El / C / C / Lom bard Two Wheeler Package Policy

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L i g h t n i n g F a s t C l a i m s
CERTIFICATE CUM POLICY SCHEDULE

For instant renewal of your insurance policy log on

www.icicilombard.com
For all your insurance needs & query call us at our Toll free No.: 1800 - 2666(Accessible from your mobile also), you can also E - mail us at:
customersupport@icicilombard.com
Certificate cum Policy No: 3005/2010707463/0000012098

Policy Issuing Office ICICI LOMBARD HOUSE, 414, Veer Savarkar M arg, Near Siddhi Vinayak T emple, Chennai.600 035
1
TAMILNADU-
RTO Location
Period of Insurance From 09:06 23/ 11/2013 To 22/ 11/2014 midnight CHENNAI
Intermediary Code 201368595990
Insured Name STEPHEN.N Policy Issued On 23/ 0 3/ 2 01 3

Insured Address NO 2/413 VIVEKANANTHA STREET, METTUKUPPAM, VANAGARAM Hypothecated With

Primary Vertical Name BANC ASSUR ANC E- M oto r T wo Whe el er (M 6) Category

Contact No. 96 77 14 2 39 7
Registration Mfg Seat
Make Model Type of body CC Chassis Number Engine Number
Number Year Cap
TN-20 CX PULSAR 150CC
Solo With Pillion 150 2012 2 MD2A11CZ8CCF44473 D HZC CF 44 37 2
4173 BAJAJ UG
Vehicle IDV Side Car Additional Acc NonElectrical Acc Electrical/Electronic Acc CNG/LPG Unit Total Value
0 o o o o o 65124.00
SCHEDULE OF PREMIUM
Own Damage(A) Liability(B)
Basic Own Damage Basic Third Party Liability 889.00
491.00
Total PA Cover For Owner-Driver Of Rs. 100000
491.00 00.00
Total 889.00

Total Own Damage Premium I 491.00 Total Liability Premium I 889.00

Total Package Premium (A+B) 357.00

Net Premium 1401.00
!
Service Tax(Incl Edu.Cess And Higher Edu.Cess)
Total Premium IC/Ca lornbard 1401.00
00.00

owl) mem gitraneetached

-

with this schedule, in case of you have not received

For No claim Bonus (NCB), Coverages and exclusi
your kindly write to us at the below mentioned mailing addrei
Compulsory Deductibles : Rs.100 IGeographicalArea India I *** All Premium figures are in R upees
Limits Of Liability : (a)Under Section II- 1 (i) of the policy- >Death of or bodily injury: Such amount as is necessary to meet there requirements of the Motor
Vehicles Act,1988.( b)Under Section II- 1 (ii) of the policy- > Damage to Third Party P roperty Rs 100000.00; P A Cover for Owner-D river under section III:
C S I R s 1 0 0 0 0 0 . 0 0 Vo l un t a ry D ed uc ta b le R s . 0
LIMITATIONS AS TO USE: The policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of goods(other than samples or personal
luggage), Organized racing, Pace making, Speed testing, Reliability trials, Any purpose in connection with M otor T rade.
DRIVER'S CLAUSES: Any person including the insured : Provided that a person driving holds an effective Driving License at the time of the accident and is not
disqualified from holding or obtaining such a license. Provided also that the person holding an effective Learner's License may also drive the vehicle and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
IMPORTANT NOTICE : The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this Schedule. Any payment made by the
Company by reason of wider terms appearing in the Certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the Insured. See the clause
headed "AVOID ANCE OF CERT AIN TER MS AND RIGHT OF RECOVERY". For legal interpretation,English version will hold good
Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto : 22,28
Premium Collection Details :
I/ We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter
X,XI of M.V.Act 1988.

Agency Code: 9040892 Agency Name: STEPHEN.N

Agent's Mobile No.: 91-9677142397 Agent's Landline No.:
Disclaimer: Policy is valid subject to Realization of Cheque.
Grievance Clause:
For res olut ion of a ny que ry o r gri e vance , Insu red may co ntact t he res pective b ranc h of fice of th e C omp a ny or m ay ca ll to ll f re e n o.1 8 00- 2 6 66 or may app ro ach
us at th e sub s ectio n "Gri eva nce R edre ssa l" on o ur w ebsit e www .ic icil omba rd.c om (Cu sto me r Suppo rt s e ction). How eve r, if th e r eso luti on p rovid ed by us is n ot
satisfactory you may approach Insurance R egulatory and D evelopment Authority (IRD A) through the Integrated Grievance M anagement Section (IGM S) or IRD A
Gri evanc e C all Ce ntr e(IGC C) at th ei r tol l fr ee no. 1 55 25 5. Y ou m ay a lso appro ach Ins ur ance O mbuds man , subject t o vest ed ju risd icti on, f or t he r edr essa l of
grievance. D etails of Insurance Ombudsman offices are available at IRD A website: www.irdaindia.org, or on the Company's website at www.icicilombard.com.
 For ICICI Lombard General Insurance Company Ltd
The stamp duty of Re 0.5 paid in cash or by demand draft or by payorder,vide
receipt/ challan no. 43201 dated 19/03/ 2013
Service Tax Registration No. : GIS / MUMBAI-I / 1528 / 2001
Service Tax Code Number. :AAACI7904GST001
Duly Constituted Attorney(s)
Category: General Insurance Business Services 00440005. COPY OF POLICY

ICICI Lombard General Insurance Company Ltd

Mailing Add. Office: ICICI LOMBARD HOUSE, 414, Veer Savarkar M arg, Near Siddhi Vinayak Temple, Prabhadevi, M umbai 400025.
Corporate Office: ICICI LOMBAR D HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400025.