonthebasisofandunderstandingunderstandingbetweentheinsurerandtheinsured.