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Product Code: 3003 UIN: IRDAN115P0013V01200203

Ref. No. W87279570

Date: Jan 22, 2020
CENTURY ROAD TRANSPORT PVT LTD
PROP. RAJKUMAR GUPTA, 783, BLDG-L, GALA N0 617,
JAISHRIRAM DEVELOPERS, DAPODE, BHIWANDI, THANE
THANE
MAHARASHTRA 421302
Mobile No: 9999999999

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. 3003/191192081/00/000, which has been issued based on the below mentioned details:

Insured & Vehicle Details

Name of Insured CENTURY ROAD TRANSPORT PVT LTD
Period of Insurance Jan 20, 2020 to Jan 19, 2021
Vehicle Make / Model TATA MOTORS / TATA LPT 2518
RTO City MAHARASHTRA-THANE
Vehicle Registration No. MH04GR2931
Vehicle Registration Date Jan 21, 2015
Engine No. 177136
Chassis No. AH07643
Current Year NCB(%) 50%
Previous Policy Details
Previous Policy No. 2315 2026 0806 5200 001
Previous Policy Period 20-01-2019 to 19-01-2020
Previous Year NCB(%) 50%
Claims Made Under Previous Policy 0
Previous Insurer Name HDFC ERGO
Previous Policy Type Comprehensive Package
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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.
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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
customersupport@icicilombard.com 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.

The Compulsory Personal Accident cover has not been opted in this policy on account that, the vehicle to be insured is not
owned by an individual.
CORP/SUP/OPI/2014/1777

Jan 19, 2021

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
1
POS - Goods Carrying Vehicles Package Policy
Product Code: 3003 UIN: IRDAN115P0013V01200203

Insured Name : CENTURY ROAD TRANSPORT PVT LTD Policy No : 3003/191192081/00/000

Address : PROP. RAJKUMAR GUPTA, 783, BLDG-L, GALA N0 617,, Period of Insurance : Jan 20, 2020 00:00 to
JAISHRIRAM DEVELOPERS, DAPODE, BHIWANDI, THANE, Midnight of Jan 19, 2021
THANE, MAHARASHTRA 421302
Telephone No : - Mobile No: 9999999999 E-Policy No :
Email Address : RAJKUMARGUPTA@CENTURYLOGISTICS.NET Policy Issued On : Jan 22, 2020
Nominee Name : - Named Passenger's Nominee: Covernote No : 191192081
Relationship : - - RTO Location : MAHARASHTRA-THANE
Age : - Hypothecated To : ICICI BANK LTD,MUMBAI
GSTIN Number (Customer) : Vehicle Class : Public Carrier
Servicing Branch Name : Mumbai Category :
Invoice Number : 1001201026791
Servicing Branch Address : 414, ICICI LOMBARD HOUSE, VEER SAVARKAR MARG, NEAR SIDDHI VINAYAK TEMPLE MAIN GATE, PRABHADEVI, MUMBAI,
400025, MAHARASHTRA
Registration No. Make Vehicle Model Model Build Type of GVW Mfg Yr Carrying Chassis No. Engine No. Trailer Chassis
SubClass Body Capacity No.
TATA TATA LPT 2518 PARTIALLY
MH04GR2931 TRUCKS Closed 25000 2014 3 AH07643 177136 0
MOTORS BUILT
Body IDV Chassis IDV Trailer Electrical / Electronic Accessories Non Electrical Accessories CNG / LPG Unit Total IDV
(`) (`) (`) (`) (`) (`) (`)
211279 1265488 0 0 0 0 1476767

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 4350 Basic Third Party Liability 43037
IMT-23 Loading 653 Total 43037
Sub Total 5003 Add:
Less: Legal Liability to Paid Driver 50
No Claim Bonus 50% 2502 Legal Liability for Cleaner/Conductor 50
Sub-Total Deductions 2502 Sub-Total 100
Total Own Damage Premium(A) 2501 Total Liability Premium(B) 43137
Total Package Premium (A+B) 45638 430
Premium Taxable @ 12% (Basic TP Liability) 43037
- CGST @ 6% 2582.22
- SGST @ 6% 2582.22
Premium Taxable @ 18% (Other than Basic TP Liability) 2601.00
CGST @ 9% 234.09
- SGST @ 9% 234.09

Total Tax Payable in ` 5633

Total Premium Payable in ` 51271

Geographical Area: India Applicable IMT Clauses: 7 , 23

Compulsory Deductible: ` 1500 Voluntary Deductible: ` 0

Premium Collection No. 1107386338 Premium Amount ` 51271 Receipt Date 19-01-2020
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 ` 750000/-; 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 vehicle to be insured is not owned by an individual. 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 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 i s 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 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 customersupport@icicilombard.com. 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 M.V. Act, 1988. In witness whereof, this Policy has been signed at Mumbai on Jan 22, 2020 in lieu of Covernote no. 191192081. The stamp duty of ` 0.5 paid
vide deface no. CSD2472019610219 dated Dec 18, 2019.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
Mumbai 400 025.
CORP/SUP/OPI/2014/1777

Jan 19, 2021

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
1
POS - Goods Carrying Vehicles Package Policy
Product Code: 3003 UIN: IRDAN115P0013V01200203
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.
Point of Sale (POS) Details
POS Number POS Name Contact Details PAN Card Number
201928601758 ARCHANA DILIP JAIN 9029302333 APQPJ1864G

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE COMPANY
LIMITED
Date: 2021.01.19 10:57:18 IST
CORP/SUP/OPI/2014/1777

Jan 19, 2021