07/12/2022, 10:31 PVT RN

ICICI Lombard General Insurance Company Limited

Corp. Office: ICICI Lombard House, 414, Veer Savarkar Marg,
Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025
IRDA Registration no.115
Deal No. - DL-3001/2874180   Agent Name :-RAKESH KUMAR VERMA    Intermediary Code -`202146108102,  Type -
AGENCY,   A/I - A,   IL Branch - DILSHAD GARDEN
RENEWAL NOTICE Renewal notice date:- Aug
28, 2022

Insured Name: SAMEER

Insured Address: S/O ASHRAF H.NO-L-204 GALI NO-2 SUNDER NAGRI NAND
NAGRI NORTH EAST
NEW DELHI - 110093, Delhi
Contact Nos: (M):9650615010
Email Id: ADVSAMEERMALIK.786@GMAIL.COM
Customer Relationship No: `100586873219
Ref:- Renewal of Standalone Own Damage Private Car Insurance, Policy No: 3001/O/233769452/00/000 which is
expiring on Dec 09, 2022
Dear Customer,
This is to remind you that your Standalone Own Damage Private Car Insurance Policy Policy
no: 3001/O/233769452/00/000 expires on Dec 09, 2022. We will be delighted if you renew the policy with us and give us the
opportunity to serve you again. Your representative will get in touch with you shortly to facilitate your policy renewal.
Your Third Party Policy No: 98000031200909700000 expires on Dec 09, 2023
Your vehicle details and renewal premium computation is given below:
Vehicle Details:- Vehicle Registration Date:Jan 08, 2021
Registration no Year
Vehicle NCB/Loading Claims No.of Claim
& RTO Engine no. Chasis no. of
Make Model % Status Claims Amount
Location mfg.
IGNIS DL5CS2886
SIGMA MT DELHI-NEW `K12MN4692295 `MA3NFG81SLL288556 2021  25 No 0 0.00
MARUTI DELHI
Renewal premium computation:- Ex. Price:- 466338.00
 
Depreciated IDV: 373070.00
 
  Tenure - 1 year
Basic Premium:: 5573.00
Zero Depreciation() 2611.00
Consumables: 821.00
Own Damage Premium: 9005.00
Anti theft discount 139.00
Deduct NCB / Loading 25% 1359.00
Total Own Damage Premium: 7507.00
Package Premium: 7507.00
GST: 1351.00
Final Premium: 8858.00
   
Vehicle Hypothecated with :-   
 
   
 
Now add essential add-on covers to your
existing Motor Policy  
 
Add on Covers Amount
Road Side Assistance(RSA) 199.00

https://ipartner.icicilombard.com/Webpages/Agents/MotorRenewalNotice.aspx?POLICY_NUMBER=2337694520&POLICY_TYPE=2 1/2
07/12/2022, 10:31 PVT RN

Engine Protect(EP) 746.00

Total of Add on Covers 945.00
GST: 170.00
Final Premium(With Add-ons) 9973.00
 
NOTE:
1.In case a claim is lodged before the commencement of the renewed policy, ?No Claim Bonus? shall not be applicable and the
Company would be entitled to recover the same. Policy premium/covers would be charged/offered as per company
underwriting guidelines effective on the date of renewal.
2.If the renewal happens after Dec 10, 2022 acceptance of risk is subjective to satisfactory inspection vehicle.
3.Please issue the cheque/DD in favour of  "ICICI Lombard General Insurance Co. Ltd."
4.If policy is sought to be renewed after renewal date then premium would be calculated and charged as per company
underwriting guidelines effective on that day.
5.The risk for following cover has been adjusted according to maximum limits provided under India Motor Tariff . Number of
Non fare Paying passenger . Number of Workmen . Number of Employees
6.If any address change please mentioned herein below:-
 Address
 Telephone/Mobile no. 
 Nominee details                                                 PA-Owner Driver                         Named Passenger PA(Add/Delete/Modify)

 Name:                                                                                                                           Age:
 Relationship:
PA Owner-driver nominee applicable for individual customer only
I agree to recieve a One Page Motor Insurance Policy in Physical Form     Yes   No 
Payment Details

Cheque/DD Cheque/DD
Dated:______________________
Number:______________________ Amount:______________________

Bank Name:___________________________________________________ Branch:_______________________

For other mode of

Payment:_______________________________________________________________________________________________
 
Customer Signature:                                      Date:                          

"For more information, please visit our website www.icicilombard.com orcallus at our 24 hours All India Toll Free Number
1800 2 666 (Also accessible fromyourmobile)"
 
Deal No. - DL-3001/2874180    Agent Name :-RAKESH KUMAR VERMA
Intermediary Code - `202146108102,   Type - AGENCY,   A/I - A,   IL Branch - DILSHAD GARDEN

https://ipartner.icicilombard.com/Webpages/Agents/MotorRenewalNotice.aspx?POLICY_NUMBER=2337694520&POLICY_TYPE=2 2/2