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Product Code: 3003 UIN: IRDAN115RP0013V01200203

Reference No.: W245696131

Date: Sep 27, 2023
PARMOD KUMAR
VIKAS KUNJ, INDIRA ENCLAVE - LONI,
GHAZIABAD
UTTAR PRADESH 201102
Mobile No: 8851207859

Sub: Risk Assumption Letter

Dear PARMOD KUMAR,

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. 3003/307949980/00/000, 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 PARMOD KUMAR
Period of Insurance Sep 28, 2023 to Sep 27, 2024
Vehicle Make / Model SHRI NAMO ELECTRIC AUTOMO / EWA ECO FRIENDLY LOADER
RTO City UTTAR PRADESH-GHAZIABAD
Vehicle Registration No. UP14LT4183
Vehicle Registration Date Oct 05, 2022
Engine No. SNL0644
Chassis No. M4PSNEAEL22E00644
Current Year NCB(%) 20%
Vehicle Usage RAW MATERIALS
Previous Policy Details
Previous Policy No. VGC0853268000100
Previous Policy Period 28-09-2022 to 27-09-2023
Previous Year NCB(%) 0%
Claims Made Under Previous Policy 0
Previous Insurer Name RSAICL
Previous Policy Type Comprehensive Package
1
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.

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.

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.
( 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.
CORP/SUP/OPI/2014/1777

Sep 27, 2023

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Goods Carrying Vehicles Package Policy
Product Code: 3003 UIN: IRDAN115RP0013V01200203

Name of the Insured : PARMOD KUMAR Policy No. : 3003/307949980/00/000

Address : VIKAS KUNJ, INDIRA ENCLAVE - LONI,, GHAZIABAD, Period of Insurance : Sep 28, 2023 00:00 to
UTTAR PRADESH 201102 Midnight of Sep 27, 2024
Telephone No : - Mobile No: 8851207859 E-Policy No. :
Email Address : AN************@GMAIL.COM Policy Issued On : Sep 27, 2023
Nominee Name : - Named Passenger's Nominee: Covernote No. : 307949980
Relationship : - Wife Mrs Renu RTO Location : UTTAR PRADESH-GHAZIABAD
Age : 35 Hypothecated To : -
GSTIN No. (Customer) : Vehicle Class : Public Carrier
Servicing Branch Name : Gurgaon Category :
Invoice No. : 1009232484496
Servicing Branch Address : Tower D, Twelth Global Business Park Mehrauli Gurgaon Road Gurgaon Haryana 122002

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

Vehicle Registration No. Make Vehicle Model Model Build Type of GVW Mfg Yr Carrying Chassis No. Engine No. Trailer Chassis
SubClass Body Capacity No.
SHRI
NAMO ELECTRIC - EWA ECO
FULLY M4PSNEAE
UP14LT4183 ELECTRIC PICK UP FRIENDLY Open 400 2022 1 SNL0644 0
BUILT L22E00644
AUTOMOTI VANS LOADER
VE
Trailer Registration No. Body IDV Chassis Trailer Electrical / Electronic Accessories Non Electrical Accessories CNG / LPG Total IDV
(`) IDV (`) (`) (`) Unit (`) (`)
(`)
0.00 80,000.00 0.00 0.00 0.00 0.00 80,000.00

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 328.00 Basic Third Party Liability 3,139.00
IMT-23 Loading 49.00 Total 3,139.00
Sub Total 377.00 Add:
Less: PA Cover for Owner Driver 475.00
No Claim Bonus 20% 75.00 Legal Liability to Paid Driver 50.00
Sub-Total Deductions 75.00 Sub-Total 525.00
Total Own Damage Premium(A) 302.00 Total Liability Premium(B) 3,664.00
Total Package Premium (A+B) 3,966.00 313
Premium Taxable @ 12% (Basic TP Liability) 3,139.00
- IGST @ 12% 376.68
Premium Taxable @ 18% (Other than Basic TP Liability) 827.00
- IGST @ 18% 148.86

Total Tax Payable in ` 526.00

Total Premium Payable in ` 4,492.00

Geographical Area: India Applicable IMT Clauses: 23

Compulsory Deductible: ` 500.00 Voluntary Deductible: ` 0.00

Premium Collection No. 1188548134 Premium Amount (`) 4,492.00 Receipt Date 27-09-2023
GSTIN Reg.No 06AAACI7904G1ZR 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 15,00,000.00/-. Limitations as to Use:
The Policy covers use only under a permit within the meaning of the Motor Vehicles Act,1988 or such a carriage falling under sub section(3) of Section 66 of the Motor
Vehicles Act,1988. The policy does not cover 1) Use for organised racing, pace making, reliability trails or speed testing, 2) Use whilst drawing a trailer except the towing
(other than for reward) of any one disabled mechanically propelled vehicle 3) Use of carrying passengers in the vehicles; except employees(other than the driver) not
exceeding the number permitted in the registration document and coming under the purview of Workmens's Compensation Act, 1923. 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".
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 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
CORP/SUP/OPI/2014/1777

Sep 27, 2023

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
0
Goods Carrying Vehicles Package Policy
Product Code: 3003 UIN: IRDAN115RP0013V01200203
any [email protected]. grievance please
"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
non-cooperation by or on behalf of the Insured; the Company is not obliged to refund the premium paid under this Policy
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 M.V. Act, 1988. In witness whereof, this Policy has been signed at Mumbai on Sep 27, 2023 in lieu of Covernote No. 307949980. The stamp duty of ` 0.50
paid vide deface no. CSD6142023662 dated Feb 20, 2023.
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 DB100322 :

Agency Name :
OPP INSURANCE BROKERS
PRIVATE LIMITED
Agent's Contact No 8218823019
Contact Person :

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2023.09.27 15:06:57 IST
CORP/SUP/OPI/2014/1777

Sep 27, 2023