Registration Number Make Model Type of body CC Mfg.
Year Seating Capacity Chassis Number Engine Number
D!S"#$%&' ()ND" M)T)RCYCE "CT*+". Solo ,ith #illion -.! $.-& $ %$%!%-/ %.$%%/%0 +ehicle *D+ 1in Rs.2 Side Car NonElectrical "cc 1in Rs.2 Elec3Electronic "cc 1in Rs.2 CN4 3 #4 5nit 1in Rs.2 Total +alue 1in Rs.2 &00/' . . . . &00/' Own Damage(A) 6asic #remium '7$ Tota l : 452 Add Less Deduct $. 8 for NC6 !. Tota l : 90 Liability(B) 6asic #remium including premium for T##D 9ehicle '/' Tota l : 464 Add #" co9er for ):ner Dri9er 7. #" co9er for 5nnamed #assenger -'. Sb Total(Additions) : -!. Less Sb Total(Ded!tions) : 0 Total Own Damage "#emim $62 Total Liability "#emim 654 T,) ,(EEER +E(*CE #"C;"4E #)*CY Certificate cum #olicy Schedule Certificate cum #olicy No< &..73,$0!7$0/.3..3... =or C"*MS < Call -%.. $/// 1Toll free from all phones2 =or RENE,"S < +isit :::.icicilombard.co m or call -%.. $/// D%TA&LS O' "OL&() *OLD%+ "OL&() D%TA&LS *nsured Name >E=*N E"#EN *nsured "ddress &7-" ==?6 E 6)C; ("R* N"4"R ? NE, DE(*? DE(*? --../' (onta!t ,o- %$%7%7-/'! %mail Add#ess *C*C* ombard 4eneral *nsurance "oli!y &ssing O..i!e Company td.*C*C* ombard (ouse? '-'? +eer Sa9arkar Marg? Near Siddhi +inayak Temple? #rabhade9i? Mumbai '.. .$7 "e#iod o. &ns#an!e =rom ..<..<.. hrs of -/>un$.-' to Midnight of -7>un$.-7 "oli!y &ssing on -'>un$.-' (o/e# ,ote ,o , $0!7$0/. +TO Lo!ation NE, DE(* *y0ot1e!ated to N3" Ty0e o. Ag#eement None 2%*&(L% D%TA&LS &,S3+%D D%(LA+%D 2AL3% S(*%D3L% O' "+%4&34(&, +S-) Total "a!5age "#emim ( A 6 B ) 7076 Se#/i!e Ta8(&n!l %d-(ess And *ig1e# %d-(ess) 726 Total "#emim "ayable(in +s-) 7742 (om0lso#y ded!tibles : +s- 7009 :eog#a01i!al A#ea : &ndia L&4&TS O' L&AB&L&T): 1a2 5nder Section ** - 1i2 of the policy @ Death of or bodily inAury < Such amount as is necessary to meet there reBuirements of the motor 9ehicles "ct.-!%%. 1b2 5nder Section ** - 1i2 of the policy @ Damage to Third #arty #roperty Rs -?..?... C #" Co9er for ):nerDri9er under section ***CS* Rs -?..?... L&4&TAT&O,S AS TO 3S%: The policy co9ers use of the 9ehicle for any purpose other than < (ire or re:ard?Carriage of goods1other than samples or personal luggage2? )rganiDed racing? #ace making? Speed testing?Reliability trials?"ny purpose in connection :ith Motor Trade. D+&2%+;S (LA3S%S : "ny person including the insured < #ro9ided that a person dri9ing holds an effecti9e Dri9ing icense at the time of the accident and is not disBualified from holding or obtaining such a license. #ro9ided also that the person holding an effecti9e earnerEs icense may also dri9e the 9ehicle and that such a person satisfies the reBuirements of Rule & of the Central Motor +ehicles Rules? -!%!. &4"O+TA,T ,OT&(% : The *nsured is not indemnified if the 9ehicle is used or dri9en other:ise than in accordance :ith this schedule. "ny payment made by the company by reason of :ider terms appearing in the certificate in order to comply :ith the Motor +ehicle "ct?-!%% is reco9erable from the insured. See the clause headed E"+)*D"NCE )= CERT"*N TERMS "ND R*4(T )= REC)+ERYE.=or legal interpretation? English 9ersion :ill hold good. Sb<e!t to &4T %ndo#sement ,os- = 4emo#andm 0#inted 1e#ein 9 atta!1ed 1e#eto : 22>76 "#emim (olle!tion Details <FCollection No3"mount3ReceiptDateG N"3Rs. --'$ 3 -'3./3$.-' D&S(LA&4%+: #lease 9isit :::.icicilombard.co m for the policy :ordings for complete details on terms and conditions go9erning the co9erage and NC6. This document is to be read :ith the policy :ordings. :#ie/an!e (lase =or resolution of any Buery or grie9ance? *nsured may contact the respecti9e branch office of the Company or may call toll free no.-%..$/// or may approach us at the sub section H4rie9ance RedressalH on our :ebsite :::.icicilombard.co m 1Customer Support section2. (o:e9er? if the resolution pro9ided by us is not satisfactory you may approach *nsurance Regulatory and De9elopment "uthority 1*RD"2 through the *ntegrated 4rie9ance Management Section 1*4MS2 or *RD" 4rie9ance Call Centre1*4CC2 at their toll free no.-77$77. You may also approach *nsurance )mbudsman? subAect to 9ested Aurisdiction? for the redressal of grie9ance. Details of *nsurance )mbudsman offices are a9ailable at *RD" :ebsite< :::.irdaindia.org?o r on the CompanyEs :ebsite at :::.icicilombard.com. "oli!y is /alid sb<e!t to #eali?ation o. !1e@e- Ae a!!e0t 0#emim only /ia legally #e!ogni?ed modes e8!e0t .o# !as1- &. o# #e0#esentati/e #e@est yo to 0ay in !as1> 5indly #e0o#t it to s- 'o# in.o#mation on ombdsman yo may /isit o# website www-i!i!ilomba#d-!om *3,e here by certify that the policy to :hich the certificate relates as :ell as the certificate of insurance are issued in accordance :ith the pro9ision of chapter I?I* of M.+ "ct -!%% Se#/i!e Ta8 +egist#ation ,o- ::&S9 434BA&& 9752B 92007 Se#/i!e Ta8 (ode ,mbe# :AAA(&C904:ST007 (atego#y: :ene#al &ns#an!e Bsiness Se#/i!es 00440005- *n ,itness :hereof this policy has been signed at Mumbai this -/>un$.-' in lieu of co9ernote No , $0!7$0/. The stamp duty of Rs. ..7. paid in cash or by demand draft or by pay order?9ide Receipt3Challan no. 70--/- dated .%May$.-' =or *C*C* ombard 4eneral *nsurance Company td Duly Constituted "ttorney1s2 Mailing "dd. )ffice< *C*C* ombard 4eneral *nsurance Company td. Corporate )ffice< *C*C* ombard 4eneral *nsurance Company td.*C*C* ombard (ouse? '-'? +eer Sa9arkar Marg? Near Siddhi +inayak Temple? #rabhade9i? Mumbai '.. .$7 *C*C* ombard 4eneral *nsurance Company td.*C*C* ombard (ouse? '-'? +eer Sa9arkar Marg? Near Siddhi +inayak Temple? #rabhade9i? Mumbai '.. .$7 T:o ,heeler #" "#o0osal 'o#m +ehicle Details Registration location 1RT)2 NE, DE(* Registration number D!S"#$%&' Manufacturer ()ND" M)T)RCYCE Engine number %.$%%/%0 Model "CT*+". Chassis number %$%!%-/ Manufacturing year $.-& #urchase 3 Registration date -/>un$.-& Color Registration type *ndi9idual Current sho:room price 1Rs.2 '0$.7 Electrical accessories 1Rs.2 . +oluntary deductible 1Rs.2 . Nonelectrical accessories1Rs.2 . "R"* appro9ed antitheft de9ice No "utomobile association membership Consumables No +alue of #4 3 CN4 kit if any 1Rs.2 . Return to in9oice co9er No No claim bonus protection co9er No 4arage cash co9er No Name of the *nsured >E=*N E"#EN Relationship . "ddress of T:o ,heeler ):ner 1#olicy :ill be sent here2 &7-" ==?6 E 6)C; ("R* N"4"R City NE, DE(* #incode --../' *nsurance 9alue 1*D+2 1Rs.2 &00/' No Claim 6onus 182 $. #olicy start date -/>un$.-' -$<..<.. #olicy end date Midnight of -7>un$.-7 Total "#emim Amont : --'$ *. ):n Damage This product protects you against loss or damage to your motor 9ehicle and3or accessories due to J=ire JSelf *gnition JEKplosion Jightning JTheft J 6urglary J(ousebreaking JRiot JStrike JEarthBuake J=lood and allied perils J"ccidental eKternal means JMalicious acts JTerrorist acti9ity JTransit Jandslide 3 rockslide **. Third #arty iability *n addition to the co9erage noted abo9e? this product co9ers you against legal liability to:ards third party? in respect of the follo:ing< JDeath of or bodily inAury to any person Jdamage to property as per the pro9isions of Motor +ehicle "ct. ,e are pleased to inform you that in addition? the product also includes the follo:ing< l #ersonal accident benefits for o:ner dri9er upto a 9alue of Rs.$..?.... l egal liability to:ards the paid dri9er. l Co9er for Rs. 0.7 acs third party property damage. l #" co9er for 5nnamed passengers. Signi.i!ant %8!lsions: ,e :ould like you to kno: that the policy does not co9er conseBuential loss? depreciation? normal :ear and tear? mechanical or electrical breakdo:n failures or breakages. The 9ehicle is not held co9ered if used for commercial purposes or if dri9en by an unauthoriDed dri9er. Note< The foregoing is only an indication of the co9er offered. =or details please refer to the policy. *t is our endea9or to pro9ide consistent Buality ser9ice to all our customers. ,e :ould like to let you kno: that insurance is a contract of 5tmost 4ood =aith reBuiring the customer to disclose all material facts. *f in your opinion any fact is material and is not co9ered by the information sought in the application form? :e reBuest you to disclose it. *t is important to note that our liability :ill commence only after :e ha9e accepted your proposal and the premium has been recei9ed in full. De!la#ation: *3,e hereby declare that the statements made by me3us in this #roposal =orm are true to the best of my3our kno:ledge and belief and no material information? :hich may be rele9ant? has been :ithheld or not disclosed *3,e hereby agree that this declaration shall form the basis of the contract bet:een me3us and the H*C*C* ombard 4eneral *nsurance Co. td.H *3,e also declare that any additions or alterations are carried out after the submission of this proposal form then the same :ould be con9eyed to the insurers immediately. *3,e agree that the #olicy shall become 9oid able at the option of the *nsurer? in the e9ent of any untrue or incorrect statement? misrepresentation? nondescription or nondisclosure in any material particular in the proposal form 3 personal statement? declaration and connected documents? or any material information has been :ithheld by me or anyone acting on my behalf to obtain any benefit under this policy. *3,e hereby declare and :arrant that the abo9e statements are true? accurate and complete. *3,e desire to effect an insurance as described herein :ith the Company and *3,e agree that this proposal and declarations shall be the basis of contract bet:een me3us and the Company and *3,e agree to accept a policy subAect to the conditions prescribed by the Company. &,S3+A,(% A(T 79$B> S%(T&O, 47 "+O*&B&T&O, O' +%BAT%S -. No person shall allo: or offer to allo:? either directly or indirectly as an inducement to any person to take out or rene: or continue an insurance in respect of any kind or risk relating to li9es or property in *ndia? any rebate of the :hole or part of the commission payable or any rebate of the premium sho:n on the policy? nor shall any person taking out or rene:ing or continuing a policy accept any rebate eKcept such rebate as may be allo:ed in accordance :ith the prospectus or tables of the *nsurer. $. "ny person making default in complying :ith the pro9isions of this section shall be punishable :ith fine? :hich may eKtend to fi9e hundred rupees. S(*%D3L% O' D%"+%(&AT&O, 'O+ A++&2&,: AT &D2 "4E )= T(E +E(*CE 8 )= DE#REC*"T*)N =)R =*I*N4 *D+ Not eKceeding / months 78 EKceeding / months but not eKceeding - year -78 EKceeding - year but not eKceeding $ years $.8 EKceeding $ years but not eKceeding & years &.8 EKceeding & years but not eKceeding ' years '.8 EKceeding ' years but not eKceeding 7 years 7.8 Note. *D+ of obsolete models of 9ehicles 1ie. Models :hich the manufacturers ha9e discontinued to manufacture2 and 9ehicles beyond 7 years of age :ill be determined on the basis of and understanding understanding bet:een the insurer and the insured.
Eric Freedlander, and Freedlander, Incorporated, the Mortgage People, Freedlander, Incorporated, Freedlander Financial Services of Kentucky, Freedlander, Incorporated, the Mortgage People of California, Freedlander, Incorporated, the Mortgage People of Tennessee, Freedlander Financial Services of New Mexico, Jamestown Life Insurance Company, Freedlander Racing Team, Incorporated, Eve Freedlander, Reuben Freedlander v. Ncnb National Bank of North Carolina, 921 F.2d 272, 4th Cir. (1990)