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TWO WHEELER CERTIFICATE-CUM-POLICY SCHEDULE

Cert. No.
3005/19218553/10051/000

ICICI Lombard General Insurance Company Ltd


414,Veer Savarkar Marg,Near Siddhi Vinayak
Temple, Prabhadevi, Mumbai 400025

Prev. Policy No:


3005/16156172/10051/000

customersupport@icicilombard.com
Insured

Business/Profession

Mr Y.AVINASH

OTHERS

Vehicle Regn No.

Engine No.

Address of The Insured

Valid From

Flatno:206, Rajyalaxmiapts, Streetno:8, Habsiguda


Hyderabad AndhraPradesh-500007
Frame No.

Make & Model

02-12-2014 12:42:59

To
Midnight of 01-1-2015

Year of Mfg

Cubic Capacity

2007

180

CNG/LPG/Bi-Fuel IDV

Total IDV

BAJAJ PULSAR180

AP-29-AA-9085

DJGBPC54207

Declared Value (IDV) of Vehicle

Side Car IDV

MD2DHDJZZPCC06811

Non-Electrical
Accessories IDV

Electrical Accessories
IDV
0.00

NA

50573.00

Branch Office of
HP/Lease/Hire-Purchase

Seating Capacity

Premium

53235.00

NA

0.00

Place of Regn.

Body Type

HP/Lease/Hire-Purchase

Agreement With
Hyderabad

Solo

---

---

A. Own Damage Premium Computation (Section 1) in Rs.


Basic Premium On
:

Electronic & Electrical Accessories

Bi-Fuel Kit

Total

c) Optional PA Cover(Pillion Rider)


0.00 Legal Liability
d) Legal Liability Cover (Paid Drivers, Cleaners)

:
:

Sub Total
Less Discounts
For anti-theft devices

Any other discount

NCB
Total Deductions

:
:

Net Own Damage Premium(A)

b) Optional PA Cover(Un Named Passenger)

300.00

Add Extras:
Geographical Extension
For any other extra

716.00

Basic Premium Including Premium for TPPD


300.00 Vehicle
0.00 CNG/LPG/Bi-Fuel Kit
0.00 Add
a) Compulsary PA Cover (Owner Driver)

Vehicle
Accessories

B. Liability Premium Computation (Section II) in Rs.

300.00

e) Legal Liability Cover (Other then Paid Drivers, Cleaners)


Total Liablity Premium (B)
0.00 Total Premium (A + B)
For any other extra

135.00 Add Service Tax


135.00
Gross Premium
165.00

:
:

422.00
0.00

:
:
:
:
:
:
:

:
:
:

50.00
0.00
0.00
0.00
0.00
472.00
637.00
0.00
79.00
716.00

LIMITATIONS AS TO USE: The Policy covers use of the vehicle for any purpose other than: a) Hire Or Reward b) Carriage of goods (other than samples or personal luggage) c)
Organized Racing d) Pace Making e) Speed Testing f) Reliability Trials g) Any purpose in connection with Motor Trade.
IMPORTANT NOTICE: The insured is not indemified 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 RIGHTS OF RECOVERY'
DRIVER: Any person including insured: Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from Holding or obtaining
such a licence.Provided also that the person holding an effective Learner's Licence may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central
Motor Vehicle Rules, 1989.
LIMIT OF LIABILITY: Limit of the amount of the Company's liability under the Section II-I(i) in respect of any one accident as per M.V. Act 1988. Limit of the amount of the
Company's liability under Secion II-I(ii) in respect of any one claim or series of claims arising out of one event : Upto Rs 100000/I/We certify that the policy to which the certificate relates as well the certificate of insurance are issued in accordance with the provisions of Chapter X & XI of M.V. Act 1988

Issued through NsurePlus Application


Software
Premium of Rs.

02Dec2014

Dealer's Stamp &


Signature

Received Vide
716.00 Cash/Cheque No. CASH
Y
JAYANTH
I KUMARI

Dated

Nominee Name

Drawn on

Nominee Age

Acknowledgement Dt

02-12- Nominee
2014 Relation

50
MOTHER

The policy is subject to a compulsory excess of Rs. 100/- & Depreciation is


applicable as per policy terms & conditions* (Please turn overleaf for details)

Consolidted Stamp Duty Paid


Endorsements: IMT - 22

Agent / Broker Details - Direct


02-Dec-2014
Date & Signature of
proposer

On behalf of ICICI Lombard General Insurance Company Ltd

FOR RENEWALS CONTACT: PHEONIX MOTORS LTD Ph.No-040-27177335


BESIDE GE CAPITAL,IDA UPPAL,HABSIGUDA

Duly Constituted Attorney


Regd. & Head Office : ICICI Lombard General Insurance Company Limited,ICICI Bank Tower,Bandra Kurla Complex,Bandra East,Mumbai-400051 The stamp
duty of Re. 0.5 paid in cash or by demand draft or pay order, vide Receipt / Challan No 35430 dated SEP 30th, 2013