TWO WHEELER VEHICLE PACKAGE POLICY

Certificate Cum Policy Schedule

Certificate cum Policy No :3005/W-1673304/00/000

For CLAIMS : Call 1800-209-8888 (Toll free from all phones)
For RENEWALS : Visit www.icicilombard.com or call 1800-209-8888
DETAILS OF THE POLICY HOLDER POLICY DETAILS

Insured Name BALASUBRAMANYAM PINGALI Policy Issuing Office Zenith House, Keshav Rao Khadye Marg, Mahalaxmi,
Mumbai - 400034
Insured Address 501, A2 BLOCK, ALAKNANDA CHS, SECTOR
19A NERUL,NAVI MUMBAI-400706
Period of Insurance From 00:00 hrs 23-Apr-2010 to 22-Apr-2011 midnight
Contact No (s) 9619608758(Mobile No.) 91(Telephone No.)
Email Address bpingali@gmail.com Policy Issued On 23-Apr-2010 12:00:00

Cover Note No W-1673304

RTO Location MAHARASHTRA-MUMBAI

Hypothecated to

Category 0

VEHICLE DETAILS
Registration Number Make Model Type of body CC Mfg. Year Seating capacity
MH03AP7774 HONDA MOTORCYCLE UNICORN Saloon 150 2008 2
Chassis Number Engine Vehicle IDV Side Car Additional Acc Non-Electrical Elec/ Electronic CNG / LPG Total Value
Number (in Rs.) (in Rs.) (in Rs.) Acc.(in Rs.) Acc.(in Rs.) Unit (in Rs.) (in Rs.)
ME4KC098B88074080 KC09E4076546 46351 0 0 0 0 0 46351
SCHEDULE OF PREMIUM (IN RS.)
Own Damage(A) Liability (B)
Basic Own Damage 633.00 Basic Third Party Liability 300.00
Total 633.00 PA Cover for Owner-Driver of Rs. 1,00,000 50.00
Sub Total (Additions): 0.00 Total 350.00
Less Add
Sub Total (Deductions) 0.00 Sub Total (Additions) 0.00
Bonus Percent 20 % 127.00
Total - 127.00
Total Own Damage Premium 506.00 Total Liability Premium 350.00
Total package Premium(A+B) 856.00
Service Tax(Incl Edu.Cess And Higher Edu.Cess) 88.00
Total Premium Payable (in Rs.) 944.00

Geographical Area : India Compulsory deductibles : Rs. 50

LIMITS OF LIABILITY: (a) Under Section II - 1 (i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the
motor vehicles Act.1988.
(b) Under Section II - 1 (i) of the policy -> Damage to Third Party Property Rs 100,000; PA Cover for Owner-Driver under section III-CSI Rs 100,000 ;Voluntary
Deductible Rs.0
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 or personal
luggage), Organized racing, Pace making, Speed testing,Reliability trials,Any purpose in connection with Motor Trade.
DRIVER'S CLAUSES : 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.
Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto :22,28
Premium Collection Details :-[Collection No/Amount/ReceiptDate] 422101717/Rs.944 / 22/04/2010
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.
Policy is valid subject to realization of cheque. We accept premium only via legally recognized modes except for cash. If our representative
request you to pay in cash, kindly report it to us.
For information on ombudsman you may visit our website www.icicilombard.com
I/We here by certify that the policy to which the certificate relates as well as the certificate of insurance are issued in For ICICI Lombard
accordance with the provision of chapter X,XI of M.V Act 1988 General Insurance Company
Service Tax Registration No. :GIS/ MUMBAI-I /1528 /2001, Service Tax Code Number.:AAACI7904GST001 Ltd
Category: - General Insurance Business Services 00440005
In Witness whereof this policy has been signed at Mumbai this 23 day of April of 2010 in lieu of covernote No W-1673304
The stamp duty of Rs. 0.5 paid in cash or by demand draft or by pay order,vide Receipt/Challan no. 30155 dated 14/12/2009

Duly Constituted Attorney(s)

Copy of policy
ICICI Lombard General Insurance Company Ltd.
Mailing Add. Office: ICICI Lombard General Insurance Company Ltd.Zenith House, Keshavrao Khadye Marg, 2nd
Floor, Mahalaxmi, Mumbai - 400 034
Corporate Office: ICICI Lombard General Insurance Company Ltd.Zenith House, Keshavrao Khadye Marg, 2nd
Floor, Mahalaxmi, Mumbai - 400 034
 ICICI Lombard

Two Wheeler PA Proposal Form

Vehicle details

Registration location :
MUMBAI Registration number : MH03AP7774
(RTO)
: HONDA
Manufacturer Engine number : KC09E4076546
MOTORCYCLE
Model : UNICORN Chassis number : ME4KC098B88074080
: Purchase / Registration
Manufacturing year 2008 : 20/3/2008
date
Color : Registration type : Individual
Current showroom price :
66216
(Rs.)

Details of discounts & additional covers

Electrical accessories (Rs.) :0 Voluntary deductible (Rs.) :0

Non-electrical accessories : ARAI approved anti-theft
0 : No
(Rs.) device
Automobile association
:
membership
Value of LPG / CNG kit if
:0
any (Rs.)

Insured details

Name of the Insured : BALASUBRAMANYAM PINGALI Relationship : SELF

Address of Two Wheeler : 501, A2 Block, Alaknanda Chs,
Owner Sector 19a nerul City : NAVI MUMBAI
(Policy will be sent here)
Pincode : 400706

New policy details

Insurance value (IDV) (Rs.) : 46351 No Claim Bonus (%) : 20

Policy start date : 23-Apr-2010 Policy end date : 22-Apr-2011

Total Premium Amount : 944

 ICICI Lombard

I. Own Damage
This product protects you against loss or damage to your motor vehicle and/or accessories due to *Fire *Self
Ignition *Explosion *Lightning *Theft * Burglary *Housebreaking *Riot *Strike *Earthquake *Flood and allied perils
*Accidental external means *Malicious acts *Terrorist activity *Transit *Landslide / rockslide
II. Third Party Liability
In addition to the coverage noted above, this product covers you against legal liability towards third party, in
respect of the following: *Death of or bodily injury to any person *damage to property as per the provisions of
Motor Vehicle Act. We are pleased to inform you that in addition, the product also includes the following:

l Personal accident benefits for owner driver upto a value of Rs.200,000.

l Legal liability towards the paid driver.
l Cover for Rs. 7.5 Lacs third party property damage.
l PA cover for Un-named passengers.
Significant Exclusions:
We would like you to know that the policy does not cover consequential loss, depreciation, normal wear and tear,
mechanical or electrical breakdown failures or breakages. The vehicle is not held covered if used for commercial
purposes or if driven by an unauthorized driver. Note: The foregoing is only an indication of the cover offered. For
details please refer to the policy. It is our endeavor to provide consistent quality service to all our customers. We
would like to let you know that insurance is a contract of Utmost Good Faith requiring the customer to disclose all
material facts. If in your opinion any fact is material and is not covered by the information sought in the application
form, we request you to disclose it.
It is important to note that our liability will commence only after we have accepted your proposal and the premium
has been received in full.

Declaration:
I/We hereby declare that the statements made by me/us in this Proposal Form are true to the best of my/our
knowledge and belief and no material information, which may be relevant, has been withheld or not disclosed I/We
hereby agree that this declaration shall form the basis of the contract between me/us and the "ICICI Lombard
General Insurance Co. Ltd."

I/We also declare that any additions or alterations are carried out after the submission of this proposal form then
the same would be conveyed to the insurers immediately.

I/We agree that the Policy shall become void able at the option of the Insurer, in the event of any untrue or
incorrect statement, misrepresentation, non-description or non-disclosure in any material particular in the proposal
form / personal statement, declaration and connected documents, or any material information has been withheld
by me or anyone acting on my behalf to obtain any benefit under this policy.
I/We hereby declare and warrant that the above statements are true, accurate and complete. I/We desire to effect
an insurance as described herein with the Company and I/We agree that this proposal and declarations shall be the
basis of contract between me/us and the Company and I/We agree to accept a policy subject to the conditions
prescribed by the Company.

INSURANCE ACT 1938, SECTION 41 - PROHIBITION OF REBATES

1. No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or
renew or continue an insurance in respect of any kind or risk relating to lives or property in India, any rebate of the
whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person
taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in
accordance with the prospectus or tables of the Insurer.
2. Any person making default in complying with the provisions of this section shall be punishable with fine, which
may extend to five hundred rupees.

SCHEDULE OF DEPRECIATION FOR ARRIVING AT IDV

AGE OF THE VEHICLE % OF DEPRECIATION FOR FIXING IDV
Not exceeding 6 months 5%
Exceeding 6 months but not exceeding 1 year 15%
Exceeding 1 year but not exceeding 2 years 20%
Exceeding 2 years but not exceeding 3 years 30%
Exceeding 3 years but not exceeding 4 years 40%
Exceeding 4 years but not exceeding 5 years 50%
Note. IDV of obsolete models of vehicles (ie. Models which the manufacturers have discontinued to manufacture)
and vehicles beyond 5 years of age will be determined on the basis of and understanding understanding between
the insurer and the insured.