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Product Code: 3001 UIN: IRDAN115RP0017V01200102 1

Ref. No. W461219160

Date: Sep 05, 2025
E ARUN KUMAR
C/O ERRUSAPPAN, 57/6 BLOCK NO - 32, PERUMAL KOIL STREET,
PERIYASEKKADU, VTC MADHAVARAM, PO MADHAVARAM MILK COLONY, SUB
DISTRICT PONNERI, DISTRICT TIRUVALLUR, STATE TAMIL NADU, PIN CODE
600051,
CHENNAI
TAMIL NADU 600051
Mobile No: 90******18

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. 3001/407106507/00/000, which has been issued based on the below mentioned details:

Insured & Vehicle Details

Name of Insured E ARUN KUMAR
Period of Insurance Sep 11, 2025 to Sep 10, 2026
Vehicle Make / Model HYUNDAI / EON ERA PLUS
RTO City TAMILNADU-RED HILLS
Vehicle Registration No. TN18AB4402
Vehicle Registration Date Sep 08, 2014
Engine No. G3HAEM287135
Chassis No. MALA251ALEM324807
Current Year NCB(%) 25%
Ownership Serial Number 1
Previous Policy Details
Previous Policy No. DCAR10256704677/00
Previous Policy Period 11-09-2024 to 10-09-2025
Previous Year NCB(%) 20%
Claims Made Under Previous Policy 0
Previous Insurer Name ACKO
Previous Policy Type Comprehensive Package
1
1
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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.
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 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” 1

If you require any changes in the Certificate of Insurance cum Policy Schedule, you are requested to inform us by writing to
[email protected] 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.

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
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CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

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d. In case of total loss
Product / constructive
Code: total loss / Total theft / cash loss of the vehicle, the claim will be settled at invoice price i.e amount paid by
3001 UIN: IRDAN115RP0017V01200102 1
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 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.

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CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

Private Car Package Policy 0 0

Product Code: 3001 UIN: IRDAN115RP0017V01200102 1

Insured Name : E ARUN KUMAR Policy No : 3001/407106507/00/000

Address : C/O ERRUSAPPAN, 57/6 BLOCK NO - 32, PERUMAL Tenure : 1
KOIL STREET, PERIYASEKKADU, VTC MADHAVARAM,
PO MADHAVARAM MILK COLONY, SUB DISTRICT
PONNERI, DISTRICT TIRUVALLUR, STATE TAMIL
NADU, PIN CODE 600051,, CHENNAI, TAMIL NADU
600051
Telephone No : - Mobile No: 90******18 Period of Insurance : Sep 11, 2025 00:00 to
Midnight of Sep 10, 2026
Email Address : OP*@INSURIGHT.CO.IN E-Policy No :
Nominee Name : - Named Passenger's Nominee: Policy Issued On : Sep 05, 2025
Relationship : - - Covernote No : 407106507
Age : - RTO Location : TAMILNADU-RED HILLS
GSTIN Number (Customer) : Hypothecated To : -
Servicing Branch Name : Bangalore Invoice Number : 100925363818
:
Servicing Branch Address : 27, Third And Fourth Floor, Sjr Tower, Bannerghatta Main Road, 3rd Phase, JP Nagar, Bangalore, Bengaluru Urban,
Karnataka-560078

Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of 1
No
PEPs*?
Registration No. Make Model Type of Body CC/KW Mfg Yr Seating Capacity Chassis No. Engine No.
TN18AB4402 HYUNDAI EON ERA PLUS HATCHBACK 814 2014 5 MALA251ALEM324807 G3HAEM287135
Vehicle IDV Trailer Non Electrical Accessories (`) Electrical / Electronic Accessories (`) CNG / LPG Unit Total IDV
(`) (`) (`) (`)
114805 0 0 0 0 114805
Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 386 Basic Third Party Liability 2094
Total 2094
Smart Saver Plus 100 Add:
Sub Total 486 Legal Liability to Paid Driver 50
Less: Sub-Total 50
No Claim Bonus 25% 97
Sub-Total Deductions 97
Total Own Damage Premium(A) 389 Total Liability Premium(B) 2144
Total Package Premium(A+B): 2533
% 18
IGST
` 455.94
Total Tax Payable in ` 456
Total Premium Payable In ` 2989
Unique Identification Number (UIN) Details
Smart Saver Plus
IRDAN115RP0017V01200102/A0002V01202425
Geographical Area: India Applicable IMT Clauses: 28 , 22
Compulsory Deductible: ` 1000 Voluntary Deductible: ` 0
Features of Add-on Covers: 0 0 0 0 0 0 0 0

1. Smart Saver Plus ensures your damaged car is repaired within 5 days and also provides 24 months assurance on the quality of workmanship (for own damage claims
where our liability is below Rs. 50,000). You are also eligible for alternate travel arrangements beyond 5 days of repair time (up to Rs. 700 per day for a maximum of 5
days). Provided claim should be reported directly to our call center on 1800 2666 (toll-free )and vehicle must be reported to selected preferred partner garages (List of
preferred partner garages can be accessed through https://www.icicilombard.com/cashless-garages ).
Premium Collection No. 1245855538 Premium Amount ` 2989 Receipt Date 05-09-2025
GSTIN Reg.No 29AAACI7904G1ZJ HSN/SAC code 997134 / GENERAL
INSURANCE SERVICES
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is 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 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.
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
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CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

Private Car Package Policy 0 0

Product Code: 3001 UIN: IRDAN115RP0017V01200102 1

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 is 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 Sep 05, 2025 in lieu of Covernote no. 407106507. The
stamp duty of ` 0.5 paid vide deface no. CSD4920251428 dated Apr 24, 2025.
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 DB93622 :

INSURIGHT INSURANCE
Agency Name :
BROKING PRIVATE LIMITED
Agent's Contact No : 8147709996
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: 2025.09.05 15:32:27 IST
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Sep 05, 2025