TWOWHEELERVEHICLEPACKAGEPOLICY

CertificatecumPolicySchedule
CertificatecumPolicyNo:3005/W41958400/00/000
ForCLAIMS:Call18002666(Tollfreefromallphones)
ForRENEWALS:Visitwww.icicilombard.comorcall18002666
DETAILSOFPOLICYHOLDER
InsuredName
InsuredAddress
ContactNo.
EmailAddress

VEHICLEDETAILS
RegistrationNumber

POLICYDETAILS

NAGESWARARAOD
FLATNO102,VASANTGOPAL
PolicyIssuingOffice
APPARTMENT,,TULASINAGAR,ROADNO4,
VIJAYAWADA,KRISHNA,ANDHRAPRADESH,
520007
PeriodofInsurance
9440177033
PolicyIssuingon
devnrao@gmail.com
CoverNoteNo

Make

Model

Typeofbody

AP28AR3102
TVS
SCOOTYPEPPLUS
Solo
INSUREDDECLAREDVALUE
VehicleIDV(inRs.)
SideCar NonElectricalAcc(inRs.)
23400
0
0
SCHEDULEOFPREMIUM(INRS.)
OwnDamage(A)

ICICILombardGeneralInsurance
CompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayak
Temple,Prabhadevi,Mumbai400025
From00:00:00hrsof10Feb2016to
Midnightof09Feb2017
07Feb2016
W41958400

RTOLocation

HYDERABAD

Hypothecatedto
TypeofAgreement

N/A
None

C C Mfg.Year

SeatingCapacity

ChassisNumber

EngineNumber

90

39299

37481

2006

Elec/ElectronicAcc(inRs.)
0

CNG/LPGUnit(inRs.)
0

Liability(B)
336 BasicPremiumincludingpremiumforTPPDvehicle
336 Total:
Add
PAcoverforOwnerDriver
84 PAcoverforUnnamedPassenger
84 SubTotal(Additions):
Less
SubTotal(Deductions):

BasicPremium
Total:
Add
Less
Deduct25%forNCB
Total:

TotalOwnDamagePremium

252 TotalLiabilityPremium

TotalPackagePremium(A+B)

TotalValue(inRs.)
23400

538
538
50
140
190
0
728
980

ServiceTax(includes0.5%ofSwachhBharatCess)

142
TotalPremiumPayable(inRs.)1122

Compulsorydeductibles:Rs.100/
GeographicalArea:India
PAToOwnerDriverNomineeDetails
NomineeName

Age

RelationShip

SYAMALAD

51

Spouse

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.1122/07/02/2016
DISCLAIMER:Pleasevisitwww.icicilombard.comforthepolicywordingsforcompletedetailsontermsandconditionsgoverningthecoverageandNCB.This
documentistobereadwiththepolicywordings.
GrievanceClause
Forresolutionofanyqueryorgrievance,InsuredmaycontacttherespectivebranchofficeoftheCompanyormaycalltollfreeno.18002666ormayapproach
usatthesubsection"GrievanceRedressal"onourwebsitewww.icicilombard.com(CustomerSupportsection).However,iftheresolutionprovidedbyusis
notsatisfactoryyoumayapproachInsuranceRegulatoryandDevelopmentAuthority(IRDA)throughtheIntegratedGrievanceManagementSection(IGMS)or
IRDAGrievanceCallCentre(IGCC)attheirtollfreeno.155255.YoumayalsoapproachInsuranceOmbudsman,subjecttovestedjurisdiction,fortheredressal
ofgrievance.DetailsofInsuranceOmbudsmanofficesareavailableatIRDAwebsite:www.irdaindia.org,orontheCompany'swebsiteat
www.icicilombard.com.
Policyisvalidsubjecttorealizationofcheque.Weacceptpremiumonlyvialegallyrecognizedmodesexceptforcash.Ifourrepresentativerequestyou
topayincash,kindlyreportittous.
Forinformationonombudsmanyoumayvisitourwebsitewww.icicilombard.com
I/Weherebycertifythatthepolicytowhichthecertificaterelatesaswellasthecertificateofinsuranceare
ForICICILombardGeneralInsurance
issuedinaccordancewiththeprovisionofchapterX,XIofM.VAct1988
CompanyLtd
ServiceTaxRegistrationNo.:GIS/MUMBAII/1528/2001
ServiceTaxCodeNumber:AAACI7904GST001
Category:GeneralInsuranceBusinessServices00440005.

IRDARegistrationNo.115
DulyConstitutedAttorney(s)
InWitnesswhereofthispolicyhasbeensignedatMumbaithisinlieuofcovernoteNoThestampdutyofRs.
paidincashorbydemanddraftorbypayorder,videReceipt/Challanno.dated
MailingAdd.Office:

ICICILombardGeneralInsuranceCompanyLtd.
RegisteredOffice:

ICICILombardGeneralInsuranceCompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayakTemple,Prabhadevi,Mumbai400
025

ICICILombardGeneralInsuranceCompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayakTemple,Prabhadevi,Mumbai400
025