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Product Code: 3005 UIN: IRDAN115RP0015V05201415
Reference No.: W418022049
Date: Apr 17, 2025
ARUNAVA RAY
QUATER NO 39 TYPE IV SECTOR 3 SADIQ NAGAR
NEW DELHI
DELHI 110049
Mobile No: 98******34
Sub: Risk Assumption Letter
Dear ARUNAVA RAY,
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. 3005/389296383/00/000, 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 ARUNAVA RAY
Period of Insurance May 07, 2025 to May 06, 2028
Vehicle Make / Model HONDA MOTORCYCLE / ACTIVA 5G STD
RTO City UTTAR PRADESH-VARANASI
Vehicle Registration No. UP65DB4919
Vehicle Registration Date Jun 10, 2018
Engine No. JF50ET7046717
Chassis No. ME4JF50ACJT046671
Current Year NCB(%) 20%
Previous Policy Details
Previous Policy No. PBT/000000460704
Previous Policy Period 07-05-2024 to 06-05-2025
Previous Year NCB(%) 0%
Claims Made Under Previous Policy 0
Previous Insurer Name KMGI
Previous Policy Type Comprehensive Package
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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 1
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.
“Updating your bank details with us would help facilitating future transactions. Bank details can be easily updated using “IL – Take care” App.Download the app
now for all your insurance and wellness needs and for faster resolution”
Please check the policy details for accuracy. Should you find any discrepancy / require any changes in the Certificate of Insurance cum Policy chedule, 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.
d. In case of total loss / constructive total loss / Total theft / cash loss of the vehicle, the claim will be settled at invoice price i.e amount paid by the insured /
policyholder at the time of purchasing the vehicle, excluding subsidy amount, if included in the invoice, or the Insured declared value (IDV) whichever is lower,
subject to terms and conditions of the policy and admissibility of claims.
( 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
CORP/SUP/OPI/2014/1777
Apr 17, 2025
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 1 1
0
Two Wheeler Vehicles Package Policy 0 1
Product Code: 3005 UIN: IRDAN115RP0015V05201415
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 Owner driver has a separate existing Personal Accident cover
against Death and Permanent Disability (Total and Partial) for Sum Insured of at least Rs.15 lacs.
CORP/SUP/OPI/2014/1777
Apr 17, 2025
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 1 1
0
Two Wheeler Vehicles Package Policy 0 1
Product Code: 3005 UIN: IRDAN115RP0015V05201415
Name of the Insured : ARUNAVA RAY Policy No. : 3005/389296383/00/000
Address : QUATER NO 39 TYPE IV SECTOR 3 SADIQ NAGAR, NEW Tenure : 3 years
DELHI, DELHI 110049
Telephone No : Mobile No: 98******34 Period of Insurance : May 07, 2025 00:00:00 to
Midnight of May 06, 2028
Email Address : RA*******@GMAIL.COM E-Policy No. : 3005/389296383/00/000
Nominee Name : SwetaRay Named Passenger's Nominee: Policy Issued On : Apr 17, 2025
Relationship : Wife - Covernote No. : 389296383
Age : 30 - RTO Location : UTTAR PRADESH-VARANASI
GSTIN No. (Customer) : Hypothecated To : -
Servicing Branch Name : New Delhi Invoice No. : 1004251424206
:
Servicing Branch Address : Fourth Parsavnath Capital Tower Bhai Veer Singh Marg, New Delhi New Delhi 110001
Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of PEPs*? No
Vehicle Registration Make Model Type of Body CC/KW Mfg Yr Seating Chassis No. Engine No.
No. Capacity
HONDA ACTIVA 5G STD Two Solo With ME4JF50ACJT0466
UP65DB4919 109 2018 2 JF50ET7046717
MOTORCYCLE Wheeler Pillion 71
Vehicle IDV Side Car Additional Accessories Electrical / Electronic Non Electrical Accessories CNG / LPG Unit Total IDV
(`) (`) (`) Accessories (`) (`) (`) (`)
31,852.00 0.00 0.00 0.00 0.00 0.00 31,852.00
Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 28.00 Basic Third Party Liability 2,142.00
Sub Total 28.00 Total 2,142.00
Less:
No Claim Bonus 20% 6.00
Sub-Total Deductions 6.00
Total Own Damage Premium(A) 22.00 Total Liability Premium(B) 2,142.00
Total Package Premium(A+B): 2,164.00
% 9.00
CGST
` 194.76
% 9.00
SGST
` 194.76
Total Tax Payable in ` 390.00
Total Premium Payable In ` 2,554.00
Geographical Area: India Applicable IMT Clauses: 22
Compulsory Deductible: ` 100.00 Voluntary Deductible: ` 0.00
No Claim Bonus Benefit : Avail 40% NCB on renewal for zero claims during the policy tenure
Insured Declared Value
The schedule of age-wise insured declared(IDV) as shown in the below table i s applicable for the purpose of Total loss including Theft/Constructive Total Loss(TL/CTL)
claims only on basis of loss date falling in the respective year. A vehicle will be considered to be a CTL, where the aggregate cost of retrieval and/or repair of the vehicle
subject to terms and conditions of the policy exceeds 75% of the IDV.
Tenure Total IDV (`)
From May 07, 2025 To May 06, 2026 31,852.00
From May 07, 2026 To May 06, 2027 31,852.00
From May 07, 2027 To May 06, 2028 31,852.00
Premium Collection No. 1235023158 Premium Amount (`) ` 2,554.00 Receipt Date 17-04-2025
GSTIN Reg.No 07AAACI7904G1ZP HSN/SAC code 997134 / GENERAL INSURANCE SERVICES
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards i s 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 ` 0/-. The Compulsory Personal Accident
cover has not been opted in this policy on account that, the Owner driver has a separate existing Personal Accident cover against Death and Permanent Disability (Total and
Partial) for Sum Insured of at least Rs.15 lacs. 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 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 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
CORP/SUP/OPI/2014/1777
Apr 17, 2025
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 1 1
0
Two Wheeler Vehicles Package Policy 0 1
Product Code: 3005 UIN: IRDAN115RP0015V05201415
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 "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
In case of total loss / constructive total loss / Total theft / cash loss of the vehicle, the claim will be settled at invoice price i.e amount paid by the insured / policyholder at
the time of purchasing the vehicle, excluding subsidy amount, if included in the invoice, or the Insured declared value (IDV) whichever i s lower, subject to terms and
conditions of the policy and admissibility of claims.
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 Apr 17, 2025 in lieu of Covernote no. 389296383. The
stamp duty of ` 0.5 paid vide deface no. CSD10520244764 dated Oct 04, 2024.
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 DB79719 :
Agency Name :
POLICY BAZAAR INSURANCE
BROKERS PVT LTD
Agent's Contact No : 1800120800
Contact Person : D:/CLICK/images/Gaurav_Arora.png
Click here or scan the QR code to view the Customer Information Sheet (CIS). It provides an overview
of the policy features, service and claim processes, as well as other important terms.
Signature Not Verified
Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2025.04.17 15:07:19 IST
CORP/SUP/OPI/2014/1777
Apr 17, 2025
