Welcome to the ICICI Lombard Family!

MRS RASHMI CHOUDHURY

W/O PANKAJ KUMAR CHOUDHURY,,
R/O 1/140 VIJAYANT KHAND GOMTI
VINEET KHAND
226010
Email ID : ASMISHRA01@GMAIL.COM
Contact No. :9450112055

Dear MRS RASHMI CHOUDHURY,

We hope this communication finds you in good health.

We would like to inform you that Bharti AXA General Insurance has been merged with ICICI Lombard General Insurance.
We are confident that this milestone will benefit our esteemed customers like you. Being a valued ICICI Lombard family
member, you can look forward to a host of benefits in due course of time: -

Avail a range of innovative and technology enabled insurance solutions across health, motor, travel, home,cyber
insurance etc.

Seamless and efficient in-house claim settlement process .

Benefit from our Artificial Intelligence (AI) powered health insurance processes for claim settlement with in few minutes

Access our 24*7 digital solutions across web, mobile apps, voice assisted chatbot, WhatsApp etc.

Access a cashless network of 6100+ hospitals (health insurance), 10,000+ garages (motor insurance) spread across
the country.

User-friendly apps like ILTakeCare to meet your wellness and insurance needs e.g. tele-consult doctors, motor claim
approval in real-time with InstaSpect facility.

Renew your expired motor policy guided by our AI enabled vehicle self-survey facility.

For any queries, visit https://www.ilgic.co.in/VQdfhQb61 .

To know more, please call us at 1800 103 2292 or write to us customersupportba@icicilombard.com.
Thank you for trusting us for your insurance needs. We look forward to serving you in the years ahead.

Warm Regards,.
For ICICI Lombard General Insurance Company Limited

(Authorised Signatory)
Stand-Alone Own Damage Private Car insurance Policy
We would like to inform you that Bharti AXA General Insurance has merged with ICICI Lombard General Insurance w.e.f. September 08, 2021. Enjoy our
seamless services while exploring our enhanced offerings and diverse non-life insurance solutions.
Insured Name MRS RASHMI CHOUDHURY
Address W/O PANKAJ KUMAR CHOUDHURY,,
R/O 1/140 VIJAYANT KHAND GOMTI,
VINEET KHAND,
LUCKNOW,
UTTAR PRADESH- 226010
Mobile No 9450112055 Policy No SF941026
Email Address ASMISHRA01@GMAIL.COM Period Of Insurance 08/12/2021 17:23 to
midnight of 07/12/2022

Nominee Name
Nominee Relationship Policy Issued On 08/12/2021
Appointee Name Details of Motor TP Cover
Appointee Relationship Name of Insurer The New India Assurance
Co. Ltd.
Covernote No 12964314SF941026 Policy Number 42050131200900006705
RTO Location LUCKNOW Policy Start Date 07/12/2020
Hypotheticated To STATE BANK OF INDIA , LUCKNOW Policy End Date 06/12/2023

Agent Name & No AMIT JAIN (U1000148)

Agent Contact No 9336293363
Registration No. Make/Model Cubic Capacity Manufacturing Year Seating Capacity Engine No Chassis No.
UP32LU0123 MAHINDRAXUV 300 1197 2020 5 NMLZL22871 MA1NM2NM1L2L775
98
Vehicle IDV(Rs) SideCar Non Electrical Electrical/Electronic Value of CNG/ LPG Additional Accessories Total IDV (Rs)
Accessories Accessories (Rs) kit (Rs) (Rs)
(Rs)
901000.00 0 0.00 0.00 0.00 901000
Premium Details
Own Damage Premium (A) Rs. Add-on (B) Rs.
Basic OD Premium 28750.91
CNG/LPG 0
Premium on Vehicle and Non-Electrical Accessory 0 Zero Depreciation 3153.50
Electrical Accessory 0 Hospital Cash Cover
Anti-theft 0 Medical Expenses Reimbursement
Handicap 0 Ambulance Charges Cover

NCB 20% -1725 Return to Invoice

Load Discount -20125.64 Road Side Assistance
Own Premises 0 NCB Protect
Voluntary Excess 0 NCB Protect
Fibre Glass Tank 0 Engine Protect Plus
IMT-23 0 Consumable Items 901.00
AAI Value 0 EMI COVER
Geographical Area 0.00 Outstanding Loan Cover
Total Premium (A) 6900.27 Rodent bite cover.
Key Protect
Total Premium (A+B) 10954.5 Towing Charges- Lump sum limits
GST (18%) 1971.81 Engine Protect Plus
Total Premium Payable in Rs. 12926.00 Total Premium (B) 4054.5

Compulsory Deductible Applicable IMT Clauses IMT22-IMT7-I102-I067-

Voluntary Deductible
Receipt No Premium Amount 12926.00
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 of personal
luggage), Organized racing, Pace Making, Reliability trails or Speed testing, any purpose in Connection with Motor Trade.

Driver’s Clause: Any person including the insured: Provided also that a person driving holds an effective driving licence at the time of the accident and is not
disqualified from holding or obtaining such a licence. Provided also that the person holding an effective learner’s licence may also drive the vehicle and that such
a person satisfies the requirement 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 “AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY”. For legal interpretation, English version will hold good.

No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made of pending during the
preceding year(s) as follows: The preceding year - 20%, preceding two consecutive years - 25%, preceding three consecutive years - 35%, preceding four
consecutive years - 45%, preceding five consecutive years - 50% of NCB on OD Premium. NCB will only be allowed provided the policy is renewed within 90
days of the expiry date of the previous policy.

Disclaimer: Please visit customersupportba@icicilombard.com for the policy wordings, for complete details on terms and conditions governing the coverage
and NCB. This document is to be read with the policy wordings. The policy is valid subject to realisation of cheque. We accept premium only via legally
recognised modes. In case of dishonour of premium cheque, the company shall not be liable under the policy and the policy shall be void ab-initio. In case of any
discrepancy with respect to the policy, please revert within 15 days from the policy start date. This policy is underwritten on the basis of the information provided
by you and as detailed in the Risk Assumption Letter shared with you along with the policy.

Grievance Redressal:For redressal of your grievance, if any, you may approach any one of the offices – 1. Policy issuing office 2. Corporate office. 3. Contact
us: 0804-357-3450 (Toll free), 4.Register Grievances at: customersupportba@icicilombard.com. In case, you are not satisfied with our own grievance redressal
mechanism; you may also approach Insurance Ombudsman. Details of Insurance Ombudsman offices are available at IRDA website: www.irda.gov.in, or on the
website of the General Insurance Council: www.gicouncil.in or on the company website customersupportba@icicilombard.com

ISSUED BY – AVO on 08/12/2021 Product Name: Stand-Alone Own Damage Private Car insurance Policy Product UIN: IRDAN115RP0001V01201920

I/We hereby certify that the policy to which this Certificate relates as well as this certificate of insurance are ICICI LOMBARD GENERAL INSURANCE COMPANY LTD.
issued in accordance with the Provisions of Chapter X and XI of Motor Vehicle Act, 1988. In witness of this
policy has been signed at ___________ on ___________ in lieu of covernote no. dated
Receipt No. 6254879
ICIC Lombard GST No. 09AAACI7904G1ZL
UIN No. IRDAN115RP0001V01201920
Authorised Signatory
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 Vehicles Act is recoverable from the insured. See the clause
headed “AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY” The Schedule, the attached Policy and Endorsements mentioned herein above shall
read together and word or expression to which a specific meaning has been attached in any part of this Policy or of the Schedule shall bear the same meaning
wherever it may appear.Any amendments / modifications / alterations made on this system generated policy document is not valid and Company shall not be
liable for any liability whatsoever arising from such changes. Any changes required to be made in the policy, once issued, would be valid and effective, only after
written request is made to the company and Company accepts the requested amendments/modifications/ alterations and records the same through separate
endorsement to be issued by the Company.
The stamp duty of INR 0.50 paid vide deface no. CSD10620212911 dated 03/08/2021
"I declare that the vehicle insured holds a valid Pollution Under Control (PUC) Certificate on the date of commencement of the Policy."
Date:08/12/2021
Policy Number: SF941027

Compulsory Personal Accident (Owner-Driver) under Motor Insurance Policies

Your Compulsory Personal Accident (Owner-Driver) under Motor Insurance Policies Policy Number(SF941027) is enclosed. The terms, conditions, guidelines and other relevant details
of your Insurance coverage is given below.
Policy Information
Policy Number SF941027
Source
Proposer MRS RASHMI CHOUDHURY
Address W/O PANKAJ KUMAR CHOUDHURY,W/O PANKAJ KUMAR CHOUDHURY,
R/O 1/140 VIJAYANT KHAND GOMTIR/O 1/140 VIJAYANT KHAND GOMTI
VINEET KHANDVINEET KHAND
Period of Insurance 08/12/2021-00:00:00.000 TO07/12/2022-Midnight
Premium
Premium
GST
Total Payable
Risk Details
Name of member insured MRS RASHMI CHOUDHURY
Date of birth 04/09/1953
Occupation
Class
Sum Insured
Beneficiary
Relationship
Coverage Details
Plan Name
Benefit Details i)100% of CSI for Death, Loss of Two Limbs or sight of both eyes or one limb and sight of
one eye.
ii)50% of CSI for Loss of one Limb or sight of one eye.
iii)100% for Permanent Total Disablement from injuries other than named above

UIN NO IRDAN115RP0034V01201819

Issued by:AVO on:08/12/2021

ICICI Lombard General Insurance Company Ltd

Authorised Signature