TWOWHEELERINSURANCECOVERNOTE

CoverNoteNo:W45528985

TheCoverNotewordingsprovidedontheothersideconstitutethelegaldocumentwith
Theinsured,describedinForm'52'referredtobelow,havingproposedforinsurancein
regardtothecoverage.Inordertohelpyouunderstandthecovernotebetter,weare
respectofMotorVehicle(s)describedthereinandhavingpaidthesumofRs.3719as
providingyouwiththiscommentary.Theexplanation,interpretation,commentaryprovided
premium,theriskisherebyheldcoveredunderthetermsoftheCompany'susualformof
hereshallnotbeconstruedaspartoftheCoverNoteattachedalongside.Wearenotliable
PackagePolicyapplicablethereto(subjecttoanySpecialConditionmentionedbelow)
byanyinterpretationinthiscommentaryandthecontractisrestrictedtothewordings
unlessthecoverbeterminatedbytheCompanybynoticeinwritinginwhichcasethe
insurancewillthereuponceaseandaproportionatepartofthepremiumotherwisepayable providedalongside.Foranyfurtherclarification,pleasecontactourCallCentres.Asper
yourdeclarationintheproposalformwithreferencetoyourvehicledescribedbelowandthe
forsuchinsuranceshallbechargedforthetimetheCompanyhadbeenatrisk.
premiumpaidbyyou,wearecommencinganinsurancecoverforyourvehicleunderTWO
InsuredDeclaredValue
Gross
WHEELERPackagePolicyfromthedateandtimementionedbelow(subjecttospecial
(IDV)
Vehicle
conditionsdescribedbelow,ifapplicable).Thecoverwouldbeprovidedfortheduration
Licensed
Make,Model&
Weight
Accessories describedbelowunlessduetosomecircumstances,wehavetocancelthepolicy.Insucha
Yearof
Cubic
Carrying
Reg.No.ofthe
(GVW)
notincludedin case,wewouldsendyouawrittennoticeandcancelthepolicybyproportionatelyrefunding
Manufacture Capacity
Capacity For
vehicle
(Good
premiumtoyoufortheunexpiredperiodofcover
(LCC) Vehicle Mfr'slisted
Carrying
Rs.
sellingprice
Vehicle)
Rs.
HONDA
MOTORCYCLE,
2013
109
2
28323 0
ACTIVA.,
DL7SBT1460
EngineNo:80306392

ChassisNo:8307113

AdditionalRisks,ifany:
SpecialConditions:
HypothecatedTo:N/A

N.B.Intheeventofanaccident,theInsuredshouldinformtheCompanytoarrangespot
survey.
Thedetailsofyourvehicleareasdescribedalongside.
Specialconditionsifapplicabletoyourpolicyareasdescribedhere.

Form52(SeeRule142(1)ofCentralMotorVehicleRules,1989)
1.Registrationmarkandnumberordescriptionofthe
vehicleinsured
2.Nameandaddressofinsured
3.Effectivedateandtimeofcommencementof
insuranceforthepurposeofthisAct
4.Dateofexpiryofinsurance
5.Personsorclassesofpersonsentitledtodrive

6.AnylimitationsastouseofMotorvehicle

DL7SBT1460

Thisrepresentsyourvehicle,forwhichweare
providingtheinsurancecover
DRSHARMA,706,RUBY2,GARDENIAGLAMOURSEC3,
YourNameandaddressasmentionedbyyouinthe
VASUNDHARA,GHAZIABAD,UTTARPRADESH,201012
proposalform
Time:12:00Date:22Jun2016
Thedateandtimeofthecommencementofthis
insurancecover.
21Jun2019
Thedateandtimeoftheexpiryofthisinsurancecover.
Anypersonincludingtheinsured:Providedthatapersondrivingholds Forthecovertobevalid,thedriverofyourvehicle
aneffectiveDrivingLicenceatthetimeoftheaccidentandisnot
musthaveavalidlicense.Italsobecomesvoidifthe
disqualifiedfromholdingorobtainingsuchalicence.Providedalsothat driverofyourvehicle,atthetimeofaccidentwas
thepersonholdinganeffectiveLearner'sLicencemayalsodrivethe
disqualifiedfromholdingorobtainingadriver's
vehicleandsuchapersonsatisfiestherequirementofRule3ofthe
license.Thiscoveralsoallowsadriverofyourvehicle
CentralMotorvehiclesRules,1989.
holdingalearner'slicenseprovidedthatsuchadriver
satisfiestherequirementsofCentralMotorVehicle
Rulesasprescribedbythegovernment.
ThePolicycoversuseforanypurposeotherthan(a)Hireorreward(b)
Thisinsurancecoverisnotvalidifyourvehicleisused
Carriageofgoods(otherthansamplesorpersonalluggage)(c)Organised forthepurposeof(a)Hireorreward(b)Carriageof
racing(d)Pacemaking(e)Speedtesting(f)Reliabilitytrials(g)Any
goods(otherthansamplesorpersonalluggage)(c)
purposeinconnectionwithMotorTrade
Organisedracing(d)Pacemaking(e)Speedtesting(f)
ReliabilityTrials(g)Anypurposeinconnectionwith
MotorTrade
21Aug2016
ThevalidityofthisCoverNoteistillthedate
mentioned

7.Theperiodofvalidityofthiscovernotewillexpire
on

I/WeherebycertifythatthisCoverNoteisissuedinaccordancewiththeprovisionsofChapterXIoftheMotorVehiclesAct,1988
ItbringsuspleasureinannouncingthatouroperationsfunctionhasbeenISO9001:2000certifiedwitheffectfrom7thSeptember2004.ThecertifyingagencywasDetNorskeVeritas
(DNV).Thiswouldmeanthatwewouldmeettheservicerelatedpromisesthatwemaketoourcustomers.
Dateofissue:22Jun2016
Timeofissue:12:00

ForICICILombardGeneralInsuranceCompanyLtd

Intheeventofdishonourofcheque,insurancecoverprovidedunderthisdocumentautomaticallystandscancelledAbinitio.Thecompanyisundernoobligationtosendseparate
communicationinformingthesaiddishonourofcheque.
N.B.:Intermediaryorrelevantcontactdetailswillbeprovidedinthepolicyschedule
Ahmedabad:07955309877AndhraP'desh:9849577877Bangalore:08051187464Calcutta:9831377877Chandigarh:01725055707Chennai:04442017877Coimbatore:04225387877
Delhi:09818177877Gujarat:9898277877Hyderabad:04023128511Indore:07315027877Karnataka:9845577877Kerala:9895477877Kochin:04842384511Lucknow:05222294511
M.P.:9893047877Maharashtra:9890017877Mumbai:02228307711Pune:02026103511Rajasthan:9829796547TamilNadu:9894477877
ICICILombardGeneralInsuranceCompanyLimited
RegisteredOffice:ICICILombardGeneralInsuranceCompanyLTD,ICICILombardHouse,414,VeerSavarkarMarg,NearSiddhiVinayakTemple,PrabhadeviMumbai4
ServiceTaxReg.No.:GIS/MumbaiI/1528/2001