TWOWHEELERVEHICLEPACKAGEPOLICY

CertificatecumPolicySchedule
CertificatecumPolicyNo:3005/W39788368/00/000
ForCLAIMS:Call18002666(Tollfreefromallphones)
ForRENEWALS:Visitwww.icicilombard.comorcall18002666
DETAILSOFPOLICYHOLDER
InsuredName
InsuredAddress
ContactNo.
EmailAddress

VEHICLEDETAILS
RegistrationNumber

POLICYDETAILS

ANANTHARAMK
C/o.G.Raghuraman,16,G1,B1,SriBalaji
ApartmentsThirumalaiNagarMainRoad,
HasthinapuramNearLingamHardwares,
KANCHEEPURAM,TAMILNADU,600064
9444296239
raghu.grr@gmail.com

Make

Model Typeofbody

TN22CW7672
HONDAMOTORCYCLE
DIO
Solo
INSUREDDECLAREDVALUE
VehicleIDV(inRs.)
SideCar NonElectricalAcc(inRs.)
23100
0
0
SCHEDULEOFPREMIUM(INRS.)
OwnDamage(A)
BasicPremium
Total:
Add
Less
Deduct45%forNCB
Total:
TotalOwnDamagePremium
TotalPackagePremium(A+B)
ServiceTax(includes0.5%ofSwachhBharatCess)

PolicyIssuingon
CoverNoteNo

ICICILombardGeneralInsurance
CompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayak
Temple,Prabhadevi,Mumbai400025
From00:00:00hrsof30Nov2015to
Midnightof29Nov2016
15Nov2015
W39788368

RTOLocation
Hypothecatedto
TypeofAgreement

CHENNAI
N/A
None

PolicyIssuingOffice

PeriodofInsurance

C C Mfg.Year SeatingCapacity

ChassisNumber

EngineNumber

102 2011

B8161295

E4161400

Elec/ElectronicAcc(inRs.)

CNG/LPGUnit(inRs.)

TotalValue(inRs.)

23100

Liability(B)
276 BasicPremiumincludingpremiumforTPPDvehicle
276 Total:
Add
PAcoverforOwnerDriver
124 SubTotal(Additions):
124 Less
SubTotal(Deductions):
152 TotalLiabilityPremium

538
538
50
50
0
588
740
107

TotalPremiumPayable(inRs.)847
Compulsorydeductibles:Rs.100/

GeographicalArea:India

LIMITSOFLIABILITY:(a)UnderSectionII1(i)ofthepolicy>Deathoforbodilyinjury:Suchamountasisnecessarytomeetthere
requirementsofthemotorvehiclesAct.1988.
(b)UnderSectionII1(i)ofthepolicy>DamagetoThirdPartyPropertyRs1,00,000PACoverforOwnerDriverundersectionIIICSIRs
1,00,000
LIMITATIONSASTOUSE:Thepolicycoversuseofthevehicleforanypurposeotherthan:Hireorreward,Carriageofgoods(otherthansamples
orpersonalluggage),Organizedracing,Pacemaking,Speedtesting,Reliabilitytrials,AnypurposeinconnectionwithMotorTrade.
DRIVER'SCLAUSES:Anypersonincludingtheinsured:ProvidedthatapersondrivingholdsaneffectiveDrivingLicenseatthetimeofthe
accidentandisnotdisqualifiedfromholdingorobtainingsuchalicense.ProvidedalsothatthepersonholdinganeffectiveLearner'sLicensemay
alsodrivethevehicleandthatsuchapersonsatisfiestherequirementsofRule3oftheCentralMotorVehiclesRules,1989.
IMPORTANTNOTICE:TheInsuredisnotindemnifiedifthevehicleisusedordrivenotherwisethaninaccordancewiththisschedule.Anypayment
madebythecompanybyreasonofwidertermsappearinginthecertificateinordertocomplywiththeMotorVehicleAct,1988isrecoverablefrom
theinsured.Seetheclauseheaded'AVOIDANCEOFCERTAINTERMSANDRIGHTOFRECOVERY'.Forlegalinterpretation,Englishversionwillhold
good.
SubjecttoIMTEndorsementNos.&Memorandumprintedherein/attachedhereto:22
PremiumCollectionDetails:[CollectionNo/Amount/ReceiptDate]NA/Rs.847/15/11/2015
DISCLAIMER:Pleasevisitwww.icicilombard.comforthepolicywordingsforcompletedetailsontermsandconditionsgoverningthecoverageandNCB.This
documentistobereadwiththepolicywordings.
GrievanceClause
Forresolutionofanyqueryorgrievance,InsuredmaycontacttherespectivebranchofficeoftheCompanyormaycalltollfreeno.18002666ormayapproach
usatthesubsection"GrievanceRedressal"onourwebsitewww.icicilombard.com(CustomerSupportsection).However,iftheresolutionprovidedbyusis
notsatisfactoryyoumayapproachInsuranceRegulatoryandDevelopmentAuthority(IRDA)throughtheIntegratedGrievanceManagementSection(IGMS)or
IRDAGrievanceCallCentre(IGCC)attheirtollfreeno.155255.YoumayalsoapproachInsuranceOmbudsman,subjecttovestedjurisdiction,fortheredressal
ofgrievance.DetailsofInsuranceOmbudsmanofficesareavailableatIRDAwebsite:www.irdaindia.org,orontheCompany'swebsiteat
www.icicilombard.com.
Policyisvalidsubjecttorealizationofcheque.Weacceptpremiumonlyvialegallyrecognizedmodesexceptforcash.Ifourrepresentativerequestyou
topayincash,kindlyreportittous.Forinformationonombudsmanyoumayvisitourwebsitewww.icicilombard.com
I/Weherebycertifythatthepolicytowhichthecertificaterelatesaswellasthecertificateofinsuranceare
ForICICILombardGeneralInsurance
issuedinaccordancewiththeprovisionofchapterX,XIofM.VAct1988
CompanyLtd
ServiceTaxRegistrationNo.:GIS/MUMBAII/1528/2001
ServiceTaxCodeNumber:AAACI7904GST001
Category:GeneralInsuranceBusinessServices00440005.

IRDARegistrationNo.115
DulyConstitutedAttorney(s)
InWitnesswhereofthispolicyhasbeensignedatMumbaithisinlieuofcovernoteNoThestampdutyofRs.
paidincashorbydemanddraftorbypayorder,videReceipt/Challanno.dated
ICICILombardGeneralInsuranceCompanyLtd.
MailingAdd.Office:
RegisteredOffice:
ICICILombardGeneralInsuranceCompanyLtd.ICICILombardHouse,414,
ICICILombardGeneralInsuranceCompanyLtd.ICICILombardHouse,414,
VeerSavarkarMarg,NearSiddhiVinayakTemple,Prabhadevi,Mumbai400
VeerSavarkarMarg,NearSiddhiVinayakTemple,Prabhadevi,Mumbai400
025
025

TwoWheelerPAProposalForm

VehicleDetails
Registrationlocation(RTO)
Manufacturer

CHENNAI
HONDAMOTORCYCLE

Registrationnumber
Enginenumber

TN22CW7672
E4161400

Model
Manufacturingyear
Color

DIO
2011

Chassisnumber
Purchase/Registrationdate
Registrationtype

B8161295
29Nov2011
Individual

Currentshowroomprice(Rs.)

46200

Voluntarydeductible(Rs.)
ARAIapprovedantitheftdevice
Consumables
Returntoinvoicecover

0
No
No
No

Detailsofdiscounts&additionalcovers
Electricalaccessories(Rs.)
Nonelectricalaccessories(Rs.)
Automobileassociationmembership
ValueofLPG/CNGkitifany(Rs.)

0
0

Noclaimbonusprotectioncover
Garagecashcover

No
No

Insureddetails
NameoftheInsured

ANANTHARAMK
Relationship
C/o.G.Raghuraman,16,
City
G1,B1,SriBalajiApartments
AddressofTwoWheelerOwner(Policywill
ThirumalaiNagarMainRoad,
besenthere)
HasthinapuramNearLingam
Hardwares
Pincode
600064

0
KANCHEEPURAM

Newpolicydetails
Insurancevalue(IDV)(Rs.)
Policystartdate

23100
30Nov201512:00:00

NoClaimBonus(%)
Policyenddate

TotalPremiumAmount:

847

45
Midnightof29Nov2016

I.OwnDamage
Thisproductprotectsyouagainstlossordamagetoyourmotorvehicleand/oraccessoriesdueto*Fire*SelfIgnition*Explosion*Lightning*Theft
*Burglary*Housebreaking*Riot*Strike*Earthquake*Floodandalliedperils*Accidentalexternalmeans*Maliciousacts*Terroristactivity*Transit
*Landslide/rockslide
II.ThirdPartyLiability
Inadditiontothecoveragenotedabove,thisproductcoversyouagainstlegalliabilitytowardsthirdparty,inrespectofthefollowing:*Deathofor
bodilyinjurytoanyperson*damagetopropertyaspertheprovisionsofMotorVehicleAct.Wearepleasedtoinformyouthatinaddition,the
productalsoincludesthefollowing:
l
l
l
l

PersonalaccidentbenefitsforownerdriveruptoavalueofRs.200,000.
Legalliabilitytowardsthepaiddriver.
CoverforRs.7.5Lacsthirdpartypropertydamage.
PAcoverforUnnamedpassengers.

SignificantExclusions:
Wewouldlikeyoutoknowthatthepolicydoesnotcoverconsequentialloss,depreciation,normalwearandtear,mechanicalorelectrical
breakdownfailuresorbreakages.Thevehicleisnotheldcoveredifusedforcommercialpurposesorifdrivenbyanunauthorizeddriver.Note:The
foregoingisonlyanindicationofthecoveroffered.Fordetailspleaserefertothepolicy.Itisourendeavortoprovideconsistentqualityserviceto
allourcustomers.WewouldliketoletyouknowthatinsuranceisacontractofUtmostGoodFaithrequiringthecustomertodiscloseallmaterial
facts.Ifinyouropinionanyfactismaterialandisnotcoveredbytheinformationsoughtintheapplicationform,werequestyoutodiscloseit.
Itisimportanttonotethatourliabilitywillcommenceonlyafterwehaveacceptedyourproposalandthepremiumhasbeenreceivedinfull.

Declaration:
I/Weherebydeclarethatthestatementsmadebyme/usinthisProposalFormaretruetothebestofmy/ourknowledgeandbeliefandnomaterial
information,whichmayberelevant,hasbeenwithheldornotdisclosedI/Weherebyagreethatthisdeclarationshallformthebasisofthecontract
betweenme/usandthe"ICICILombardGeneralInsuranceCo.Ltd."

I/Wealsodeclarethatanyadditionsoralterationsarecarriedoutafterthesubmissionofthisproposalformthenthesamewouldbeconveyedto
theinsurersimmediately.

I/WeagreethatthePolicyshallbecomevoidableattheoptionoftheInsurer,intheeventofanyuntrueorincorrectstatement,misrepresentation,
nondescriptionornondisclosureinanymaterialparticularintheproposalform/personalstatement,declarationandconnecteddocuments,or
anymaterialinformationhasbeenwithheldbymeoranyoneactingonmybehalftoobtainanybenefitunderthispolicy.I/Weherebydeclareand
warrantthattheabovestatementsaretrue,accurateandcomplete.I/WedesiretoeffectaninsuranceasdescribedhereinwiththeCompanyand
I/Weagreethatthisproposalanddeclarationsshallbethebasisofcontractbetweenme/usandtheCompanyandI/Weagreetoacceptapolicy
subjecttotheconditionsprescribedbytheCompany.

ProhibitionofRebatesUnderSection41ofInsuranceLaw(AmendmentAct2015)
1.Nopersonshallalloworoffertoallow,eitherdirectlyorindirectlyasaninducementtoanypersontotakeoutorreneworcontinueaninsurance
inrespectofanykindorriskrelatingtolivesorpropertyinIndia,anyrebateofthewholeorpartofthecommissionpayableoranyrebateofthe
premiumshownonthepolicy,norshallanypersontakingoutorrenewingorcontinuingapolicyacceptanyrebateexceptsuchrebateasmaybe
allowedinaccordancewiththeprospectusortablesoftheInsurer.
2.Anypersonmakingdefaultincomplyingwiththeprovisionsofthissectionshallbeliableforapenalty,whichmayextendtotenlakhsrupees.

AGEOFTHEVEHICLE

SCHEDULEOFDEPRECIATIONFORARRIVINGATIDV
%OFDEPRECIATIONFORFIXINGIDV

Notexceeding6months
5%
Exceeding6monthsbutnotexceeding1
15%
year
Exceeding1yearbutnotexceeding2years20%
Exceeding2yearsbutnotexceeding3
30%
years
Exceeding3yearsbutnotexceeding4
years
Exceeding4yearsbutnotexceeding5
years

40%
50%

Note.IDVofobsoletemodelsofvehicles(ie.Modelswhichthemanufacturershavediscontinuedtomanufacture)andvehiclesbeyond5yearsof
agewillbedeterminedonthebasisofandunderstandingunderstandingbetweentheinsurerandtheinsured.