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Bundled - Two wheeler Policy

Product Code: 3005 UIN:IRDAN115RP0020V01202122

CERTIFICATE CUM POLICY SCHEDULE

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:
[email protected]
Certificate cum Policy No : 3005/2011539545/00/0000029125

Name of the Servicing IL Kolkata

Branch
Address of IL Branch Seventh Apeejay House 15 Park Street Kolkata West Bengal 700016
WEST BENGAL-
Tenure 5 Years RTO Location
KOLKATA
OD-From 19:30
19:50 26/09/2022
08/08/2022 To
To25/09/2023
07/08/2023midnight
midnight
Period of Insurance TP-From 19:30
19:5026/09/2022
08/08/2022ToTo
25/09/2027 midnight
07/08/2027 midnight Intermediary Code 2011207588740001
PA OwnerDriver 19:30
19:5026/09/2022
08/08/2022ToTo
25/09/2023 midnight
07/08/2023 midnight
Insured Name KHOKAN
FAYJULLAMAL
GAJI Policy Issued On 08/08/2022
26/09/2022
DAKSHIN BARASAT DAKSHIN
N0104 , MUSALMAN KALIKAPUR
PARA KULDIA , JOYNAGAR
, MAGRAHAT , 24 PARAGANA
, 24 PARGANAS ( SOUTH ) , L&T Finance
Insured Address Hypothecation With
(WEST BENGAL,
SOUTH PIN - 743609
), WEST BENGAL, Pin - 743372 LTD,KOLKATA
Invoice No 17042226653139 Category
91-908894864
Primary Vertical Name BANCASSURANCE-Motor Two Wheeler (M6) Contact No.
(Mobile No.)
Registration Mfg Seat
Make Model Type of body CC Chassis Number Engine Number
Number Year Cap
HONDA ME4JC83DHNG133970
ME4JC85DGND081436
NEW SPCB
125 DISC
SHINE Solo With Pillion 125 2022 2 JC85ED2225574
JC83EG3264005
MOTORCYCLE
Vehicle IDV Side Car Additional Acc NonElectrical Acc Electrical/Electronic Acc CNG/LPG Unit Total Value
71718 0 0 0 0 0 71718
SCHEDULE OF PREMIUM
Own Damage(A) Liability(B)
Basic Own Damage 735.11 Basic Third Party Liability 3285.00
Total 735.00 PA Cover For Owner-Driver Of Rs. 1500000 375.00
Total 3660.00
Total Own Damage Premium 735.00 Total Liability Premium 3660.00
Total Package Premium (A+B) 4395.00
Net Premium 4395.00
CGST@9% 395.55
SGST@9% 395.55
Total Tax Payable 791.10
Total Premium 5186.00
For No claim Bonus (NCB), Coverages and exclusion of policy Please refer to the policy wordings attached with this schedule, in case of you have not received your
kindly write to us at the below mentioned mailing address.
Compulsory Deductibles : Rs.100 GeographicalArea India *** All Premium figures are in Rupees
PA Owner Driver Nominee Details
Name of Nominee Age Relationship
KANU
EJAJUL MAL
GAJI 56
58 FATHER
FATHER
Limits Of Liability : (a)Under Section II-1 (i) of the policy->Death of or bodily injury: Such amount as is necessary tomeet there requirements of the Motor Vehicles
Act,1988.(b)Under Section II-1(ii)of the policy-> Damage to ThirdParty Property Rs 100000.00;PA Cover for Owner-DriverundersectionIII: CSI Rs 1500000.00. *
as opted for the above-mentioned period *
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 Motor Trade.
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 "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
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, this certificate of insurance are issued in accordance with the provision of Chapter XI of
Motor Vehicle Act, 1988.

Agency Code: AABFL8567A46787 Agency Name: LEADERS

Agent's Mobile No.: 91-9903386991 Agent's Landline No.:
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 is valid subject to realization of cheque. We accept premium only via legally recognized modes. In case of dishonor 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. 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 Clause:
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.

The stamp duty of Re. 0.5 paid vide deface no. CSD232202184 dated Jan 06, For ICICI Lombard General Insurance Company Ltd
2022
GSTIN Registration No. : 19AAACI7904G1ZK

file://C:\Program Files (x86)\ILPOS Motor Insurance\PolicySchedule.html 23-Apr-22