Policy No. lClCl Lombard General lnsurance Co. Ltd.

ala'S#l:tYl lClCl Lombard House, 414, Veer Savarkar Maro. Her o

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iltril{otor lttiurance -*
I1 0251 t 000 Second Floor, Bhagwati Bhawan, M.l.Road,
Jaipur, Rajasthan 302001 H *r0
ffiw&iffi
customersupport@icicilombard.com
lnsured Business/Profession Address of The lnsured TP Valid TP Valid To
From
M/S 85,1 ST FLOOR RMV ROAD,
ENTERTAINMENT Manufacturing KHATIKWADA,SURAJ POLE,UDAtpUR Udaipur 16-11-2018
Midnight of I 5-1'l -2023
PARADISE RAJASTHAN 3O3OO1 16:44:32

Vehicle Regn No. Engine No. Chassis No. Make & Model Year of Mfg Cubic I GSTIN No.
Gapacity | (Customer)
JF33ABJ4KO3879 Hero MotoCorp
MBLJFWOl 5J4KO1 OOO 2018 110
Maestro Edqe
Declared Value Side Car IDV Non-Electrical Electrical CNG'LPG/Bi.
(lDV) of Vehicle
Total IDV
Accessories IDV Accessories IDV Fuel IDV
50160.00 NA 0.00 0.00 0.00 501 60
Place of Regn. Body Type HP/Lease/Hire. Branch Office of Seating Premium
Purchase Agreement HP/Lease/Hire. Capacity
with Purchase
Udaipur Solo 2 5294.00
amage Premium Cgmputation (Sectionl) in nGI B.t-iabilityPremi@
Basic Premium lncluding premium for Tp
Vehicle : 841.00 Vehicle
Accessories : 32BS.OO
O.O0 CNG/LPG/Bi-Fuel Kit :
0'00
Electronic & Electrical Accessories i
Bi-Fuel Kit
o.OO Add
Totat i O.OO a) Compulsary PA Cover (Owner Driver) . O.OO
a+t.oo b) Optional PA Cove(Un Named passenger) ; 105.00
Add Extras:
c) Optional PA Cove(Un Named Driver) ; 105.00
Extension
Geographical : 0.00 Legal Liability
ND Cover : 150.00 d) Legal Liability Cover (Paid Drivers, Cleaners) .
extra
For any other :
e) Legal Liability Cover (Per Licensed
O.O0
Sub Total 991.00 Passenger) : 0'00 -

Less Discounts
. Total Llablity Premlum (B) : 3495.00
Handicapped Discount O.OO Total Premium (A + B) : 4486.00
devices
For anti-theft O.OO For any other extra
discount
Any other ;
ccsT@s.oo% j aon.oo
O.O0
NCB o.0O SGST@g.oC%
Total Deductions : : 404.00
Gross Premium ! szs+.oo
Net own Damage Premium(A) , nt?:33
1. Registration No.: i ll 2. CIN No. : U67200MH200-0|L-9?9_a0S
11
ll 3. GSTIN No. : osAneCtzsoactzNt ll UIN r.lo.- tnonulGRFOOOTyott;;;
OD Tenure
IDV 50'160
LIMITATIQNS AS TO USE:-The Poticy cover
than samples or personal luggage) c) organized Racing d) Pace Making e) dpeed Testing f) Reliability
Trials g; Any purpose in connection with
Motor Trade.
qBIEE; Any person including insured: Provided that a person driving holds an effective driving licence
at the time of the accldent and is not
disqualified from Holding or obtaining such a licence.Provided also thit the person holding an iffective
Learner,s Licence may also drive the
veiicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vlhicle Rules, 1989.
LIMIT oF LIABILITY: Limit of the_amount of the Company's liability under the Section ll-l(i) in respect
of any one accident as per M.V. Act
1988' Limit of the amount of the Company's liability under Secion it-l1ii; ln respect of any one claim
or seriei of claims arising out of one event :
Upto Rs - 100000/
IMPoRTANT NOTICE:-The insured is not indemified if the vehicle
payment made by the company by reason of wider terms appearing in the Certificate
in order to comply with the Motor Vehicle Act, 19gg is
recoverable from the insured. See the clause headed'AVOIDANCE OF CERTAIN TERMS AND RIGHiS
OF REcovERy,
l/Wecertifythatthepolicytowhichthecertificate'ulut"'as.n"ll
M.V. Act 1988

.plgker : Hero Insurance Broking India pvt. Ltd.

Received Vide From 1st July 2014, lnsured is Liable for a voluntary
d,Ettm otn'. 5294.00 CASH deductible of Rs. 250/- for each Claim,if policy
Cash/Cheque No. having
l,[ peiqql. Nominee Name
ND product.
The policy is subject to a compulsory excess of Rs.
o:'. Diawn on Nominee Age 10C/- & Dqpreciation is applicable as per policy terms

t Acknowledgement
Dt
1

2018
6-1 1-
Nominee Relation
& conditions.(Please turn overleaf for details)
Consolidted Stamp Duty Paid Endorsements: IMT -
22,16,18
Registration No: 649 Tel No: 1800-102-4376 On behalf of lClCl Lombard General lnsurance
Company Ltd
1 6-Nov-201 8 FOR RENEWALS CONTACT: MANAMA MOTORS PhNO. O2%:-
Date & Signature 2412738
of proposer OPPB.N.COLLEGE,PAATHM
ROAD,UDAIPUR.
Deale/s Stamp & Signature Dulv Constitrled Aft^rno
: lClcl Gompany Kurla
The stamp duty of Re. 0.5 paid in cash or by demand draft or pay order, vide Receipt / Chailan No
5g13g90
dated Septemb er 28th, 2017
For further information about motor insurance policy please also visit http://irda.gov.in >> Grievances >> policyholder
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