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Product Code: 3005 UIN: IRDAN115RP0015V03201415

Ref. No. W133675014

Date: Feb 16, 2022
SUMAN SAINI
527 BLOCK B 11 J J COLONY
RAGHUBIR NAGAR
NEW DELHI
DELHI 110027
Mobile No: 9958135619

Sub: Risk Assumption Letter

Dear Sir/Madam,

Thank you for choosing ICICI Lombard General Insurance Company Limited (ICICI Lombard) as your preferred service
provider.
Please find enclosed Policy No. 3005/99673439/05/000, which has been issued based on the below mentioned details:

Insured & Vehicle Details

Name of Insured SUMAN SAINI
Period of Insurance Feb 18, 2022 to Feb 17, 2023
Vehicle Make / Model HONDA MOTORCYCLE / ACTIVA.
RTO City DELHI-NEW DELHI
Vehicle Registration No. DL8SBH8491
Vehicle Registration Date Feb 02, 2014
Engine No. 80620123
Chassis No. 8621243
Current Year NCB(%) 25%
Previous Policy Details
Previous Policy No. 3005/99673439/04/000
Previous Policy Period 18-02-2021 to 17-02-2022
Previous Year NCB(%) 20%
Claims Made Under Previous Policy 0
Previous Insurer Name ICICI LOMBARD
Previous Policy Type Comprehensive Package
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The information provided above is based on the information received from you and accordingly, the policy has been processed. Coverage of risk is subject to
realisation of the full premium, post which, insurance coverage under the policy would commence. In case the premium is not received by us due to cheque
dishonour or any other reason, the insurance cover shall be void ab-initio.
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We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.
1
Government of India has mandated electronic toll payments using FASTag to reduce vehicular traffic at toll plazas. Customers are advised to comply with the
direction of the government and get their FASTag from Point of Sale locations at Toll Plazas or from Issuer Agency. Please visit http://www.fastag.org/ for
details.

“Updating your bank details with us would help facilitating future transactions. Bank details can be easily updated using “IL – Take care” App.Download the app
now for all your insurance and wellness needs and for faster resolution”

If you require any changes in the Certificate of Insurance cum Policy Schedule, you are requested to inform us by writing to
[email protected] or calling our 24 hour toll free helpline on 1800 2666. Absence of any communication within a period of 15 days of the date
mentioned on this letter, would mean that the issued policy is in order and as per your proposal.

The information provided is merely illustrative and shall not be construed to be an evidence of existence of a contract of insurance. The Risk Assumption Letter
is to be read in conjunction with the policy and shall be considered null and void without the same.
CORP/SUP/OPI/2014/1777

Feb 16, 2022

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
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Two Wheeler Vehicles Package Policy
Product Code: 3005 UIN: IRDAN115RP0015V03201415

Insured Name : SUMAN SAINI Policy No : 3005/99673439/05/000

Address : 527 BLOCK B 11 J J COLONY, RAGHUBIR NAGAR, NEW Period of Insurance : Feb 18, 2022 00:00:00 to
DELHI, DELHI 110027 Midnight of Feb 17, 2023
Telephone No : Mobile No: 9958135619 E-Policy No : 3005/99673439/05/000
Email Address : [email protected] Policy Issued On : Feb 16, 2022
Nominee Name : - Named Passenger's Nominee: Covernote No : 99673439
Relationship : Select - RTO Location : DELHI-NEW DELHI
Age : - Hypothecated To : -
GSTIN Number (Customer) : Invoice Number : 1002221172124
Servicing Branch Name : Mumbai
Servicing Branch Address : 414, ICICI LOMBARD HOUSE, VEER SAVARKAR MARG, NEAR SIDDHI VINAYAK TEMPLE MAIN GATE, PRABHADEVI, MUMBAI,
400025, MAHARASHTRA

Registration No. Make Model Type of Body CC/KW Mfg Yr Seating Chassis No. Engine No.
Capacity
HONDA Solo With
DL8SBH8491 ACTIVA. DLX 109 2014 2 8621243 80620123
MOTORCYCLE Pillion
Vehicle IDV Side Car Additional Accessories (`) Electrical / Electronic Non Electrical CNG / LPG Unit Total IDV
(`) (`) Accessories (`) Accessories (`) (`) (`)
25000 0 0 0 0 0 25000

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 339 Basic Third Party Liability 752
Road Side Assistance (TW-199) 199 Total 752
Sub Total 538 Add:
Less: Unnamed PA Cover for 2 Persons of ` 100000 each 140
No Claim Bonus 25% 85 PA Cover for Owner Driver 375
Sub-Total Deductions 85 Sub-Total 515
Total Own Damage Premium(A) 453 Total Liability Premium(B) 1267
Total Package Premium(A+B): 1720
% 18
IGST
` 309.60
Total Tax Payable in ` 310
Total Premium Payable In ` 2030
Unique Identification Number (UIN) Details
Road Side Assistance
IR
IRDAN115RP0015V01200607/A0002V01201213

Geographical Area: India Applicable IMT Clauses: 16 , 22

Compulsory Deductible: ` 100 Voluntary Deductible: ` 0

Features of Add-on Covers:

1. List of services for Road Side Assistance :Towing on breakdown/accident - upto 50 KMs,Accommodation Benefits for one person upto Rs. 1000,Minor on spot
Repairs,Breakdown support over phone,Flat Tyre support,Arrangement/Supply of fuel

Premium Collection No. 1139249443 Premium Amount ` 2030 Receipt Date 16-02-2022
GSTIN Reg.No 27AAACI7904G1ZN HSN/SAC code 997134 / GENERAL INSURANCE SERVICES

Limits of Liability: (a) Under Section II-I(i) of the policy: Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act 1988. (b)
Under Section II-I(ii) of the policy: Damage to Third Party Property ` 100000/-; PA Cover for Owner-Driver under Section III: CSI ` 1500000/-. 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), Organised racing, Pace Making,
Reliability trails or Speed testing, any purpose in Connection with Motor Trade. Driver's Clause: Any person including the insured: Provided that a person driving holds an
effective driving license at the time of the accident and i s 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 i s not indemnified if the vehicle i s 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 RIGHT OF RECOVERY".
In consideration of the premium for this extension being calculated at a pro-rata proportion of the annual premium, it is hereby declared and agreed by the insured that upon
expiry of this extension, this policy shall be renewed for a period of twelve months, failing which the difference between the extension premium now paid on pro rata basis
and the premium at short period rate shall become payable by the insured.For Legal interpretation, English version will hold good. Disclaimer: Please visit
www.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 i s valid subject to realization of cheque. We accept premium only via legally recognized 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 i s 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. On renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be subject to change. Grievance
Redressal: For resolution of any query or grievance you may contact us on our toll free no. 1800 2666, or visit any of our branch offices. You can also write to us at
[email protected]. For detailed grievance redressal mechanism please visit the "Grievance Redressal" section on our website www.icicilombard.com.
I/We hereby certify that the Policy to which this Certificate relates, as well as, this Certificate of Insurance are issued in accordance with the provisions of Chapter X and
Chapter XI of Motor Vehicle Act, 1988. In witness whereof, this Policy has been signed at Mumbai on this date of Feb 16, 2022 in lieu of Covernote no. 99673439. The
stamp duty of ` 0.5 paid vide deface no. CSD232202184 dated Jan 06, 2022.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
Mumbai 400 025.
CORP/SUP/OPI/2014/1777

Feb 16, 2022

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Two Wheeler Vehicles Package Policy
Product Code: 3005 UIN: IRDAN115RP0015V03201415
Mumbai 400 025.
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as applicable, on the
date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of
the Policy. Further, the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate.

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE COMPANY
LIMITED
Date: 2022.02.16 15:38:31 IST
CORP/SUP/OPI/2014/1777

Feb 16, 2022