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Bundled - Two wheeler Policy

Product Code: 3005 UIN:IRDAN115RP0007V01201819

CERTIFICATE CUM POLICY SCHEDULE

For all your insurance needs & query call us at our Toll free No.: 1800-2666(Accessible from your mobile also), you can also E-mail us at:
customersupport@icicilombard.com
Certificate cum Policy No : 3005/2011448408/00/0000010804
Name of the Servicing IL Jaipur
Branch
Address of IL Branch Second Bhagwati Bhawan, M.I.Road Jaipur Rajasthan 302001
Tenure 5 Years RTO Location RAJASTHAN-AJMER
OD-From 15:18 10/09/2021 To 09/09/2022 midnight
Period of Insurance TP-From 15:18 10/09/2021 To 09/09/2026 midnight Intermediary Code 200242495589
PA Owner Driver 15:18 10/09/2021 To 09/09/2022 midnight
Insured Name SONIA MOOLCHANDANI Policy Issued On 10/09/2021
D/O JAMNA DAS MOOLCHANDANI 69 MITRA NAGAR RATIDANG AJMER ,
Insured Address Hypothecated With
AJMER, RAJASTHAN, Pin - 305001
Invoice No 1709212576662 Category
91-8764205648
Primary Vertical Name BANCASSURANCE-Motor Two Wheeler (M6) Contact No.
(Mobile No.)
Registration Mfg Seat
Make Model Type of body CC Chassis Number Engine Number
Number Year Cap
HONDA ME4JF992HMW045177
NEW GRAZIA DLX Solo With Pillion 125 2021 2 JF99EW0094283
MOTORCYCLE
Vehicle IDV Side Car Additional Acc NonElectrical Acc Electrical/Electronic Acc CNG/LPG Unit Total Value
80522 0 0 0 0 0 80522
SCHEDULE OF PREMIUM
Own Damage(A) Liability(B)
Basic Own Damage 607.14 Basic Third Party Liability 3285.00
Zero Depreciation 161.04 PA Cover For Owner-Driver Of Rs. 1500000 375.00
Total 768.00
Total 3660.00
Total Own Damage Premium 768.00 Total Liability Premium 3660.00
Total Package Premium (A+B) 4428.00
Net Premium 4428.00
CGST@9% 398.52
SGST@9% 398.52
Total Tax Payable 797.04
Total Premium 5225.00
UIN Details
Zero Depreciation
IRDAN115A0020V01200910
For No claim Bonus (NCB), Coverages and exclusion of policy Please refer to the policy wordings attached with this schedule, in case of you have not received your
kindly write to us at the below mentioned mailing address.
Compulsory Deductibles : Rs.100 GeographicalArea India *** All Premium figures are in Rupees
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 (ii)of the policy-> Damage to Third Party Property Rs 100000.00; PA Cover for Owner-Driver under section III: CSI Rs 1500000.00. *
as opted for the above-mentioned period *
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.
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
Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto : 22,28
Premium Collection Details :
I/We hereby certify that the policy to which the certificate relates as well as, this certificate of insurance are issued in accordance with the provision of Chapter XI of
Motor Vehicle Act, 1988.

Agency Code: AAIFA2148R43560 Agency Name: AJMER AUTO AGENCIES

Agent's Mobile No.: 91-9887889186 Agent's Landline No.:
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 dishonor 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 Clause:
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.
For ICICI Lombard General Insurance Company Ltd
The stamp duty of Re. 0.5 paid vide deface no. CSD10620212911 dated Mar 08,
2021
GSTIN Registration No. : 08AAACI7904G1ZN

file:///C:/Program%20Files%20(x86)/ILPOS%20Motor%20Insurance/PolicySchedule... 10/09/2021