TWO WHEELER INSURANCE COVER NOTE

Cover Note No : W41341168

The insured, described in Form '52' referred to below, having proposed for insurance in The Cover Note wordings provided on the other side constitute the legal document with
respect of Motor Vehicle(s) described therein and having paid the sum of Rs. 1294 as regard to the coverage. In order to help you understand the cover note better, we are
premium, the risk is hereby held covered under the terms of the Company's usual form of providing you with this commentary. The explanation, interpretation, commentary provided
Package Policy applicable thereto (subject to any Special Condition mentioned below) here shall not be construed as part of the Cover Note attached alongside. We are not liable
unless the cover be terminated by the Company by notice in writing in which case the by any interpretation in this commentary and the contract is restricted to the wordings
insurance will thereupon cease and a proportionate part of the premium otherwise payable provided alongside. For any further clarification, please contact our Call Centres. As per
for such insurance shall be charged for the time the Company had been at risk. your declaration in the proposal form with reference to your vehicle described below and the
premium paid by you, we are commencing an insurance cover for your vehicle under TWO
Gross Insured Declared Value
WHEELER Package Policy from the date and time mentioned below (subject to special
Vehicle (IDV)
Licensed conditions described below, if applicable). The cover would be provided for the duration
Make, Model & Weight Accessories described below unless due to some circumstances, we have to cancel the policy. In such a
Year of Cubic Carrying
Reg. No. of the (GVW)
Manufacture Capacity Capacity For not included in case, we would send you a written notice and cancel the policy by proportionately refunding
vehicle (Good
(LCC) Vehicle Mfr's listed premium to you for the unexpired period of cover
Carrying Rs. selling price
Vehicle) Rs.
TVS,
TVS WEGO
2012 110 2 22500 0
SALOON,
MH02CU2878
N.B. In the event of an accident,the Insured should inform the Company to arrange spot
Engine No: 57165 Chassis No: 71859 survey.
The details of your vehicle are as described alongside.
Additional Risks,if any:
Special Conditions: Special conditions if applicable to your policy are as described here.
Hypothecated To : N/A

Form 52 (See Rule 142(1) of Central Motor Vehicle Rules,1989)

1. Registration mark and number or description of the
vehicle insured
2. Name and address of insured
3. Effective date and time of commencement of
insurance for the purpose of this Act
4. Date of expiry of insurance
5. Persons or classes of persons entitled to drive
6. Any limitations as to use of Motor vehicle
7. The period of validity of this cover note will expire
on
MH02CU2878 This represents your vehicle, for which we are
providing the insurance cover
AKBAR KARIM MUJAWAR Your Name and address as mentioned by you in the
Thomas vaz chawl, room no 2,chawl no 2, chimatpada, proposal form
A K road, Marol, Andheri east
Time : 12:00 Date : 04Aug2017 The date and time of the commencement of this
insurance cover.
03Aug2018 The date and time of the expiry of this insurance cover.
Any person including the insured: Provided that a person driving holds For the cover to be valid, the driver of your vehicle
an effective Driving Licence at the time of the accident and is not must have a valid license.It also becomes void if the
disqualified from holding or obtaining such a licence. Provided also that driver of your vehicle, at the time of accident was
the person holding an effective Learner's Licence may also drive the disqualified from holding or obtaining a driver's
vehicle and such a person satisfies the requirement of Rule 3 of the license.This cover also allows a driver of your vehicle
Central Motor vehicles Rules, 1989. holding a learner's license provided that such a driver
satisfies the requirements of Central Motor Vehicle
Rules as prescribed by the government.
The Policy covers use for any purpose other than (a)Hire or reward(b) This insurance cover is not valid if your vehicle is used
Carriage of goods (other than samples or personal luggage)(c) Organised for the purpose of (a) Hire or reward(b)Carriage of
racing (d) Pace making (e) Speed testing (f) Reliability trials (g) Any goods (other than samples or personal luggage) (c)
purpose in connection with Motor Trade Organised racing (d)Pace making (e) Speed testing (f)
Reliability Trials (g) Any purpose in connection with
Motor Trade
04Nov2017 The validity of this Cover Note is till the date
mentioned

I/We hereby certify that this Cover Note is issued in accordance with the provisions of Chapter XI of the Motor Vehicles Act,1988
It brings us pleasure in announcing that our operations function has been ISO 9001:2000 certified with effect from 7th September 2004. The certifying agency was Det Norske Veritas
(DNV). This would mean that we would meet the service related promises that we make to our customers.
Date of issue : 04Aug2017 For ICICI Lombard General Insurance Company Ltd
Time of issue : 12:00

In the event of dishonour of cheque, insurance cover provided under this document automatically stands cancelled Abinitio. The company is under no obligation to send separate
communication informing the said dishonour of cheque.
N.B.: Intermediary or relevant contact details will be provided in the policy schedule
Ahmedabad : 07955309877 Andhra P'desh : 984957 7877 Bangalore : 0805118 7464 Calcutta : 983137 7877 Chandigarh : 0172505 5707 Chennai : 0444201 7877 Coimbatore : 0422538 7877
Delhi : 0981817 7877 Gujarat : 989827 7877 Hyderabad : 04023128511 Indore : 0731502 7877 Karnataka : 984557 7877Kerala : 989547 7877 Kochin : 04842384511 Lucknow : 05222294511
M.P. : 989304 7877Maharashtra : 989001 7877 Mumbai : 02228307711 Pune : 020 26103511 Rajasthan : 9829796547 Tamil Nadu : 989447 7877
ICICI Lombard General Insurance Company Limited
Registered Office: ICICI Lombard General Insurance Company LTD, ICICI Lombard House, 414, Veer Savarkar Marg,Near Siddhi Vinayak Temple, Prabhadevi Mumbai 4
Service Tax Reg. No. : GIS/Mumbai I/1528/2001