ICICI Lombard General Insurance Co.

Ltd
Stand-Alone Own Damage Two wheeler Insurance Policy
UIN: IRDAN115RP0002V02201920
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)

Policy No 3005/O/BM-17514574/00/000 Proposal No. & Date PIMS434769, 27-Sep-2022

Policy Issued On 27-Sep-2022 (17:39:00) Period of Own Damage 29-Sep-2022 (00:00:00) To 28-Sep-2023 (Midnight)
Insured Name MR. PALLAVARAJAN K Period of Third Party 29-Sep-2018 (00:00:00) To 28-Sep-2023 (Midnight)
Liability
Insured Add. NO. 5/47B, DR VARADHARAJAN STREET, VEDHACHALA
NAGAR, CHENGALPATTU , TAMIL NADU-603001
Servicing Office of Second and Third Floor, Nungambakkam High Road, Chottabhai Previous Own Damage 3005/O/BM-16459425/00/000
Insurer: Centre, Chennai, Tamil Nadu 600034,CIN:, PH-- State Code(33) Policy No.

PAN: AAACI7904G GSTIN:33AAACI7904G2ZT Previous Own Damage

ICICI Lombard General Insurance Co. Ltd
Insurer
Previous Third Party
Liability Policy No. 3005/BM-13361391/00/000
Previous Third Party ICICI Lombard General Insurance Co. Ltd
Liability Insurer.
Make Model Sub Model Cubic Capacity/KW Manufacturing Year Seating capacity
BMW G 310 G 310 R 313 2018 2
Body Type Registration No. RTO Invoice Date Fuel Type Chassis No.
TN 19 AJ 8881 CHENGALPATTU 29-Sep-2018 PETROL WB30G0100KR848523
Engine No. Vehicle IDV Elec. Accessories Non-Elec. Accessories CNG/LPG Kit Total IDV
31180011 149500 0 0 0 149,500
Schedule of Premium (Amount in Rs.)
Own Damage Premium
Basic Premium Deductibles
Vehicle 2,105 Voluntary Deductibles (0) (IMT-22A) 0
Non-Elec. Accessories (IMT-24) 0 Anti Theft Device (IMT-10) 0
Elec. Accessories (IMT-24) 0 AA Membership (IMT-8) 0
CNG/LPG Kit(IMT-25) 0 No Claim Bonus (45%) 948
Sub Total (Basic Premium) 2,105 Sub Total (Deductibles) 948
Add On Coverages ( Zero Dep ) 1,719 Handicap Discount 0
Geographical Area Extension (IMT-1) 0 Net Own Damage Premium 2,876
IMT 23 Premium 0
IMT 33 Premium 0

Total Premium 2,876

SGST(9.00%) 259
CGST(9.00%) 259
Gross Premium Paid 3,394

Note: 1.Warning that in case of dishonour of the premium cheque, this document stands automatically cancelled 'ab-initio. 2.Consolidated Stamp duty Paid vide Letter of Authorisation No.
CSD32520221695 dated 19 Apr 2022 at General Stamp Office, Mumbai. ** Not Applicable for the State of Jammu & Kashmir. 3.The policy is subject to compulsory deductible of Rs.100 (IMT-22) ,
Additional excess of Rs.2,500.. 4.Geographical Area-India. 5.Add-on : Zero Depreciation. 6: The insurance company will display terms & conditions on its website www.icicilombard.com
which can be accessed by you online. *Subject to IMT Endt. Nos.& Memorandum:

Limitations as to use: The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace
making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Driver’s Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such
license. Provided also that the person holding an effective learner’s license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules,
1989.
Grievance Clause: For resolution of any query or grievance, Insured may contact us our toll free no. 18002666 , or visit any of our branch offices. You can also write to us at
customersupport@icicilombard.com. For detailed grievance redressal mechanism please visit the "Grievance Redressal" section on our website www.icicilombard.com
. Or You may also contact BMWFS Insurance Grievance Redressal No:1800-102-2269
Payment Details: UTR No.: 227012333053, TXN Date: 27-Sep-2022, Bank Name: ICICI BANK LTD. , Bank City:Mumbai
Hypothecation Details: YES BANK LTD , PARRYS - CHENNAI
MISP CODE - KMCPLSF , MISP NAME - KUN MOTOR COMPANY PRIVATE LIMITED
ISP : SARASWATHI RAKESH,ISP Aadhaar Number:-563466710614
Important Notice: The insured is not indemnified, if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT OF
RECOVERY”. For legal interpretation, English version will hold good.
Own Damage Cover is subject to a valid Third Party Policy.
This policy covers damages to vehicle only and not the Third Party losses. Third Party cover is taken by the customer in previous policy, details of which are as per the customer declaration
only. Customer needs to ensure that there is a valid TP cover at all times.
This Policy covers only Own Damage Risk with no other liability in connection with Stand-Alone Own Damage Two wheeler Insurance Policy vehicle including third party cover and is issued basis
the following :
Third party Policy no. – 3005/BM-13361391/00/000, valid from 29-Sep-2018 (00:00:00) To 28-Sep-2023 (Midnight), Insured by ICICI Lombard General Insurance Co. Ltd.
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.
HSN/SAC :997134, DESCRIPTION OF SERVICE : Motor Vehicle Insurance Services, PLACE OF SUPPLY : TAMIL NADU(STATE CODE : 33), INVOICE NUMBER
:180922230751
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
For & On Behalf of ICICI Lombard General Insurance Co. Ltd

Corporate Agent's Name & Add.: BMW India Financial Services Private Limited , The Oberoi Corporate Tower, Building No. 11, 3rd Floor, DLF Cyber City, Phase 2, Gurugram, Haryana -122002

Corporate Agent's IRDA Lic. No. : CA0186 ,Corporate Agent's CIN No.:U65921HR2009FTC039654 ,Corporate Agent's Validity:31 Mar 2022
RECEIPT NO.- 180922230751 , PAYMENT MODE - Online
In case of any claim or assistance requird please contact our 24*7 help line at 1800-102-2269