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Product Code: 3001 UIN: IRDAN115P0017V01200102

Ref. No. W52336186

ANU THAPAR
A 3/4 JANAK
PURI
NEW DELHI
DELHI 110058
Mobile No: 9212463632

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. 3001/188091199/00/000, which has been issued based on the below mentioned details:

Insured & Vehicle Details

Name of Insured ANU THAPAR
Period of Insurance Jan 02, 2020 to Jan 01, 2021
Vehicle Make / Model FORD / FIGO ASPIRE 1.5 TDCI TREND
RTO City DELHI-NEW DELHI
Vehicle Registration No. DL4CAX2632
Vehicle Registration Date Feb 07, 2017
Engine No. GS47887
Chassis No. GS477887
Current Year NCB(%) 25%
Previous Policy Details
Previous Policy No. 231120010218700385701000
Previous Policy Period 02-01-2019 to 01-01-2020
Previous Year NCB(%) 20%
Claims Made Under Previous Policy 0
Previous Insurer Name LIBERTY
Previous Policy Type Comprehensive Package
1

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.

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.
CORP/SUP/OPI/2014/1777

Dec 12, 2019

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

Private Car Package Policy

Product Code: 3001 UIN: IRDAN115P0017V01200102

Insured Name : ANU THAPAR Policy No : 3001/188091199/00/000

Address : A 3/4 JANAK, PURI, NEW DELHI, DELHI 110058 Tenure : 1
Telephone No : - Mobile No: 9212463632 Period of Insurance : Jan 02, 2020 00:00 to
Midnight of Jan 01, 2021
Email Address : INSURANCEBROKER21@GMAIL.COM E-Policy No :
Nominee Name : - Named Passenger's Nominee: Policy Issued On :
Relationship : - - Covernote No : 188091199
Age : - RTO Location : DELHI-NEW DELHI
GSTIN Number (Customer) : Hypothecated To : HDFC BANK LTD,DELHI
Servicing Branch Name : New Delhi Invoice Number : 101219382792
:
Servicing Branch Address : Fourth Parsavnath Capital Tower Bhai Veer Singh Marg, New Delhi New Delhi 110001

Registration No. Make Model Type of Body CC/KW Mfg Yr Seating Chassis No. Engine No.
Capacity
FIGO ASPIRE 1.5 TDCI
DL4CAX2632 FORD Sedan 1498 2016 5 GS477887 GS47887
TREND
Vehicle IDV Trailer Non Electrical Electrical / Electronic Accessories CNG / LPG Unit Total IDV
(`) (`) Accessories (`) (`) (`) (`)
500000 0 0 0 0 500000

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 6566 Basic Third Party Liability 3221
Zero Depreciation (ZD -) 2250 Total 3221
Road Side Assistance (RSA-With Key Protect) 599 Add:
Sub Total 9415 Legal Liability to Paid Driver 50
Less: PA Cover for Owner Driver 325
No Claim Bonus 25% 1642 Sub-Total 375
Sub-Total Deductions 1642
Total Own Damage Premium(A) 7773 Total Liability Premium(B) 3596
Total Package Premium(A+B): 11369
% 9
CGST
` 1023.21
% 9
SGST
` 1023.21
Total Tax Payable in ` 2046
Total Premium Payable In ` 13415
Unique Identification Number (UIN) Details 22 0
Zero Depreciation Road Side Assistance 0 0
IRDAN115A0020V01200910 IRDAN115A0002V01201213 590

Geographical Area: India Applicable IMT Clauses: 28 , 7

Compulsory Deductible: ` 1000 Voluntary Deductible: ` 1000

Features of Add-on Covers:

1. List of services for Road Side Assistance :Arrangement of keys,Accommodation Benefits,Arrangement/Supply of fuel,Towing on breakdown/accident,Battery jump
start,Message Relay,Flat Tyre support,Alternate Travel/Taxi Benefits,Minor on spot Repairs,Breakdown support over phone,Key Protect of Rs.10000
2. Zero Depreciation Coverage : Zero Depreciation covers only the depreciation on the replaced parts. Consumables and HydroStatic Lock are not coverd under Zero
Depreciation unless opted as separate add-on.

Premium Collection No. 1105140612 Premium Amount ` 13415 Receipt Date 12-12-2019
GSTIN Reg.No 07AAACI7904G1ZP 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 ` 1500000/-. 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 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 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. 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 Motor Vehicle Act, 1988. In witness whereof, this Policy has been signed at Mumbai on this date of in lieu of Covernote no. 188091199. The stamp duty of `
0.5 paid vide deface no. CSD2242019563019 dated Nov 25, 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

Dec 12, 2019

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

Private Car Package Policy

Product Code: 3001 UIN: IRDAN115P0017V01200102
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 : ILG50541

Agency Name : RANGOLI GUPTA

Agent's Contact No : 9911233129

Contact Person :

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE COMPANY
LIMITED
Date: 2019.12.12 12:18:52 IST
CORP/SUP/OPI/2014/1777

Dec 12, 2019