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Bundled - Two wheeler Policy

Product Code: 3005 UIN:IRDAN115RP0007V01201819

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:
customersupport@icicilombard.com
Certificate cum Policy No : 3005/2011530909/00/0000000426
Name of the Servicing IL Vishakaptnam
Branch
Address of IL Branch F6 Fourth The Landmark Sampath Vinayak Temple Road,Vishakaptnam Andhra Pradesh 530003
ANDHRA PRADESH-
Tenure 5 Years RTO Location
VIZIANAGARAM
OD-From 15:19 14/02/2020 To 13/02/2021 midnight
Period of Insurance TP-From 15:19 14/02/2020 To 13/02/2025 midnight Intermediary Code 200569140612
PA Owner Driver 15:19 14/02/2020 To 13/02/2021 midnight
Insured Name LAVETI APPALA RAJU Policy Issued On 18/02/2020
HNO -2-1, GULLEPALLI, SABBAVARAM MANDAL,VISAKHAPATNAM, INDUSIND BANK
Insured Address Hypothecation With
ANDHRA PRADESH, Pin -531035 LTD,VIZIANAGARAM
Invoice No 170220265443 Category
91-9052480135(Mobile
Primary Vertical Name BANCASSURANCE-Motor Two Wheeler (M6) Contact No.
No.)
Registration Mfg Seat
Make Model Type of body CC Chassis Number Engine Number
Number Year Cap
HONDA 2020 ME4JF50ALKG404102
NEW ACTIVA 5G STD Solo With Pillion 109 2 JF50EG0404122
MOTORCYCLE
CNG/LPG
Vehicle IDV Side Car Additional Acc NonElectrical Acc Electrical/Electronic Acc Unit Total Value

55603 0 0 0 0 0 55603
SCHEDULE OF PREMIUM
Own Liability(B)
Damage(A)
Basic Own Damage 559.37 Basic Third Party Liability 3285.00
Total 559.00 PA Cover For Owner-Driver Of Rs. 1500000 375.00
T otal 3660.00
Total Own Damage Premium 5 59.00 Total Liability Premium 3 660.00
Total Package Premium (A+B) 4219.00
Net Premium 4219.00
CGST@9% 379.71
SGST@9% 379.71
Kerla Flood Cess @1% 0.00
Total Tax Payable 759.42
Total Premium 4978.00
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
Limits Of Liability : (a)Under Section II-1 (i) of the policy->Death of or bodily injury: Such amount as is necessary to meet there requirements of the Motor
Vehicles Act,1988.(b)Under Section II-1 (ii)of the policy-> Damage to Third Party Property Rs 100000.00; PA Cover for Owner-Driver under section III: 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". 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 the certificate of insurance are issued in accordance with the provision of chapter X,XI of
M.V.Act 1988.
Agency Code: AMJPD7524P46373 Agency Name: DADI MOTORS
Agent's Mobile No.: 91-9100914566 Agent's Landline No.:
Disclaimer: Policy is valid subject to Realization of Cheque.
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
customersupport@icicilombard.com. 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. CSD30720205102020 dated For ICICI Lombard General Insurance Company Ltd
Jan 30, 2020
GSTIN Registration No. : 37AAACI7904G1ZM
HSN/SAC Code: 9971
SAC DESC: General Insurance Services Duly Constituted Attorney(s)
IRDA Registration no. 115 COPY OF POLICY

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

ICICI Lombard General Insurance Company Ltd