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    Sub: Risk Assumption Letter: Insured & Vehicle Details

    Uploaded by

    Chandan Kumar Yadav
    - The policy is issued to Biju Kumar for his motorcycle from July 15, 2020 to July 14, 2021. - The basic own damage and third party liability premiums are Rs. 404 and Rs. 752 respectively. - The total premium payable is Rs. 1640 including taxes.

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    Sub: Risk Assumption Letter: Insured & Vehicle Details

    Uploaded by

    Chandan Kumar Yadav
    76 views2 pages
    - The policy is issued to Biju Kumar for his motorcycle from July 15, 2020 to July 14, 2021. - The basic own damage and third party liability premiums are Rs. 404 and Rs. 752 respectively. - The total premium payable is Rs. 1640 including taxes.

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    INSURANCE

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    - The policy is issued to Biju Kumar for his motorcycle from July 15, 2020 to July 14, 2021. - The basic own damage and third party liability premiums are Rs. 404 and Rs. 752 respectively. - The total premium payable is Rs. 1640 including taxes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    76 views2 pages

    Sub: Risk Assumption Letter: Insured & Vehicle Details

    Uploaded by

    Chandan Kumar Yadav
    - The policy is issued to Biju Kumar for his motorcycle from July 15, 2020 to July 14, 2021. - The basic own damage and third party liability premiums are Rs. 404 and Rs. 752 respectively. - The total premium payable is Rs. 1640 including taxes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    0

    Product Code: 3005 UIN: IRDAN115P0015V02200708

    Ref. No. W68595536


    Date: Jul 12, 2020
    BIJU KUMAR
    F301 FLAT NUM 1514 SHANTI HOUSING SOCIETY CHANOD COLONY
    GIDC VAPI CHAR RASTA
    VAPI
    GUJARAT 396195
    Mobile No: 8962248138

    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. 3005/201942050/00/B00, which has been issued based on the below mentioned details:

    Insured & Vehicle Details


    Name of Insured BIJU KUMAR
    Period of Insurance Jul 15, 2020 to Jul 14, 2021
    Vehicle Make / Model HERO MOTOCORP LTD / PASSION PRO
    RTO City GUJARAT-VALSAD
    Vehicle Registration No. GJ15BN9633
    Vehicle Registration Date Jul 09, 2017
    Engine No. HA10ACHHC05261
    Chassis No. MBLHAR182HHC64832
    Current Year NCB(%) 35%
    Previous Policy Details
    Previous Policy No. 3005/3595769710289/000
    Previous Policy Period 02-06-2019 to 01-06-2020
    Previous Year NCB(%) 25%
    Claims Made Under Previous Policy 0
    Previous Insurer Name ICLB
    Previous Policy Type Comprehensive Package
    1

    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.

    We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

    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

    Jul 12, 2020


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

    Insured Name : BIJU KUMAR Policy No : 3005/201942050/00/B00


    Address : F301 FLAT NUM 1514 SHANTI HOUSING SOCIETY CHANOD Period of Insurance : Jul 15, 2020 00:00:00 to
    COLONY GIDC VAPI CHAR RASTA, VAPI, GUJARAT Midnight of Jul 14, 2021
    396195
    Telephone No : Mobile No: 8962248138 E-Policy No : 3005/201942050/00/B00
    Email Address : [email protected] Policy Issued On : Jul 12, 2020
    Nominee Name : SMIYA Named Passenger's Nominee: Covernote No : 201942050
    Relationship : WIFE - RTO Location : GUJARAT-VALSAD
    Age : 32 - Hypothecated To : -
    GSTIN Number (Customer) : Invoice Number : 100720292361
    Servicing Branch Name : Mumbai
    Servicing Branch Address : 414, ICICI LOMBARD HOUSE, VEER SAVARKAR MARG, NEAR SIDDHI VINAYAK TEMPLE MAIN GATE, PRABHADEVI, MUMBAI,
    400025, MAHARASHTRA
    Registration No. Make Model Type of Body CC/KW Mfg Yr Seating Chassis No. Engine No.
    Capacity
    HERO MOTOCORP Solo With
    GJ15BN9633 PASSION PRO 97 2017 2 MBLHAR182HHC64832 HA10ACHHC05261
    LTD Pillion
    Vehicle IDV Side Car Additional Accessories (`) Electrical / Electronic Non Electrical CNG / LPG Unit Total IDV
    (`) (`) Accessories (`) Accessories (`) (`) (`)
    32104 0 0 0 0 0 32104

    Premium Details
    OWN DAMAGE(A) (`) LIABILITY(B) (`)
    Basic OD Premium 404 Basic Third Party Liability 752
    Sub Total 404 Total 752
    Less: Add:
    No Claim Bonus 35% 141 PA Cover for Owner Driver 375
    Sub-Total Deductions 141 Sub-Total 375
    Total Own Damage Premium(A) 263 Total Liability Premium(B) 1127
    Total Package Premium(A+B): 1390
    % 18
    IGST
    ` 250.20
    Total Tax Payable in ` 250
    Total Premium Payable In ` 1640
    Geographical Area: India Applicable IMT Clauses: 22
    Compulsory Deductible: ` 100 Voluntary Deductible: ` 0

    Premium Collection No. 1114779860 Premium Amount ` 1640 Receipt Date 12-07-2020
    GSTIN Reg.No 27AAACI7904G1ZN HSN/SAC code 9971 / 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 i s 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 i s not indemnified if the vehicle i s 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 i s to be read with the policy wordings. The policy i s 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 Jul 12, 2020 in lieu of Covernote no. 201942050. The
    stamp duty of ` 0.5 paid vide deface no. CSD14202013942020 dated May 26, 2020.
    Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
    Mumbai 400 025.
    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.

    Signature Not Verified


    Digitally signed by DS ICICI
    LOMBARD GENERAL
    INSURANCE COMPANY
    LIMITED
    Date: 2020.07.12 10:02:50 IST
    CORP/SUP/OPI/2014/1777

    Jul 12, 2020

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