0

Product Code: 3005 UIN: IRDAN115P0015V02200708

Ref. No. 91218132755

Date: Dec 08, 2018

SAVITA SETHIA
225 GALI NO 1 WEST AZAD NAGAR
KRISHNA NAGAR
NEW DELHI
DELHI 110051
Mobile No: 9650165264

Sub: Risk Assumption Letter

Dear Sir/Madam,

Thank you for choosing ICICI Lombard General Insurance Company Limited (ICICI Lombard) as your preferred service provider.
Please find enclosed Policy No. 3005/110283291/03/000, which has been issued based on the below mentioned details:

Insured & Vehicle Details

Name of Insured SAVITA SETHIA
Period of Insurance Dec 12, 2018 to Dec 11, 2019
Vehicle Make / Model HONDA MOTORCYCLE / ACTIVA.
RTO City DELHI-NEW DELHI
Vehicle Registration No. DL13S6377
Vehicle Registration Date Dec 12, 2009
Engine No. 390729
Chassis No. 333581
Current Year NCB(%) 50%
Previous Policy Details
Previous Policy No. 3005/110283291/02/000
Previous Policy Period Dec 12, 2017 to Dec 11, 2018
Previous Year NCB(%) 50%
Previous Insurer Name ICICI LOMBARD
Previous Policy Type Comprehensive Package

The information provided above is based on the information received from you and accordingly, the policy has been processed.
Coverage of risk is subject to realisation of the full premium, post which, insurance coverage under the policy would commence. In
case the premium is not received by us due to cheque dishonour or any other reason, the insurance cover shall be void ab-initio.

If you require any changes in the Certificate of Insurance cum Policy Schedule, you are requested to inform us by writing to
[email protected] or calling our 24 hour toll free helpline on 1800 2666. Absence of any communication within a
period of 15 days of the date mentioned on this letter, would mean that the issued policy is in order and as per your proposal.

The information provided is merely illustrative and shall not be construed to be an evidence of existence of a contract of insurance. The
Risk Assumption Letter is to be read in conjunction with the policy and shall be considered null and void without the same.
CORP/SUP/OPI/2014/1777

Mailing Address: 401 & 402, 4th Floor, Interface 11, New Linking Road, Malad (West), Mumbai - 400 064, IRDA Reg. No. 115, CIN: L67200MH2000PLC129408

Dec 09, 2018

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Two Wheeler Vehicles Package Policy
Product Code: 3005 UIN: IRDAN115P0015V02200708

Insured Name : SAVITA SETHIA Policy No : 3005/110283291/03/000

Address : 225 GALI NO 1 WEST AZAD NAGAR, KRISHNA NAGAR,
NEW DELHI, DELHI 110051
Telephone No : 0-0 Mobile No: 9650165264 Period of Insurance : Dec 12, 2018 00:00 to
Midnight of Dec 11, 2019
Email Address : [email protected] E-Policy No : 3005/W-81494419/00/000
Nominee Name : - Named Passenger's Nominee: Policy Issued On : Dec 08, 2018
Relationship : Select - Covernote No : 110283291
Age : - RTO Location : DELHI-NEW DELHI
GSTIN Number : Hypothecated To : -
(Customer)
Servicing Branch Name : New Delhi Invoice Number : 101218224988
Servicing Branch Address : Fourth Parsavnath Capital
Tower Bhai Veer Singh Marg,
New Delhi New Delhi 110001
:

Registration No. Make Model Type of Body CC Mfg Yr Seating Chassis No. Engine No.
Capacity
HONDA Solo With
DL13S6377 ACTIVA. MOTORCYCLE 109 2009 2 333581 390729
MOTORCYCLE Pillion
Vehicle IDV Side Car Additional Electrical / Electronic Non Electrical CNG / LPG Unit Total IDV
(`) (`) Accessories (`) Accessories (`) Accessories (`) (`) (`)
19094 0 0 0 0 0 19094
Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 308 Basic Third Party Liability 720
Sub Total 308 Total 720
Less: Add:
No Claim Bonus 50% 154 Unnamed PA Cover for 2 Persons of ` 10000 each per year 14
Sub-Total Deductions 154 PA Cover for Owner Driver 750
Sub-Total 764
Total Own Damage Premium(A) 154 Total Liability Premium(B) 1484
Total Package Premium(A+B): 1638
% 9
CGST
` 147.42
% 9
SGST
` 147.42
Total Tax Payable in ` 295
Total Premium Payable In ` 1933
Geographical Area: India Applicable IMT Clauses: 16 , 22
Compulsory Deductible: ` 100 Voluntary Deductible: ` 0

Premium Collection No. 1085902291 Premium Amount ` 1933 Receipt Date 08/12/2018
GSTIN Reg.No 07AAACI7904G1ZP HSN/SAC code 00440005 / GENERAL INSURANCE SERVICES
Limits of Liability: (a) Under Section II-I(i) of the policy: Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicles Act
1988. (b) Under Section II-I(ii) of the policy: Damage to Third Party Property ` 100000/-; PA Cover for Owner-Driver under Section III: CSI ` 1500000/-. 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 of personal luggage), Organised
racing, Pace Making, Reliability trails or Speed testing, any purpose in Connection with Motor Trade. Driver's Clause: 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. Disclaimer: Please visit
www.icicilombard.com for the policy wordings, for complete details on terms and conditions governing the coverage and NCB. This document is to be read with the
policy wordings. The policy is valid subject to realization of cheque. We accept premium only via legally recognized modes. In case of dishonour of premium cheque,
the company shall not be liable under the policy and the policy shall be void ab-initio. In case of any discrepancy with respect to the policy, please revert within 15
days from the policy start date. This policy is underwritten on the basis of the information provided by you and as detailed in the Risk Assumption Letter shared with
you along with the policy. On renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be subject to
change. Grievance Redressal: For resolution of any query or grievance you may contact us on our toll free no. 1800 2666, or visit any of our branch offices. You
can also write to us at [email protected]. For detailed grievance redressal mechanism please visit the "Grievance Redressal" section on our
website www.icicilombard.com.
I/We hereby certify that the Policy to which this Certificate relates, as well as, this Certificate of Insurance are issued in accordance with the provisions of Chapter X
and Chapter XI of Motor Vehicle Act, 1988. In witness whereof, this Policy has been signed at Mumbai on this date of Dec 08, 2018 in lieu of Covernote no.
110283291. The stamp duty of ` 0.5 paid vide deface no. CSD2082018445218 dated Oct 19, 2018.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple,
Prabhadevi, Mumbai 400 025.
CORP/SUP/OPI/2014/1777

Mailing Address: 401 & 402, 4th Floor, Interface 11, New Linking Road, Malad (West), Mumbai - 400 064, IRDA Reg. No. 115, CIN: L67200MH2000PLC129408

Dec 09, 2018

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Two Wheeler Vehicles Package Policy
Product Code: 3005 UIN: IRDAN115P0015V02200708

Agency Code AAFCS1018J43612

:

Agency Name :
SWARUP MOTORS
PRIVATE LIMITED
Agent's Contact No 9711832001
:

Signature Not Verified

Digitally signed by
SANJAY DATTA
Date: 2018.12.09
12:20:05 IST
CORP/SUP/OPI/2014/1777

Mailing Address: 401 & 402, 4th Floor, Interface 11, New Linking Road, Malad (West), Mumbai - 400 064, IRDA Reg. No. 115, CIN: L67200MH2000PLC129408

Dec 09, 2018