Tax !

,rvoice
Invoice 000322 v0:r297 DO No:
INV-PBor000l-22

L,egal N:rme: ARNEJA AUTOS l,cgnl Name:

Dealer Name: ARNEJA AUTOS Dealer Name: ARNEJA AUTOS
;\ddress: PLOT NO. I 332/12, KHASRA NO,2865/726, NEAR BANK OF Adrl ress : PLOT NO, I 332/42, KHASRA NO.2865/726, NEAR BANK OF
INDIA, BATALA ROAD AMRITSAR Punjab 143001 INDIA, BATALA ROAD AMRITSAR Punjab 143001
Pin C-ode: I 4300 I , ['in (]ode: t43001
CSTIN No 03ALQPS5623L I ZM I statc: Punjab
Phonc: llnra il anre jahonda(ii)grnai l.corn I Statc Code: 3

(;s'f tN: 03Al.QPS5(r231- IZM

PAN No: ALQPS562.rL (llN No:
State: Punjab Strte (lode: J

l,egal Name: SANDEEP STNCH SiO GURMEET SINGH i i cqrl Name: SANDEEP SINGH S/O GURMEET SINCH
(iustomer Nanre: SANDEEP SINGH S/O GURMEET SINCH ('uslonrer Name: SANDEEP SINCH S/O GURMEET SINCH
Adtl ress : HNO 2 I GALI NO 4 GL]RI] RAM DAS AVENUE I .\rldress: HNO 2 I CALI NO 4 GURU RAM DAS AVENUE AMRITSAR
AMRITSAR Punlab 14.100 I I
Punjab I 4300 I
Pin Code: r 4300 | l'ir ('ode: I 4100 |
Email Address: llntail Addrss:
Stlte: Purlatr State Code: .l SI il tc: Punlab Stste Code: .]
CS'l'lN No: tllN No: I
I OSTIN No: tllN No:
Phone(M): 8054t38t94 Phone(O): I'hone(llt): 8054t38194 Phone(O):
Customer GST No: PAN Number: -iristomer GST No: PAN Number:
(lust/Enq Category: lndrvidual / lndtvidual l,S Orde r No: Senice No:
Bookins No: VEHBK-PBO I 0003- | -l2ll-0.1.117 Purchase Type: Oa:h
Batten No:00 Booklet No: 00 Whethqr Supply is senice or not:
Inroice T1 pc:'l'ax Irrrorcc lnvoice Type (iode: iNV Key f!q: Pt 33
Rer ersc f'harge: Not Applicablc Sunnlv I v pe: Transaction mode:
Salesman Nanre: MUNISH Mobile No: 96460() 16.1 I LWa,r'Bill No:
Hl.'p0theca tion \\'ith : F-Wrv llill Vq
Model(lVlodel Code) HSN Code 'Iype / Variant i r
olou Frame no. Loyalty lD Engine no.
AC-I IVA(SCVI IOP8) 87tl]0t9 ID/ACI'IVA Dt-X M,\
CRA,
l',#li'. ME4rKr56BpDo22r05 JKl5EDs022t56
l)escri;ttion Otr trotlt I t :tit Price (Rs. ) Tax "l, A rnou nt(Rs. )
llasic Pricc I Nos 89 60, I .11 89
l)iscount 781 20
I il\rl)le Anr0utrt 59,352.69
l(;s' 000qo 0.00
'(;s1'
t4.00 0/o 8,109..t8
14.00. 8,109..,8
! Lrsl
:'. :i::::! i r:,;:, i,r:-t:,rtl::.,1 75.97 l..l.t
( unccsion _,- 0.00
I otrl -\rnouIt 75,97 t.00

S.no
(iustomer'fcnrp Address
Assessable Ytlue: 59,351.69
Anrount in \rords Sevcn One
I l rcr ersc
Oeclarction:

by giving nolice

('ustomer Signature
Payment Receipt No : RC'f -PBO I 000-l-222.1-0.i408 Payment l\tethod : Cash Paymenl Receipi Date: 02/03/U23i r r{aAQ
For ,{RNEJA ATITOS
lr''lia
Of
Noar Bank
Authorized Signrtory
Road, Afir:.-af
Become member today and avail exciting of fers on services & discount$tt No.
iXj partner brands Mobile
"i{}ucttilc

Note : Service Schedule for your BS\/l model is available on next page.
 Page 2 of5

Bundled - Two wheeler Policy

fl ICtCfNibhayt> Vatrle
€Lombarci
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P rod uct Code : 3005 U I N : lR iAN 11 5R?0020V 0'l 2021 22

CERTIFICATE CUM POLICI/ SCHEDULE

For instant renewal of

your insurance policy log on w?t/r/w- i c i c i I o mb a rd. c o m
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

Certificate cum Policy No I 3005/2011447990/00/000O01S315

Name of the Servicing IL Ludhiana
Branch
Address of IL Branch TF 1 5, Thrrd 88 The l'1all The l4all, Ludhiana Punjab 141001
Tenure 5 Years RTO Location PUNJAB.AMRITSAR

Period of Insurance OO-From 16:04 02/O3/2O23 ro O!03/2024 midnight

TP-From 16:04 O2/O3/2023 ro 0t/O3/2028 midnight Intermediary Code 20L6t4477973000L
Insured Name SANDEEP SINGH Policy Issued On 02/0312023
S.O GURMEET SINGH HNO 21 GALI NO 4 GL'PI' R,AM DAS AVENUE
Insured Address ,
Hypothecated With
AMRITSAR, PUNJAB, Prn - 143001.
Invoice No I 703232543513 Category
Primary vertical Name GEO-Motor Two Wheeler 91-8054 138 194( Mobile
Contact No.
No.)
Registration Mfc Seat
Number
Make Model Type of body cc Chassis Number Engine Number
Yea r cap
HONDA M E4lK 1 568PD022 105
NEW ACTIVA DLX Solo With Pillion 109 2023 2 jk1 5ed5022 I 56
MOTORCYCLE
Vehicle IDv Side Car Additional Acc NonElectrical Acc Electrica l/ E lectronic Acc CNG/LPG Unit Total Value
t3r?? 0 0 0 0 0 73122
SCHI:DULE OF PREMIUM
Own Damage(A) Liability(B)
Basic Own Damage 551.34 Basic Third Party Liability 385 1.00
Zero Depreciation 4J8.,/3
Total 9JO.00 Is!a.! 3851.O0
Total Own Damage Premrum Total Liability Premium
fotal Packaqe Premrum (A+B) 4841.00
Prerntum 484 1.00
CGST(o)9% 435.69
sGsTCO9o/o

87 1.38
Total Premium 57 L2.OO
UIN Details
eciation
N115A0020V01200910
For No clarm tsonus (NCB), Coverages and exclusion of policy please refer to the policy wordings attached with this schedule, in case of you have
not received your
kind write to us at the below mentioned mail address.
Compulsory Deductibles : Rs.100 GeographicalArea Indla r** All Premium figures are in Rupees
of Liabi I itv ) U nder Section (i) of the policy- > Death of or bodaly injury: Such amount a5 is necessary to meet there requirements of the M otor
9BB (b) Un der Section I" (ii )of the policy-> Damage to Th,rd Party Property R5 100000 ,00;
Com pulsory Persona Accrdent cover has not been opted in thi policy on a(icount that, Ow ner river has a separate existing Persona Accident cover a9ainst I
nd Perma nent D isa bit ota and fot SU m Insured of atl ea st Rs 15 lacs
TIONS AS TO USE: The pol icy covers use of the vehicle for any pu rpose other than H ire or rewa rd Ca rriage of goods (other tha n sa mples or
o raci Pace maki Reliabi tria in connection wrth Motor Trade.
DRIVER' ,s CLAU sEs: ny pe rson tn cludr n9 the nsured Provided that a person driving holds an effective Driving t.icense at the time of the accident and is
disq ual rfied from hold rng or obta ni n9 such rcen se Provrded also that the person hold ng an effective Lea rner's License may a lso rive the vehicle and that such
r
r

person satrsfres the urrements of Rule 3 of the Central M otor Ve h icles 989
ANT NOTICE The ns ured not ndemnified it the vehicle is used ()r driven otherwise tha n in accordance ith this Sched ule, payment made
by reason wider terms appeari ng ln the Certificate in order to conlply with the Motor Vehicle Act, 1988 is recoverable from the Insured See the
headed "AVO IDAN CE OF R rA IN TERMS AN D RIG HT o RECOVE RY
In consideration of the premi UM for th ts extension being lculated at a pro-rat<1 p nportiO n of the an nua premium, it hereby declared and agreed by the insured
ex pr of thrs extension, thr policy shall be re newed for a period ot t$'|elil months, fa iling which the drffe rence between the exten sion premiu m now paid on
bas is and the premr UM at short period rate shal become payable by the insured.
version will hold ood
U to IMT Endorsement Nos. & Memorandum herein attached hereto : 22,28
remium Collection Oetails :
hereby,certify tha t the policy to which the certificate re lates a5 well as, th is certificate of insurance are issued accorda nce with the provision of Chapter X
Vehicle 988
,\gcnc1 ( otlc: ,\ l,Ql'S562J1,{J555 {gcnc1, Name: i\RNIi,lA At,l'OS
,{ gcnt's \lobilc \o.: 9 I -96J60076J5 t's [,andline No.:
Disclaime icicrlomba rd.com for the polrcy word in9 s, for complete details on terms and condrtrons governinq the covera9e nd NCB,
Plea se vrs rt .
This document is
be read ith the policy word ing s. The policy rs valid ubiect to rea lizatron of cheq ue. accept pre mium only vra legally recognized modes. In case of dishonor of
cheq UE, The compa ny shall not be ia ble nder the policy and the policy sha ll be void b -i n itio. in ca 5e ol any discrepancy
with respect to the policy, please
with in 5 days from the polrcy start date Thi s policy is underwritten on the basis of the information provided by you and
a5 detailed in the Risk Assumption
shared wrth you along with the pol icy On renewal, the benefits provided uId er the policy andl ol terms and conditions of
the policy incl ud ng premium rate ma v i
s to
nce Clause:
resolution of any query or gflevance you may contact us on our toll free no.1g0O- 2666, or visit any of our branch offices. you
can also write to us at
icicilombard,com. For detailed redressal mechanism slease visit the "Grievance Redressal" section on our website www.
The stamp duty of Re. 0.5 paid vide deface no. CSD36420222395 dated Jun 03, ICICI Lombard ceneral Insurance Company Ltd
2022
GSTIN Registration No. : 03AAACI7904G1ZX
HSN/SAC Code: 997134
TTF,{*tYI.r
fl\e : III C : I P r o gr amoh2 0F- iIe s/ I L P o S % 2 0 M o to ro% 2 [, I n s u ran c e/ p o Ii c y S c ,,.,ii,il,i;q;i$er,h*,,,, J