ICICI Lombard General Insurance Company Limited

TF 1 - 5, Third Floor, 88, The Mall, The Mall, Ludhiana, Punjab 141001
Help Desk No.:18002666 IRDA Regn. No. : 115
SERVICING BRANCH GSTIN NO.:03AAACI7904G1ZX , PAN NO.:AAACI7904G

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE

PRIVATE CAR BUNDLED POLICY (IRDAN115RP0021V02202122) ISSUED AT: 12:41 HOURS ON 07-JUL-2022

POLICY DETAILS NEW

POLICY NUMBER PROPOSAL NUMBER AND DATE PERIOD OF OWN DAMAGE (OD) COVER PERIOD OF LIABILITY (TP) COVER
TIL/10864521 P16003100 07-JUL-2022 (12:41 HOURS) 07-JUL-2022 To Midnight of 06-JUL-2023 (12:41 HOURS) 07-JUL-2022 To Midnight of 06-JUL-2025
PREVIOUS POLICY DETAILS
OD POLICY INSURER OD POLICY NUMBER PERIOD OF OD POLICY TP POLICY INSURER TP POLICY NUMBER PERIOD OF TP POLICY
To To
INSURED DETAILS INDIVIDUAL
NAME GSTIN PANCARD NUMBER UIN PAY AS YOU DRIVE / USE
MR. RAJU RANA NA AGTPR1572P 0
ADDRESS DATE OF BIRTH
S/O SH. PARMAL SINGH 563 SECTOR 28 FARIDABAD SECTOR 29 , FARIDABAD , HARYANA-121008 14-JUN-1969
NOMINEE NAME NOMINEE AGE NOMINEE RELATIONSHIP MOBILE NUMBER EMAIL ID
MR. BHUPINDER CHAPRANA 23 SON 84****7620 raju****@gmail.com
VEHICLE DETAILS PRIVATE
VARIANT MAKE/MODEL CHASSIS NUMBER ENGINE/ MOTOR NUMBER YEAR OF MANUFACTURE
INNOVA CRYSTA 2.4 ZPACKAGE: 7 SEATER XG TOYOTA / INNOVA MBJAB3EM402573945 2GDA652102 2022
HYPOTHECATION/LEASE INVOICE DATE CC / KW SEATING CAPACITY FUEL TYPE
07-JUL-2022 2393 7 DIESEL
GEOGRAPHICAL AREA EXT. GEOGRAPHICAL AREA RTO CITY REGISTRATION NUMBER VEHICLE USAGE
INDIA FARIDABAD -
INSURED DECLARED VALUE (Rs.)
VEHICLE NON ELECTRICAL ACCESSORIES ELECTICAL ACCESSORIES CNG / LPG TOTAL
2521300 0 0 0 2521300
SCHEDULE OF PREMIUM
A. OWN DAMAGE (OD) SECTION AMOUNT (Rs.) B. LIABILITY SECTION AMOUNT (Rs.)
BASIC PREMIUM BASIC PREMIUM
VEHICLE 46359 THIRD PARTY LIABILITY ( INCLUDING TPPD ) 24596
NON ELECTRICAL ACCESSORIES 0 GEOGRAPHICAL AREA EXT. ( IMT-1 ) 0
ELECTRICAL ACCESSORIES (IMT-24) 0 BI FUEL KIT 0
BI FUEL KIT (IMT-25) 0 SUB TOTAL (THIRD PARTY LIABILITY) 24596
SUB TOTAL (BASIC PREMIUM) 46359 PERSONAL ACCIDENT (PA) COVER
GEOGRAPHICAL AREA EXT (IMT-1) 0 COMPULSORY PA COVER FOR OWNER DRIVER (IMT-15) Rs. 15 LAC 909
IMT 23 0 PA COVER FOR PAID DRIVER (IMT-17) Rs. 2 LAC 300
SUB TOTAL 46359 PA COVER (50000 FOR 7 UNNAMED PERSONS) (IMT-16) 525
DISCOUNTS SUB TOTAL (PA COVER) 1734
VOLUNTARY DEDUCTIBLE (IMT-22A) 0 LEGAL LIABILITY
ANTI THEFT DEVICE (IMT-10) 500 PAID DRIVER (IMT-28) 150
AA MEMBERSHIP (IMT-8) 0 EMPLOYEE (FOR 0 PERSON) (IMT-29) 0
HANDICAPPED DISCOUNT (IMT-12) 0 NON-FARE PAYING PASSENGER (IMT-37) 0
NCB (0%) 0 UNNAMED PASSENGER (0) ON AMBULANCE/HEARSES (IMT- 46) 0
SUB TOTAL (DISCOUNTS) 500 SUB TOTAL (LEGAL LIABILITY) 150
NET LIABILITY PREMIUM (B) 26480
ADD-ONS 13868 TOTAL PREMIUM (A+B) 86207
LOANER CAR PREMIUM (IMT-58) 0 CGST (9%) 0
THEFT AND CONVERSION RISK (IMT-43) 0 SGST (9%) 0
INDEMNITY TO HIRER (IMT-44) 0 IGST (18%) 15517
PAY AS YOU DRIVE / USE DISCOUNT UTGST (18%) 0
NET OWN DAMAGE PREMIUM (A) 59727 GROSS PREMIUM PAID 101724

ADD-ON COVERS OPTED IN THE POLICY

CONSUMABLES NIL DEPRECIATION

Note:- 1. Issue of Policy is subject to realisation of cheque if premium is paid by cheque. 2. Consolidated stamp duty paid to state exchequer.Challan No.-CSD17520214442 Challan Date -01-NOV-2021 3. The Policy is subject to a
compulsory deductible of Rs. 2000 (IMT-22) and Voluntary Deductible of Rs. 0.
PREMIUM PAYMENT DETAILS :
INVOICE NUMBER : TIL/10864521 SAC CODE : 997134 DESCRIPTION OF SERVICE : GENERAL INSURANCE SERVICE
Warranty: Warranted that the insured named herein/owner of the vehicle holds a valid pollution under control (PUC) certificate and/or valid fitness certificate, as applicable, on the date of commencement of the policy and
undertakes to renew and maintain a valid and effective PUC and/or fitness certificate, as applicable, during the subsistence of the policy. Further, the company reserves the right to take appropriate action in case of any discrepancy in
the PUC or fitness certificate.
Limitations As To Use: Use only for social, domestic and pleasure purposes and for the insureds business. The policy does not cover the use for: (1) hire or reward (2) carriage of goods (other than samples or personal luggage) (3)
organised racing (4) pace making (5) speed testing (6) reliability trials (7) any purpose in connection with motor trade.
Driver's Clause: Any person including the insured: provided that the 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 learners license may also drive the vehicle and that such a person satisfies the requirements of rule 3 of the central motor vehicles rules, 1989.
Limits of Liability Clause: Under section ii-1 (i) of the policy- death of or bodily injury. Such amount as is necessary to meet the requirements of the motor vehicle act 1988.under section ii-1 (ii) of the policy damage to third party
property is rs.7.5 lakhs.
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 reasons 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.
Grivence Clause : For resolution of any query or grievance, insured may contact the respective branch office of the company or may call at (1800-2666) or may write an email at ([email protected]). In case the
insured is not satisfied with the response of the office, insured may contact the grievance officer of the company at ([email protected]).in the event of unsatisfactory response from the grievance office, he/she may,
subject to vested jurisdiction, approach the insurance ombudsman for the redressal of grievance. Details of insurance ombudsman offices are available at IRDAI website: www.irdai.gov.in, or on the website of general insurance
council: www.generalinsurancecouncil.org.in or on the company 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 Cchapter XI of M.V. Act, 1988.
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in
terms of the provisions of the said sub-rule.
For & On Behalf of
BROKER NAME : Toyota Tsusho Insurance Broker India Pvt Ltd SCAN QR CODE TO VIEW THE POLICY
ICICI Lombard General Insurance Company Limited

Broker Code / IRDAI Composite Licence No. : 381 (Valid up to 01/09/2023).

CIN: U66010KA2008PTC045231
Email ID : [email protected]
Contact No. : 080-40449900

MISP Code : TTIBI/T/PB/CAS1142A

MISP Name : ANR MOTORS PVT. LTD.
Designated Person Name :SANJAY HANDA
Authorised Signatory

PLEASE CONTACT INS.CO. & BROKER C/O CASTLE TOYOTA "A . N.R MOTORS
FOR RENEWAL / CLAIMS ASSISTANCE PARAGPUR NEAR PRESTIGE HONDA SHOWROOM G T ROAD JALANDHAR CANTT" JALANDHAR
PUNJAB 144005, JALANDHAR, PUNJAB, PIN CODE: 144005 CONTACT NO: -01800-1370702, 91-8288031432