OieipEhonbard ‘Two Wheeler Package Policy Meter jnenrancecc, CERTIFICATE CUM POLICY SCHEDULE oe ee cogent > WWww.icicilombard.com cosy rage pe Ry To Fs W000 rte my mike yn a oe [ceruicate cum Patiey No: 3005/7010082779/8/0000000819 pref ivunco rem 0:0 2307/2010 To 207201 mnt featoomen = RERIAEN DET nmured Nave rresh KUMAR SUA rotcy sssued on 270772010 SS Fags ENT RET FEWOEST EFT opr wan corte peer ee leer aie Ee RegietrGon | mane | model | Typect body cc wee |S [ERE _[eroine mamver L-13-80-7233, HERO T cuamour es | solowith Pi 125, 2009, 2 07760 00042 a | cee ; = ‘ : : ; ; ane foonus Percent 20.00 % 170.00 | Total eased seem beavis on parr aaatos emer ee ee Fie cars tous WC, Crepes an ation SBR IIE HARARE SIENIM s ieare ncaa oor are Teed See pee I Se a ear ienetctr mee [lenis OF Liab « (a)uncer Sedian IFT () ofthe polcy->Death of body mhur/= Such amairt as 1 Fecassary To meat tie requirements ofthe Veta hides Act,1988 (oWUnder Sector It lot tae poley-> Damage to Tard Party Property Rs 100000.00; PA Cove’ fr Owner-Drver under secton IE CSI fis 100300.00 Vountary Deductabe 420.00 fmrraTr0ne AB TO USE: The paloy covers vas of We vohioe for iy purpose other han 7 re or yard, Gaviage ot pooca(otner than sanpiaay pesca tagege). organized raclg, Pace ality, Speed esthg, Relebliy Wil Ay puposeih cannecten wih Mott Tad IMPORTANT NOTICE : The Insured snot ncemifed f the vehce is ased.or Given Grewse an h accodance wih Ts Schedue. My payment made by The lcomvany by ceason of wide toms apocarng in the Certficate n oar to comay wih the Motor Vehile Act, 1908 & recovarabee fram the Insure. Sea the premium Collection Details [sviameraby crety that ta alcy to whieh the crticats mater ne wal a he crtieate f ineurance aa imu! in aceycance wth tha proven of chaptar fbtsclaimer: foicy © wid siyea wm Reslaston a Chegie ‘he pty of te 0 pad mas or by ganane aK ory FRVTRTVGRTEEERL/TAN For TCICE Lombard General Insurance Company Ld Service Tox Registration No. G2E / MUMBAL/ 1528 / 2001 Osun rycema), Service Tax Code Number. ‘AAACI79046STOO1 Duly constituted Attorney(a) Category: Ganeral Insurance Businacz Servicer 00440005. (COPY OF PoLicy {ict Lombard General insurance Company L'D.Zertn House, Keshayrao Khadye Marg, Opp Race Course, Maram’ Mumba - 400024 [CICK Lemnard Generalinsurance Company ITD. Penth House, Keshaying Khidye Marg, Oa Race Caurse, Manali Miri = 40003 rauing 2. orn Corporate OfficReflance finance Invoice (issued in terms of Rule 4A of Service Tax Rules, 1994) Invoice No. :442958,100565 Invoice Date: 2107/2010 Name of client customer: RITESH KUMAR SINHA JS, KISHAN KUNJEXTN, Laxmi Nagar, NEW DELH|, DELH|, Pin -1 10092 Description of Sorvice: Service Chargos Contral Sowice Tax Registaion: AADCR4759HSTOO1 Galegory of Service : Insurance Austary Services For Reliance Retail inurance Broking Linited Spek Wo Authorised Signatory Corporate Orfce : Reliance Corporate Park, Bulding No.4, 1st Floor, ‘A’ Wing, Ghansal, Navi Mural ~ 400 701 Rogstored Offes : th Foor, Brindavan, Shrram Mils Compound, Ganpatrao Kadam Marg, Werl, Mumbai ~ 400.013.