Policy Schedule Il

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file://C:\Users\1003835\AppData\Local\Temp\VGJSD2H0.htm
9/10/2015
Page 2 of 7
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<TABLE id=TblSchedule border=0 width="100%">
<TBODY>
<TR>
<TD>
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<TABLE
style="Z-INDEX: 102; POSITION: relative; DISPLAY: inline-block; designtimeurl: DESIGNTIMEURL"
id=Label11>
<TBODY>
<TR>
<TD><SPAN
id=_ctl2_lblduplicate></SPAN><B></B></TD></TR></TBODY></TABLE></TD>
<TD vAlign=top>
<TABLE id=Table3 border=0 cellSpacing=1 cellPadding=1
width="100%">
<TBODY>
<TR>
<TD width="1%"></TD>
width="45%" align=left><SPAN
id=_ctl2_lbl_OfficeName_1079>Correspondence Office
Name</SPAN> : </TD>
id=_ctl2_LblOffice>MUMBAI - FORT</SPAN> </TD></TR>
<TR>
vAlign=top width="45%">Policy Number : </TD>
<TD><SPAN
id=_ctl2_LblPolicy>3001/51797784/00/000</SPAN> </TD></TR>
<TR>
vAlign=top width="45%">Period of Insurance : </TD>
<TD><SPAN
id=_ctl2_LblPeriod>From: 08/08/2015
<BR>Time: 15:23 Hours <BR>To Midnight of
07/08/2016</SPAN> </TD></TR>
<TR>
vAlign=top width="45%">Endorsement No : </TD>
id=_ctl2_LblEndtNo>3001/51797784/00/002</SPAN> </TD></TR>
<TR>
width="50%">Effective time and date: </TD>
id=_ctl2_LblEff>10:34 Hours - 10/09/2015</SPAN> </TD></TR>
<TR>
width="45%">Date of issue : </TD>
id=_ctl2_LblIssue>10/09/2015</SPAN> </TD></TR>
<TR id=_ctl2_rowinter>
width="45%">Intermediary Code : </TD>
id=_ctl2_LblICode>0</SPAN> </TD></TR></TBODY></TABLE></TD></TR>
<TR id=_ctl2_rowreginfo width="100%">
<TD vAlign=top colSpan=2>
<TABLE id=tableReg border=1 cellSpacing=0 cellPadding=0
width="100%">
<TBODY>
<TR>
<TD align=middle><B>Registration Number</B> </TD>
<TD align=middle><B>Engine Number</B> </TD>
<TD align=middle><B>Chassis Number</B> </TD></TR>
<TR>
9/10/2015
Page 4 of 7
<TD align=middle><SPAN
id=_ctl2_LblRegNo>MH-11-MH-1111</SPAN> </TD>
id=_ctl2_LblEngineNo>123456</SPAN> </TD>
id=_ctl2_LblChassisNo>123456</SPAN>
</TD></TR></TBODY></TABLE></TD></TR>
<TR>
<TD
style="TEXT-ALIGN: justify; FONT-FAMILY: Zurich BT; HEIGHT: 36px; FONT-SIZE: 11pt"
vAlign=top colSpan=2><SPAN
style="WIDTH: 95%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold"
id=_ctl2_LblStatus>Not withstanding anything to the contrary
contained in the policy, it is hereby declared and agreed that
the policy stands amended for the reasons given
below:</SPAN><BR><STRONG>Endorsement wording
:</STRONG>   <SPAN
id=_ctl2_LblEWord></SPAN>
<TABLE
style="BORDER-RIGHT-WIDTH: 0px; BORDER-COLLAPSE: collapse; BORDER-TOP-WIDTH: 0px; BORDER-BOTTOM-WIDTH: 0px; FONT-SIZE: 11pt; BORDER
id=_ctl2_Dgrid2 class=fontStyle border=0 rules=all
cellSpacing=0>
<TBODY>
<TR style="FONT-FAMILY: Zurich BT">
align=left>RTI INCLUSION</TD></TR></TBODY></TABLE></TD></TR><BR>
<TR id=_ctl2_rowgrpchange>
<TABLE style="BORDER-COLLAPSE: collapse"
id=_ctl2_grdGrpChangeNodesN border=0 cellSpacing=0>
<TBODY>
<TR>
<TD></TD>
<TD>The following Covers are added : Return To
Invoice</TD></TR></TBODY></TABLE><SPAN
style="WIDTH: 373px; FONT-SIZE: 12pt; FONT-WEIGHT: bold; TEXT-DECORATION: none"
id=_ctl2_lbl_NumNewRTI1>The following covers are added :
Return to Invoice</SPAN> <BR></ASP:DATAGRID><SPAN
style="WIDTH: 260px; FONT-SIZE: 11pt; FONT-WEIGHT: bold; TEXT-DECORATION: underline"
id=_ctl2_Lblmod>The following groups are modified :</SPAN><BR>
<TABLE
style="BORDER-BOTTOM-STYLE: none; BORDER-RIGHT-STYLE: none; WIDTH: 100%; BORDER-COLLAPSE: collapse; BORDER-TOP-STYLE: none; BORDER
id=_ctl2_grdGrpChangeNodes border=1 rules=all cellSpacing=0>
<TBODY>
<TR style="FONT-SIZE: 10px; FONT-WEIGHT: bold"
align=middle><TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Group</TD>
<TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Risk
Item</TD>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Changed
to</TD>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Description</TD>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Old</TD>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">New</TD></TR>
<TR>
vAlign=top align=middle>Covers</TD>
vAlign=top>Risks : VehicleSIComponent : Vehicle Base
Value</TD>
vAlign=top align=left>Cover Groups : Basic - OD </TD>
vAlign=top align=middle>Premium</TD>
vAlign=top align=right>15357</TD>
vAlign=top align=right>15357</TD></TR>
<TR>
Value</TD>
vAlign=top align=left>Cover Groups : Basic - TP </TD>
<TR>
Value</TD>
vAlign=top align=left>Cover Groups : Paid Driver </TD>
<TR>
vAlign=top>Risks : VehicleSIComponent : PA Cover for
Owner-Driver</TD>
9/10/2015
Page 5 of 7

vAlign=top align=left>Cover Groups : PA - Owner </TD>
<TR>
vAlign=top>Risks : VehicleSIComponent : Zero
Depreciation</TD>
vAlign=top align=left>Cover Groups : Zero Depreciation
</TD>
<TR>
vAlign=top align=middle>Risks</TD>
vAlign=top> </TD>
vAlign=top align=left>VehicleSIComponent : Vehicle Base
Value </TD>
vAlign=top align=middle>IDV /Capital SI</TD>
<TR>
vAlign=top> </TD>
vAlign=top align=left>VehicleSIComponent : PA Cover for
Owner-Driver </TD>
<TR>
vAlign=top> </TD>
vAlign=top align=left>VehicleSIComponent : Zero
Depreciation </TD>
vAlign=top
align=right>668235</TD></TR></TBODY></TABLE></TD></TR></TBODY>
<TBODY>
<TR>
<TABLE id=tableReg1 border=1 cellSpacing=0 cellPadding=0
width="100%">
<TBODY></TBODY></TABLE></TD></TR>
<TR>
<TD vAlign=top colSpan=3></TD></TR>
<TR id=_ctl2_rowendor>
<TD colSpan=2><STRONG>   <U
style="FONT-SIZE: 11pt">The following(s) are modified</U>
:</STRONG> <BR>
<TABLE class=baseTable1111 border=0 cellSpacing=0
<TBODY>
<TR>
<TD>
<TABLE
style="BORDER-BOTTOM-STYLE: solid; BORDER-RIGHT-STYLE: solid; WIDTH: 100%; BORDER-COLLAPSE: collapse; BORDER-TOP
id=_ctl2_grdChangeNodes border=1 rules=all
cellSpacing=0>
<TBODY>
<TR
style="FONT-WEIGHT: bold; TEXT-DECORATION: underline"
align=middle>
<TD
style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Description</TD>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Old
Value</TD>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">New
Value</TD></TR>
<TR>
<TD style="WIDTH: 35%" align=middle>Net TP
Premium</TD>
<TD
style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"
align=middle>1,482.00</TD>
<TD
9/10/2015
Page 6 of 7
align=middle>1,482.00</TD></TR>
<TR>
<TD style="WIDTH: 35%" align=middle>Net OD
Premium</TD>
<TD
align=middle>20,168.00</TD>
<TD
align=middle>22,039.00</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>
<TABLE id=_ctl2_tbmainpre border=1 cellSpacing=0 cellPadding=0
width="100%">
<TBODY>
<TR id=_ctl2_rowendt>
<TD style="WIDTH: 100%">
<TABLE style="WIDTH: 100%" id=_ctl2_Table6 border=0
cellSpacing=1 cellPadding=1>
<TBODY>
<TR id=_ctl2_rowEPremiumT>
<TD
style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"><STRONG>Endorsement
Premium</STRONG> </TD>
id=_ctl2_lblcurrency2></SPAN></TD>
<TD align=right><SPAN
id=_ctl2_LblEPremium>2,673.00</SPAN> </TD></TR>
<TR id=_ctl2_rowSTaxT>
<TD
Service Tax<SPAN
id=_ctl2_LblServiceTax1></SPAN></STRONG> </TD>
<TD align=right><SPAN
id=_ctl2_LblSTax>374.22</SPAN> </TD></TR>
<TR id=_ctl2_rowTotalPT>
<TD
Total Premium</STRONG> </TD>
<TD align=right>      <SPAN
id=_ctl2_LblTotalP>3047.00</SPAN>
</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE>
<TABLE id=_ctl2_tb1 border=0 cellSpacing=0 cellPadding=0
width="100%">
<TBODY>
<TR>
<TD colSpan=2>
<TABLE cellSpacing=0 cellPadding=0 width="100%"></FONT>
<TBODY></TBODY></TABLE></TD></TR></TBODY></TABLE>
<TABLE width="100%">
<TBODY>
<TR id=_ctl2_trNewRTI1 align=justify>
<TD vAlign=top width="1%"><SPAN
id=_ctl2_lbl_NumNewRTI2></SPAN></TD>
<TD><B>Return To Invoice Coverage:</B> Sum Insured under this
add-on, determined as the difference between the Insured's
Declared Value (IDV) and the total actual expenses incurred
towards acquisition of a new vehicle of same make and model ,
as specified in the on-road price listed by the
manufacturer/dealer upon the occurrence of Total Loss
including Theft / Constructive Total Loss as defined in the
Policy. </TD></TR></TBODY></TABLE>
<TABLE border=1 cellSpacing=0 cellPadding=0 width="100%">
<TBODY>
<TR>
<TD style="WIDTH: 553px"><STRONG><SPAN
id=_ctl2_lblTaxRate>Service Tax Registration No. :
GIS/MUMBAI-I/1528/2001<BR>Service Tax Code Number :
AAACI7904GST001<BR>Category: General Insurance Business
Services 00440005.</SPAN></STRONG> </TD>
<TD style="WIDTH: 40%"> <SPAN
id=_ctl2_LblSC>Receipt No. & Date :
</SPAN>    <SPAN
id=_ctl2_LblSV>1012142542 - 10/09/2015</SPAN> </TD></TR>
<TR style="FONT-FAMILY: Zurich BT">
<TD style="FONT-FAMILY: Zurich BT; FONT-WEIGHT: bold"
class=style1><B><SPAN style="FONT-SIZE: 11pt"
id=_ctl2_LabelIRDA>IRDA Registration no.115</SPAN></B> </TD></TR>
<TR>
<TD
style="TEXT-ALIGN: justify; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"
colSpan=2>Subject otherwise to the terms, conditions,
exclusions, limitations and warranties attached to the within
mentioned policy. </TD></TR></TBODY></TABLE>
<TABLE width="100%">
<TBODY>
<TR id=_ctl2_tr_1206 class=fontstyle align=justify>
align=left>Compulsory Deductibles :<SPAN
id=_ctl2_LblDeduct>Rs.1000</SPAN> </TD></TR></TBODY></TABLE>
<TABLE border=0 cellSpacing=0 cellPadding=0 width="100%" cols=2>
<TBODY>
<TR>
<TD colSpan=2> </TD></TR>
<TR>
<TD><SPAN style="WIDTH: 50%" id=_ctl2_Lblcommand></SPAN>
9/10/2015
Page 7 of 7
</TD>
<TD align=middle>     <IMG
style="HEIGHT: 55px" id=_ctl2_Image6 border=0
src="../HTMLReportSource/image1/Sanjay%20Datta.jpg"> </TD></TR>
<TR>
<TD colSpan=2> </TD></TR>
<TR>
<TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"><SPAN
id=_ctl2_lblamountinRs>All amounts are in Rs. </SPAN></TD>
align=middle><STRONG>Authorised Signatory</STRONG>
</TD></TR>
<TR>
<TD></TD>
id=_ctl2_LblICICI>ICICI Lombard General Insurance Company Ltd,
IRDA Regn. No. 115</SPAN> </TD></TR>
<TR>
<TD style="HEIGHT: 10px" colSpan=2></TD></TR>
<TR>
<TD colSpan=2></TD></TR>
<TR id=_ctl2_trICICIAddress>
vAlign=baseline colSpan=3 align=left>At ICICI Lombard we are
always at your service. If you have any questions, you are
welcome to: 1. Visit us at our nearest branch, or 2. Email us
at customersupport@icicilombard.com or 3. Write to us at
Customer Support Team, <SPAN id=_ctl2_lblcorpaddress1>ICICI
Lombard General Insurance Company LTD , ICICI LOMBARD HOUSE ,
414, Veer Savarkar Marg, Near Siddhi Vinayak Temple,
Prabhadevi, Mumbai 400 025</SPAN><BR>Now one number for all
your Insurance needs call us on<B> <SPAN
id=_ctl2_LblTollFreeNo>1800 2 666</SPAN></B> (toll free) also
accessible from your mobile phone.
</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></IMG></TD></TR></TBODY></TABLE><INPUT
id=__VIEWSTATEGENERATOR value=DA63C21C type=hidden name=__VIEWSTATEGENERATOR>
<INPUT id=__VIEWSTATEENCRYPTED type=hidden
name=__VIEWSTATEENCRYPTED></FORM></BODY></HTML>
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