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Product Code: 3005 UIN: IRDAN115RP0015V05201415

Reference No.: W366838972

Date: Nov 08, 2024
P S DURAIRAJ
CHENNAI,TAMIL NADU
CHENNAI
TAMIL NADU 600001
Mobile No: 96******41

Sub: Risk Assumption Letter

Dear P S DURAIRAJ,

We value your relationship with ICICI Lombard General Insurance Company Limited and thank you for choosing us as your
preferred insurance provider.
Please find enclosed Policy No. 3005/367921415/00/B00, The same has been issued based on below mentioned details, provided by you at the time of policy
purchase.

Insured & Vehicle Details

Name of the Insured P S DURAIRAJ
Period of Insurance Nov 11, 2024 to Nov 10, 2025
Vehicle Make / Model HONDA MOTORCYCLE / ACTIVA
RTO City TAMILNADU-CHENNAI
Vehicle Registration No. TN03Q1368
Vehicle Registration Date Mar 05, 2015
Engine No. JF50ET1765428
Chassis No. ME4JF502AFT767625
1 0
The commencement of coverage of risk under the policy is subject to realisation of payment of premium in full. In case the premium is not realised due to
cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
1
We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.
1
Government of India has mandated electronic toll payments using FASTag to reduce vehicular traffic at toll plazas. Customers are advised to comply with the
direction of the government and get their FASTag from Point of Sale locations at Toll Plazas or from Issuer Agency. Please visit http://www.fastag.org/ for
details.

“Updating your bank details with us would help facilitating future transactions. Bank details can be easily updated using “IL – Take care” App.Download the app
now for all your insurance and wellness needs and for faster resolution”

Please check the policy details for accuracy. Should you find any discrepancy / require any changes in the Certificate of Insurance cum Policy Schedule, please
contact us immediately at our toll free number 1800 2666 or email us at [email protected], so that we can rectify the same. 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.

Important Points:
a. Any accidental loss, damage and/or liability caused, sustained or incurred, while vehicle not being registered permanently will not be covered.
b. Any minor scratches to the vehcile, paint fading, wear and tear arising out of normal use and requiring touch-up or minor repair under routine maintenance
will not be covered.
c. Any liability of whatsoever nature caused by, contributed by or arising due to the vehicle being driven by a person without having valid driving license will not
be covered.
d. In case of total loss / constructive total loss / Total theft of the vehicle, the claim will be settled at invoice price i.e amount paid by the insured / policyholder at
the time of purchasing the vehicle, excluding subsidy amount, if included in the invoice, or the Insured declared value (IDV) whichever is lower, subject to terms
and conditions of the policy and admissibility of claims.
( Please visist www.icicilombard.com for the policy wordings, for complete details on terms and conditions governing the coverage and NCB)

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.

The Compulsory Personal Accident cover has not been opted in this policy on account that, the Owner driver has a separate existing Personal Accident cover
against Death and Permanent Disability (Total and Partial) for Sum Insured of at least Rs.15 lacs.
CORP/SUP/OPI/2014/1777

Nov 08, 2024

 1
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Two Wheeler Vehicles Package Policy 0
1
Product Code: 3005 UIN: IRDAN115RP0015V05201415

Name of the Insured : P S DURAIRAJ Policy No. : 3005/367921415/00/B00

Address : CHENNAI,TAMIL NADU, CHENNAI, TAMIL NADU 600001 Period of Insurance : Nov 11, 2024 00:00:00 to
Midnight of Nov 10, 2025
Telephone No : Mobile No: 96******41 E-Policy No. : 3005/367921415/00/B00
Email Address : DU********@GMAIL.COM Policy Issued On : Nov 08, 2024
Nominee Name : - Named Passenger's Nominee: Covernote No. : 367921415
Relationship : - - RTO Location : TAMILNADU-CHENNAI
Age : - Hypothecated To : -
GSTIN No. (Customer) : Invoice No. : 101124485092
Servicing Branch Name : New Delhi
Servicing Branch Address : Fourth Parsavnath Capital Tower Bhai Veer Singh Marg, New Delhi New Delhi 110001

Politically Exposed Person (PEP)/close relative of PEP: No

Vehicle Registration Make Model Type of Body CC/KW Mfg Yr Seating Chassis No. Engine No.
No. Capacity
HONDA ME4JF502AFT7676
TN03Q1368 ACTIVA Two Wheeler Solo 102 2015 2 JF50ET1765428
MOTORCYCLE 25
Vehicle IDV Side Car Additional Accessories Electrical / Electronic Non Electrical Accessories CNG / LPG Unit Total IDV
(`) (`) (`) Accessories (`) (`) (`) (`)
20,050.00 0.00 0.00 0.00 0.00 0.00 20,050.00

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 18.00 Basic Third Party Liability 714.00
Sub Total 18.00 Total 714.00
Total Own Damage Premium(A) 18.00 Total Liability Premium(B) 714.00
Total Package Premium(A+B): 732
% 0.00
CGST
` 0.00
% 0.00
SGST
` 0.00
% 0.00
UTGST
` 0.00
% 18.00
IGST
` 131.76
Total Tax Payable in ` 132.00
Total Premium Payable In ` 864.00
Geographical Area: India Applicable IMT Clauses: 22
Compulsory Deductible: ` 100.00 Voluntary Deductible: ` 0.00

Premium Collection No. 1220663731 Premium Amount ` 864 Receipt Date 08-11-2024
GSTIN Reg.No 07AAACI7904G1ZP HSN/SAC code 997134 / GENERAL
INSURANCE SERVICES
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.
Limits of Liability: (a) Under Section II-I(i) of the policy: Death of or bodily injury & (b) Under Section II-I(ii) of the policy: Damage to Third Party Property- Such amount as is
necessary to meet the requirements of the Motor Vehicles (Amendment) Act, 2019 ; PA Cover for Owner-Driver under Section III: CSI 0/-. The Compulsory Personal
Accident cover has not been opted in this policy on account that, the Owner driver has a separate existing Personal Accident cover against Death and Permanent
Disability (Total and Partial) for Sum Insured of at least Rs.15 lacs. 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 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".
In consideration of the premium for this extension being calculated at a pro-rata proportion of the annual premium, it is hereby declared and agreed by the insured that upon
expiry of this extension, this policy shall be renewed for a period of twelve months, failing which the difference between the extension premium now paid on pro rata basis
and the premium at short period rate shall become payable by the insured.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 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 i s 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.
The Company reserves the right to cancel this Policy immediately upon becoming aware of any mis-representation, fraud, non-disclosure of material facts or
CORP/SUP/OPI/2014/1777

Nov 08, 2024

 1
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Two Wheeler Vehicles Package Policy 0
1
Product Code: 3005 UIN: IRDAN115RP0015V05201415
The Company reserves the right to cancel this Policy immediately upon becoming aware of any mis-representation, fraud, non-disclosure of material facts or
non-cooperation by or on behalf of the Insured; the Company is not obliged to refund the premium paid under this Policy
In case of total loss / constructive total loss / Total theft of the vehicle, the claim will be settled at invoice price i.e amount paid by the insured / policyholder at the time of
purchasing the vehicle, excluding subsidy amount, if included in the invoice, or the Insured declared value (IDV) whichever is lower, subject to terms and conditions of the
policy and admissibility of claims.
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 Nov 08, 2024 in lieu of Covernote No. 367921415. The
stamp duty of ` 0.50 paid vide deface no. CSD372024252885 dated Jul 15, 2024.
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.

Agency Code DB79719 :

Agency Name :
POLICYBAZAAR INSURANCE
BROKERS PRIVATE LIMITED
Agent's Contact No 9999999999
:

Contact Person :

Click here or scan the QR code to view the Customer Information Sheet (CIS). It provides an overview
of the policy features, service and claim processes, as well as other important terms.

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2024.11.08 09:19:26 IST
CORP/SUP/OPI/2014/1777

Nov 08, 2024