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ICICI Lombard General Insurance Co. Ltd.

Tower D, Twelth Floor, Global Business Park, Mehr
auli, Gurgaon Road, Gurgaon, Haryana 122002
HARYANA
-122002,Ph---122002

Endorsement Details

Policy no. 3003/TM- Policy Period 14-Dec-2018 To 13-Dec-2019

100144166/00/B00
Endorsement No. ILE3003/TM- Period of Endorsement 08-Feb-2019 To 13-Dec-2019
100144166/00/B00/03
Endorsement Request Date 08-Feb-2019 Endorsement Invoice No. NA

Name Mr. SHRI NIVAS

Address S/O VEGRAJ SINGH
SARHAUL SEC 18
GURGAON
Model-Variant TATA LPK 2518-LPK 2518
Status Approved
Remarks Ok

Endorsement Type Financer Detail

Endorsement Details

Endorsement For Old Value New Value

Financier Name INDIA INFOLINE FINANCE LTD HDFC BANK LTD.

Agreement Type Hypothecation Hypothecation
Branch GURGAON GURGAON
LoanAccountNO

Payment Calculation

Other
S.No. Items IDV Premium Add-On Total
Charge/TP

1 Vehicle/Body 0 0 0 0 0

2 Trailer 0 0 0 0 0

3 Electrical Accessories 0 0 0 0 0

4 Non Electrical Accessories 0 0 0 0 0

5 Additional GVW Loading 0 0 0 0 0

6 CNG/LPG 0 0 0 0 0

7 Geographical Area Extension 0 0 0

7 Ownership Transfer 0 0

8 PA Cover (Owner) 0 0

9 IMT23 0 0

10 IMT34 0 0

11 OverTurn 0 0

12 Endorsement Service Charge 0 0

Sub Total 0

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13 NCB 0 0

14 Anti Theft Device 0 0

15 AA Membership 0 0

14 Handicapped Discount (0%) 0 0

Sub Total (Discount) 0

Endorsement Payment Charges

Net Premium GST Total Premium Payable

SGST(0%) 0
0 0
CGST(0%) 0

Authorized Signatory

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