Two Wheeler Package Policy

CERTIFICATE CUM POLICY SCHEDULE

For all your insurance needs & query call us at our Toll free No.: 1800-209-8888(Accessible from your mobile also), you can also E-mail us at:
customersupport@icicilombard.com
Certificate cum Policy No : 3005/2010042779/B/0000000819

Policy Issuing Office Zenith house Keshavrao Khade Marg, Opp Race Course, Mahalaxmi, Mumbai - 400034.
RTO Location DELHI-NEW DELHI
Period of Insurance From 00:00 23/07/2010 To 22/07/2011 midnight
Intermediary Code 201815318633
22/07/2010
Insured Name RITESH KUMAR SINHA Policy Issued On
17:46:53
J-3/1,KISHAN KUNJ EXTN, ,Laxmi Nagar, NEW DELHI, DELHI, Pin -
Insured Address Hypothecated With
110092
Primary Vertical Name Bancassurance-Reliance Retail Category
Contact No. 91-9990084588(Mobile No.)
Registration Mfg Seat Chassis
Make Model Type of body CC Engine Number
Number Year Cap Number
HERO
DL-13-SD-7233 GLAMOUR ES Solo With Pillion 125 2009 2 07760 08042
HONDA
Vehicle IDV Side Car Additional Acc NonElectrical Acc Electrical/Electronic Acc CNG/LPG Unit Total Value
42400 0 0 0 0 0 42400
SCHEDULE OF PREMIUM
Own Damage(A) Liability(B)
Basic Own Damage 852.00 Basic Third Party Liability 300.00
Total 852.00 PA Cover For Owner-Driver Of Rs. 100000 50.00
Less
Total 350.00
Bonus Percent 20.00 % 170.00
Sub Total(Deductions): 170.00
Total Own Damage Premium 682.00 Total Liability Premium 350.00
Total Package Premium (A+B) 1032.00
Net Premium 1032.00
Service Tax(Incl Edu.Cess And Higher Edu.Cess) 106.00
Total Premium 1138.00
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. 50 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 100000.00 Voluntary Deductable Rs.0.00
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.
Disclaimer: Policy is valid subject to Realization of Cheque.
The stamp duty of Re 0.5 paid in cash or by demand draft or by payorder,vide receipt/challan For ICICI Lombard General Insurance Company Ltd
no. 9930154566 dated 06/01/2009
Service Tax Registration No. : GIS / MUMBAI-I / 1528 / 2001
Service Tax Code Number. :AAACI7904GST001 Duly Constituted Attorney(s)
Category: General Insurance Business Services 00440005. COPY OF POLICY

ICICI Lombard General Insurance Company Ltd

Mailing Add. Office: ICICI Lombard General Insurance Company LTD.Zenith House, Keshavrao Khadye Marg, Opp Race Course, Mahalaxmi Mumbai - 400034
Corporate Office: ICICI Lombard General Insurance Company LTD.Zenith House, Keshavrao Khadye Marg, Opp Race Course, Mahalaxmi Mumbai - 400034
 Invoice
(Issued in terms of Rule 4A of Service Tax Rules, 1994)

Invoice No. :M/2358/100585

Invoice Date: 22/07/2010

Name of client / customer:

RITESH KUMAR SINHA
J-3/1,KISHAN KUNJ EXTN, ,Laxmi Nagar, NEW DELHI, DELHI, Pin - 110092

Description of Service: Service Charges

PARTICULARS AMOUNT
Service Charges 89.76
Sub Total 89.76
Add: Service Tax @ 10% 8.98
Add: Education Cess @ 2% 0.18
Add: SHE Cess @ 1% 0.09
Total Amount 99.00
Amount in words: Rupees Ninety Nine Only.

Central Service Tax Registration: AADCR4759HST001

Category of Service : Insurance Auxiliary Services

For Reliance Retail Insurance Broking Limited

Authorised Signatory

Corporate Office : Reliance Corporate Park, Building No. 4, 1st Floor, ‘A’ Wing, Ghansoli, Navi Mumbai – 400 701.
Registered Office : 4th Floor, Brindavan, Shriram Mills Compound, Ganpatrao Kadam Marg, Worli, Mumbai – 400 013.